Patricia Farrell's COLUMN

Cleverly Using Semantics to Deceive and Avoid Licensing as a Therapist?

A spate of people is offering life-altering services and utilizing terms that avoid the word psychotherapist to avoid licensing.

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Life presents many challenges and having someone to guide us or help us untangle knots in our lives can be helpful. The belief that therapy, of some kind, can be a boon to those seeking comfort and assistance has resulted in an expansion of the lexicon, but the services, seemingly, are the same. But those offering the service have adopted new names for themselves. What do we do?

We are now aswim in new terms that go beyond psychotherapistpsychologistpsychiatrist, or even psychotherapy. The new terms are popping up like mushrooms on the landscape, and they are distorting what the person provides and how they are permitted to offer these services. The unhidden, and often the confusion regarding training and licensing, is left to caveat emptor (let the buyer beware).

Why do we need to re-evaluate the many ads, door signage, and business cards, as well as presentations being shown to us? Until recently, much has flown under the radar when an instance of concern hit the Boston public schools.

According to the article in the Boston Globe newspaper’s The Great Divide team:

As a Boston high school sophomore, Keondre McClay said he was pressured by the head of a district-sponsored youth advocacy program to attend an overnight retreat in Newton, where white adults asked the Black teenager to wrestle out his emotions on a gym mat with them. They said it would help him purge his trauma from experiencing racism.

As he related it, the result was a physical assault by persons unlicensed to do therapy, which left him traumatized. Lying under the covers on his bed and screaming to be allowed his freedom, they persisted in attempting to get him to return to their “counseling sessions” as they hugged him. I suspect being hugged in that manner is actually a restraining method.

Students at these prestigious schools were subjected to unlicensed “counseling,” which the school believed would provide needed services. The program had been in existence at the schools for two decades, and students indicated their concerns were never addressed.

One supervisor has now been accused of psychological abuse at the hands of what has been called a cult. Another Boston student School Committee member resigned because she stated others tried to silence her in her concerns.

A New Wave of “Counselors” or Not Hits

One thing that is immediately apparent today is a co-mingling of the terms “life coach” and “therapist” or even “executive counselor.” What laws are applied to each, and does “certification” ever substitute for “licensing?” Are there differences in insurance reimbursement for them?

Certification means some organization has set themselves up to provide a course of training that will award you a certificate. No, you don’t get a diploma. And who decides that they can set themselves up as a counseling accrediting anything? No one.

Does the certificate mean you can do therapy? No, it is intended to provide evidence that you have what that organization believes are the qualifications to help people make life decisions.

Costly? Some certificate programs can cost thousands of dollars, are usually time-limited, and can be completed in a year. So, you can get certification faster than you can get a degree in psychology or social work.

A licensed psychotherapist will probably have an advanced college degree (master’s or doctoral level), supervised outpatient work, possibly an internship, and then take a licensing exam. Coaches do not have these requirements. One program for life coach training requires only 20 hours to receive a certificate.

Isn’t therapy supposed to help people make life decisions? Yes, it is, and not everyone in therapy should have a mental health diagnosis. Some therapists refer to their clients/patients as the “walking wounded” or that they are engaging in “neurotic behavior.” A rather negative view, I grant you, but not all therapists are kind in private.

It’s so easy to slide over the line here to coaching rather than therapy. But everyone in therapy, unless they are self-pay, must have a diagnosis of a mental illness for insurance reimbursement. Not a good thing. Stigma is still alive.

Photo by KOBU Agency on Unsplash

Who Are the Regulators?

Anyone who is a psychotherapist (sometimes called a “therapist”) has oversight in terms of licensing boards in each state. There are boards for social workers and psychologists and state laws that control anyone using some form of either word to get around licensing. Check your state’s laws.

In fact, there is little control over the use of the term “life coach,” and it is a largely unregulated industry. The International Coaching Federation is pretty much upfront in what they do in their certification:

ICF Credentials add legitimacy to your coaching practice and boost your bottom line.

In other words, you can lead people to believe something. The words that should be standing out are “boost your bottom line” because that may say it all; no long hours in class, no internship, no writing a thesis or dissertation, no licensing but a quick seat on the gravy train.

The ICF will even assist you in setting up your own accrediting program:

ICF sets the gold standard for coach-specific training. Get your program accredited today.

It seems to be getting better. No long hours of school or training, and you can set yourself up in business quickly. In today’s digital world, you may even be able to do coaching via telecoach (is that term taken?). Before long, you’ll be wealthy and have the life you’ve always dreamed of living.

If what I am presenting is dripping with sarcasm, I do not apologize because all of this, IMHO is too important. I will not apologize for the truth.

Coaching, without a doubt, is big business, and it is estimated to bring in $11B in 2021 and “increased faster than the economy overall.” The gravy train is getting better and better, it seems. If it makes that much money, wouldn’t it have reason to protect its industry? I would suppose that lobbying efforts would be in the offing.

Photo by KOBU Agency on Unsplash

What Might the Downside Be?

People do need help in many areas of their lives, which doesn’t mean they have mental illnesses. Life is complex, and our world will undergo dramatic changes in the future for careers and financial stability. Coaches might serve a useful purpose.

Prescience isn’t necessarily something they provide in certificate programs. Don’t confuse coaches with therapists who also lack the power to predict the future but can help you find your personal areas that may benefit from an evaluation and a behavior change.

Often, in conversation situations, a hidden area of deep concern may emerge with which a coach does not have the expertise or education to handle. Do they refer this person out to a therapist or persist in coaching?

Coaches can’t do psychological testing or evaluation, and neither can psychotherapists. Who do you need? Do you need career direction in uncharted career waters or a psychological evaluation to see your personality strengths and weaknesses to help you make decisions and handle difficulties?

There are specific, validated tests for either which cannot be performed by coaches or therapists.

Financial considerations cannot be denied when it comes to any service you need. Insurance reimbursement shouldn’t be the prime reason you choose a coach over a psychotherapist. Also, slick advertising and well-spoken salespersons shouldn’t be the reason you make a choice, either. Some people will try to use fear to have you agree to enter their program. It’s a sales device that you need to consider.

I once was with a friend who went to a hospital for a regularly scheduled evaluation of an existing medical condition. She was ushered into an office where more-than-subtle pressure was applied to get her to agree to enter a research protocol. The hospital resident even alluded to the fact that they would collude in providing a diagnosis for insurance so she wouldn’t have to pay anything.

That was out-and-out fraud. When she refused, she was met with, “You can walk out the door and drop dead if you don’t enter the program.” No, not subtle.

Listen with the third ear, don’t agree to anything without a “cooling-off period,” and make your decision carefully. If you enter either, and they don’t provide a plan of action, you don’t get results, or you feel increasingly uncomfortable, you’re the client (customer), and you make the decisions.

One disgruntled therapist, who engaged in unethical practices regularly, told a patient who was leaving, “If you leave, you will commit suicide within a year.” Again no subtlety there. The former client went on to receive a doctorate in psychology.

More than ever, there will be situations where you must make informed decisions. I suggest that you research the person/service carefully and speak to a trusted person in your life or several trusted, mature persons. Do not use the website of that person/service as your sole source.

The sharks are in the water, and you don’t want to be chumming for them.

PATIENT ADVISORY

Medika Life has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by Medika Life

Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

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DR PATRICIA FARRELL

Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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