Michigan counselors fighting ban on right to diagnose, give psychotherapy

Licensed professional counselors across Michigan fear proposed state regulations threaten their work. The contemplated changes would curtail licensed counselors’ authority to diagnose clients or conduct psychotherapy – areas where they’ve faced criticism for lacking sufficient training. (Shutterstock image)

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In a dozen years of counseling in suburban Detroit, Anahid Derbabian has helped clients navigate everything from depression to suicidal thoughts, grief over the loss of a spouse or a job, and a range of marital issues.

“My work is extremely important to me – life and death important,” Derbabian said of her Troy-based practice.

But like thousands of other licensed professional counselors across Michigan, Derbabian fears proposed state regulations threaten that work.

“How is that considered OK?” she asks. 

James Blundo, executive director of the Michigan Mental Health Counselors Association, issued a stark warning that licensing rules posed by the state Department of Licensing and Regulatory Affairs imperil the livelihood of more than 10,000 Michigan counselors.

The contemplated changes would curtail licensed counselors’ authority to diagnose clients or conduct psychotherapy – areas where they’ve faced criticism for lacking sufficient training. But such restrictions would prevent clients from getting insurance reimbursement. Blundo said that would effectively force many counselors out of business.

That in turn could harm approximately 150,000 clients across Michigan who depend on their counseling, at a time when suicide is on the rise in across the state and many rural regions lack access to a range of professional mental health care.

“This is a very serious issue that is going to affect a lot of people in a very bad way,” Blundo told Bridge Magazine. “We have people in Michigan with a suicide problem. We have people with substance abuse issues and other problems and they aren’t going to get treated.”

Licensing and Regulatory Affairs (LARA) will hold a public hearing on the proposed changes in Lansing for 9 a.m. Friday at 525 W. Ottawa St.

The brewing controversy hinges on differing – and technical – interpretations of state law and licensing rules that have been in place for decades. The situation, LARA contends, is “in need of an update.”

Derbadian

Counselor Anahid Derbabian: “My work is extremely important to me – life and death important.” (Courtesy photo)

LARA acknowledged in a statement that licensed counselors have for years been essentially “allowed to diagnose and use psychotherapy techniques” on patients. But it now asserts that those practices conflict with a 1988 state statute defining the parameters of what licensed counselors are allowed to do, which LARA says prohibits counselors from diagnosing clients and using psychotherapy.

Sara Sue Schaeffer, a licensed professional counselor appointed in 1988 as the first chair of the Michigan Board of Counseling, says LARA is wrong. Schaeffer said she was also involved in writing the language of the 1988 law.

Schaeffer said the section of the law that prohibits counselors from diagnosis only refers to diagnostic tests – not to the diagnostic interview which is how counselors commonly assess and diagnose patients.

“The state has been operating this way for 30 years. That’s why this is a head-scratcher,” Schaeffer said.

LARA’s proposed changes for licensed counselors would remove from their scope of practice “counseling and psychotherapy skills” and “diagnose and identify the problem.”

That, Blundo said, would eliminate tools critical to the counseling profession.

“You can’t have an effective practice without the ability to diagnose,” he said.

Critics of the LARA changes also note that 30 percent of therapists working with low-income people at community mental health clinics are licensed counselors. Wait times for therapy, already long, would grow exponentially if counselors by the hundreds or even thousands left the field, they say.   

A lifeline from the Legislature 

As LARA prepares to rein in counseling practices, a bill is working its way through the state House that would nullify LARA’s efforts and allow counselors to continue diagnosing and providing psychotherapy to clients. 

The sponsor, GOP Rep. Aaron Miller, R-Sturgis, said he is concerned about the consequences of the new LARA standards going through.

“It would have a huge impact,” Miller told Bridge. “I think of counselors as the front line of support for mental health care. If that domino is taken out, the whole thing comes crashing down.”

The bill was unanimously approved in September by the House Health Policy Committee and sent to the Ways and Means Committee.

Miller said he’s optimistic some version of his bill will pass the House. He’s less confident of its ultimate fate in the state Senate.

“What happens to the language is the big question,” he said.

Miller

“I think of counselors as the front line of support for mental health care,” said GOP Rep. Aaron Miller (Courtesy photo)

A similar bill passed the House in 2018, but ultimately died at the end of the legislative session after a Senate version made changes.

The Michigan Psychological Association ‒- which includes doctoral-level psychologists, who receive far more training in diagnosing patients and providing mental-health therapy ‒ has long contended that licensing rules should be updated to ensure counselors get more training in the diagnosis of mental or emotional disorders before they treat those clients.

“Nobody wants to see people go without getting care,” said Judith Kovach, the association’s public policy consultant and its former executive director. “We have enough problems in Michigan without removing access to mental health professionals.” 

But Kovach said many counselors practice beyond their scope of training by treating clients with mental health issues.

“We believe there has to be more training for counselors than a couple of introductory mental health courses,” Kovach said.

Kovach said the association would support Miller’s House bill if it added requirements for more mental health academic training and put limits on psychological tests counselors could administer.

Kovach also was quoted by Gongwer News Service this week as supporting grandfathering in protections for current licensed professional counselors, to avoid suddenly reducing access to care in the state.

As for claims by counselors that the new regulations could put them out of business, Kovach told Bridge she’s uncertain herself what might happen should they be adopted.

“There’s a lot of confusion about what it would mean. I’m not a lawyer.”

In Michigan, licensed professional counselors have to earn at least a master’s degree in counseling, pass a national exam and complete 3,000 hours of post-degree counseling experience over two years with at least 100 hours in the immediate presence of the supervisor. According to LARA, there are 10,536 licensed counselors in Michigan.

Psychologists ‒ of which there are 7,417 in Michigan ‒ must earn doctoral degrees, in addition to 2,000 hours of a supervised internship, 2,000 hours of supervised psychology experience under a limited license and pass a professional exam. 

Licensed master’s degree social workers must earn a master’s degree from an accredited program and complete at least 4,000 hours of post-degree supervised social work experience over at least a two-year period. Of 28,248 licensed social workers in the state, 22,655 have master’s degrees (MSW).

Only MSWs with a clinical designation can perform psychotherapy and diagnose patients.

Bad timing for rural Michigan 

While the debate over licensing standards continues, southwest Michigan resident Susan Anable said she harbors no doubt herself about the value of counseling.

“It saved my life,” Anable told Bridge.

In the course of one year in the early 1990s, Anable recalled, she endured the death of two grandparents and her father and watched her mother get “deathly sick” from a tumor in her kidney.

“I got very depressed. I just gave up,” she said. “I would wake up with lethargy, just frozen. I broke out in hives and had an anxiety attack. I thought I was having a heart attack.”

Anable said she connected with a counselor in Sturgis.

“Within a short period of time, I was feeling so much better. She never told me what to do. She just let me find my own path,” Anable recalled.

But Anable wonders how others like herself would cope if they could not find access to mental health care through counseling.

“Without a professional to steer you in the right direction, I don’t know what we would do.”

Rural areas across Michigan already suffer shortages of all types of mental health workers, including psychiatrists as well as social workers and counselors.

And for the state as a whole, a shortage of psychiatrists is expected to worsen over the coming decade. With just over 1,100 psychiatrists in 2016, a federal health study found Michigan is expected to be 890 psychiatrists short of need by 2030, including a shortage of 100 psychiatrists who see children.

Underscoring the need for broader access to mental health care, Michigan’s suicide rate rose by a third over two decades -‒ and is climbing even higher among young people, rural residents and military veterans.

In 2018, Auburn Hills resident Peggy Yahraus told Bridge, she found herself in desperate emotional straits after a diagnosis of breast cancer.

“When someone tells you that, you feel like it’s over. You almost feel like tomorrow, you don’t know if you are going to wake up. You just don’t know which way to turn,” Yahraus recalled.

Then she found Derbabian, the Troy counselor.

“I don’t know what I would have done without her, truthfully,” Yahraus said.

On one occasion, Yahraus recalled, she texted Derbabian in the middle of the night as she tried to fight through a bout of intense anxiety.

“Hers was the first text I got in the morning. She said, ‘I will get you in.’

“The fact that she was there and was not leaving meant everything. You just know that somebody is in your corner.”

After a round of radiation treatment for her breast cancer, Yahraus said she’s uncertain how much time she might have left.

But she said Derbabian has helped her see that cancer need not define her.

“In the beginning, all you see is a death sentence,” Yahraus said. “She kind of takes your hand and walks you off the ledge and helps you see there is a future.”

 

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Comments

Deborah
Fri, 10/04/2019 - 9:48am

Maybe you could have interviewed someone who spent thousands on therapists and they were misdiagnosed or worse. They don't have to use evidence based best practices and can and do keep you coming back indefinitely. Not all therapists provide the same therapies and its pretty much a crap shoot finding one for you. Let them talk through problems with clients and leave the diagnosing and treating to the doctors. Mental health is too important and too much damage can be done. Anybody can call themself a counselor.

Jeff
Fri, 10/04/2019 - 7:14pm

It is absolutely not true that anyone can call themselves a counselor. You need a master's degree from a CACREP accredited graduate program, specific course work totaling 60 credit hours, practicum and an internship completion. My internship was about 1,000 hours. That's before we receive a master's or even our license.

Bill Bresler
Fri, 10/04/2019 - 9:59am

Sounds like the Psychologists are trying to bring the hammer down. I'd bet this is driven by economics, not handwringing over the quality of care. Counsellors with Masters degrees work cheaper than PhDs.

Marlene Augst
Fri, 10/04/2019 - 1:06pm

I worked in the field with abused and neglected kids, under NO CIRCUMSTANCES should a COUNSELOR have the right to diagnose anyone one. They do NOT have the proper training for such. In Michigan there are an incredible number of CJ graduates who take counseling courses on line and they make for TERRIBLE COUNSELORS. Many of these people come into this field with predisposed biases and after working with professional counselors, on line counselors and psychologists, it really should remain with the psychologists.

David Murray
Fri, 10/04/2019 - 1:23pm

Language is important in this issue. Psychotherapy and counseling are not the same thing. They need clear definitions to start. The State is lenient in what it allows for persons becoming counselors. I worked at a facility for men in recovery. I could be considered a counselor if I was taking training, and I had up to three years to finish. But that also means in those early stages when I knew little about actual counseling, I was allowed to counsel. Basic counseling is about listening, being present, being non-judgmental and affirmative, empathetic and being honest. Those are qualities and skills we all should practice. And a person can become quite skilled in providing those services through good experience. But counselors are not psychotherapists. But when individuals who think they know what psychotherapy is about having read a few books or listening to online programs and attempt to diagnose from that perspective, they are hurting their 'client.' I think the State ought to examine that situation, understand that the dynamics behind counseling and therapy is on a spectrum and not black and white, determine training required for various levels of counseling, and work towards a more cooperative and integrative process of mental and emotional health practices. Legislators need to get out of the way initially and let the counselors and psychotherapists hammer out clear guidelines and training that are aimed at the benefit of the people who need help and not their own careers. We need more care givers definitely. But not everyone needs to see a psychotherapist or psychologist. Insurance companies also need to come to the table and understand and allow for a variety of counseling needs and services. Certified licensed counselors fill a vital role in mental health as do psychotherapists. To me it is a 'both-and' situation where openness, cooperation and collaboration work in the best interest of those who need those services.

Scott Roelofs (...
Fri, 10/04/2019 - 2:07pm

Good article. How about including who the bureaucrats are on the LARA board? And what/who is driving this change? It's hard to believe that this would be happening unless it was pushed by the new governor.

Donna Mizwa, MA...
Fri, 10/04/2019 - 5:24pm

I hold an LPC and have been practicing for 21 years with this license. I have completed my degree from WSU, a CACREP approved university, having several classes on psychopathology, assessment/evaluation, DSM diagnosis, etc. I have completed more than 3000 hours of supervision, completed a semester long intership & a semester long practicum. I have mastered my NCE, State examination.Prior to obtaining my LPC in 1998, I worked in mental health hospitals a a mental health technician with my Bachelors degree. I have worked in clinic settings right along side MSW's and LLP, all of us doing the same jobs. I feel all of these measures prove my ability to diagnose so we can then counsel individuals. We are not prescribing medications. I have much respect for my colleagues and also feel this is unfair and demeaning to have to fight for the right to continue to do what the State of Michigan has allowed my profession to do for 30 years. The bigger concern though is the heartbreak this would cause for approximately 150,000 Michigan patients who are treated currently by LPC's and the devastation this would cause to an already sparse community of mental health workers with long wait times, abandonment and drop out rate. Patients typically wait longer than a month to get into see a psychiatrist.
This action by LARA would be catastrophic to the state of Michigan .

Alyssa
Fri, 10/04/2019 - 8:55pm

I would just like to address some misinformation in the comments. Therapist is an unregulated term. Anyone can use it. This is absolutely not the same thing as a Licensed Professional Counselor. Masters programs for LPCs are comparable in terms of diagnosis and assessment and therapeutic techniques to psychology and social work programs. In fact, LPCs usually have more education specific to counseling than MSWs. My diagnostics and psychopathology class was taught by a psychologist.

I would also like to point out that diagnoses are fluid. They change over time and as more information is gathered. A diagnosis is only valid for a couple years and if someone with a more advanced degree diagnoses someone their diagnosis trumps all others. The majority of misdiagnoses are actually by medical doctors who have limited experience with mental health and typically diagnose what they have medication to treat.

If LPCs are not qualified why do we meet the national standards? Why have we been licensed every year? Why are our disclosure statements not questioned? Why do we have fewer complaints than most others in the mental health fields? This is political.

It’s getting really old hearing people tell us what our degrees consist of who have no idea. They assume our education and what we are doing. There are a lot of flat out lies circulating.

Mary Lea McTurnan
Fri, 10/04/2019 - 10:50pm

I couldn’t agree more- counselors diagnosing clients is as absurd as it is dangerous. And psychotherapy?? Talk about insanity.