Mental health groups have been paying a lot of attention to Netflix’s 13 Reasons Why. The show depicts a teenager’s suicide and the tapes she left explaining her actions. Counselors and therapists have expressed concern that it will inspire copycats. But there’s another show that mental health professionals should be attending to, not out of concern but because it depicts mental illness and therapy so well: You’re the Worst.
The Healthy California Act — California’s single-payer bill — continues to make progress through the state legislature. If signed into law, it would make California the first state to have a statewide single-payer health care system, even as the federal Affordable Care Act may be scaled back. How would single-payer health care impact therapists, counselors, and related mental health providers?
Here, I’ll do a quick review of what we know so far. It’s broken down into three questions providers rightly ask about the bill: How would it impact my client load? How would it impact my rates? And, How would it impact how I run my practice?
If you have a recognized disability, you can apply for a quiet room, additional time, or other appropriate accommodations for your licensing exam. Exact rules, and the process for applying, will vary by state. But every state has to make reasonable accommodations in the exam process under federal law.
Though there is little hard data, I’ve heard from multiple people who work for state licensing boards around the country that requests for disability accommodations are becoming more common in license exams for psychologists, counselors, social workers, and family therapists.
Earlier this month, the governors of Nevada and Connecticut signed laws banning conversion therapy for minors in those states. These follow the signing of a similar law in New Mexico in April. According to the National Center for Lesbian Rights, nine states now ban the practice. The District of Columbia and cities including Seattle, Cincinnati, and several in Florida have enacted similar bans.
If you are not familiar with the practice, conversion therapy (also sometimes known as reparative therapy) involves efforts to change someone’s sexual orientation. The American Psychological Association and other professional mental health groups have strongly disavowed the practice. They note that there is no evidence that the treatment is generally effective, but there is evidence of harm that it can cause.
It sometimes seems like labor abuses are a rite of passage for prelicensed therapists. Recent graduates are often appalled by the unpaid or underpaid positions their colleagues (and sometimes they) willingly take simply to get their hours done. Many wonder whether they will be able to support their families as they progress to licensure.
Therapists also often talk about inadequate supervision, dangerous working conditions, unrealistic and inappropriate demands, and a variety of other serious labor concerns on the road to licensure. Some drop out of the field altogether.
If so many therapists experience labor abuses, then why do the problems persist?
A 2015 report commissioned by the American Psychological Association determined that the organization colluded with military and CIA officials to allow psychologists to participate in torture of military detainees. Five people named in that report have now sued the APA and the report’s author, David Hoffman. (The report is widely known and referenced as the Hoffman Report.) The lawsuit alleges that Hoffman worked with longtime APA critics to create a one-sided and often inaccurate telling of how the APA interacted with military and intelligence officials. This report then allowed the APA to use the five as scapegoats, they say, in some cases ending their careers.
If you’ve been around this blog a while, you’ve heard me rail against unpaid internships that are often illegal. I’ve encouraged anyone who has been through such an internship to fight for their rights — including back wages. I’ve also argued that the “intern” title is part of the problem, and thankfully, it’s changing to “Associate” for California MFTs and PCCs in 2018. But interns aren’t alone in troubling and potentially exploitive work settings.
Around Los Angeles, it is increasingly common for agencies to charge significant fees to trainees — students in graduate school, doing the clinical hours they need to graduate — for the privilege of working for free.
It is certainly debatable what an ideal pass rate for licensing exams should be. If the pass rate is high, that means almost everyone gets through. Then the tests don’t serve a meaningful function. (That’s pretty much the status quo.) If the pass rate is low, it raises questions about the validity of the exam, given how much time most examinees spend preparing for it. But what makes a pass rate too high or too low? Given that the exams don’t do much of anything anyway, it’s hard to say for sure.
But it does raise eyebrows when pass rates for a single exam fall off a cliff, as seems to have happened for California MFTs over the past year.
In the past three weeks, we’ve discussed what we know and don’t know about online psychotherapy, and four reasons to move your practice online. As you’ve read, online psychotherapy has a great deal of potential, and may be a good fit for your practice. It does, however, come with some risks to both you and your clients. Here, I’ll address some of those risks and how you can minimize them.
As I’ve outlined in the past two weeks, there is a lot we know and a lot we don’t know about online therapy. If you’re considering moving part or all of your practice online, there are a lot of things to consider. Do you have the appropriate technology, and are you comfortable using it? Do you have policies and practices ready for online work? Have you ensured that your online work will be fully legally and ethically compliant, and consistent with best practices like those outlined in the new AAMFT Online Therapy Best Practices guide? Are your clients appropriate for online therapy?
Many therapists wrestle with the choice of whether to practice online. While these are not determining factors — in other words, I’m not saying your final decision should be to practice online, as there’s more to consider than what’s below — here are four good reasons to consider making the move.