Category Archives: counseling and the law

Update on PA HB 1250


Posted previously here about the bill proposed to go to the PA legislature that will change the Licensed Professional Counselor credential from a title act to a practice act. This would further restrict non-licensed counselors from “styling” themselves as a licensed counselor, from offering the services of a counselor. Already one cannot call themselves a professional counselor or similar titles. But these changes would eliminate many from practicing. This bill (see here for bill with highlighted changes. Go to page 10 to see most pertinent changes and list of exempted individuals) is being voted on by the committee on 1/27.

Note that the exempted parties include “pastoral counselors”. In PA they are not defined. However, in other states they are defined and licensed. Thus, who will determine who is a pastoral counselor and what to do with the overlap between the two? In other states, a pastoral counselor must be ordained and trained in pastoral counseling. Also, psychologists supervising unlicensed people with counseling degrees may be exempted but there is still fuzziness in the law.

It all comes down to the definition of “styling.” See this quote from page 10:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor counseling or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act.

Section 3.  The act is amended by adding a section to read:

Section 16.4  Unlicensed practice prohibited.

No person shall engage in the practice of as a licensed social work worker, licensed clinical social work worker, licensed marriage and family therapy therapist or licensed professional counseling counselor in this Commonwealth unless the person holds a valid license to do so as provided in this act. The provisions of this section shall not apply to the following persons:

If you are in PA and one of these representatives (scroll down for the list) are from your district, you may wish to register you opinion on the matter.

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The practice of unlicensed counseling


The practice of counseling, therapy, psychotherapy and other related terms is restricted to those with proper licensing in most, if not all, US states. Makes sense on most levels, right? You wouldn’t want to go to an unlicensed doctor for your appendectomy. In opposition to Holiday Inn’s ads, you wouldn’t want just anybody doing professional work on you. License control is supposed to protect the public from harm. Bad docs and bad therapists should lose their license and not be allowed to practice.

But with counseling and therapy, it gets a bit sticky. Lots of different professions do similar activities. Unlike surgeons, you have people from widely divergent schools of thought and training doing very similar things. LCSWs, LSWs, LMFTs, Psychologists, Psychiatrists, LPCs all do talk therapy. They all diagnose and intervene per their view of what is wrong and what needs to change (thoughts, behaviors. feelings, etc.).

And it gets stickier. Pastors, clergy, and religiously trained individuals do many of these as well. While they may not give DSM or ICD9 diagnoses and bill insurance companies, they do talk therapy with people who are depressed, anxious, angry, on the verge of divorce–just like all of those licensed people above.  In my world, there are pastoral counselors, biblical counselors, pastors who counsel, christian counselors, etc. Most of these in PA are not licensed by any body. (In PA we don’t have a pastoral counselor license as some states do.)

In an effort to tighten controls, there is a state effort underfoot (HB 1250) to tighten who can practice as a counselor. There were already controls but now the new bill would disallow someone like myself to hire or supervise an unlicensed (but in my opinion competent) person UNLESS they were actively in the process of becoming licensed.

Why does this matter?

1. There are many competent people doing counseling related work that are not licensed (nor could they be since their training is of a religious or pastoral nature). Should the state control these individuals? Right now they haven’t been actively going after these folk. The law will continue to remain vague: Here’s the restriction for LPC practice:

Only individuals who have received licenses as licensed professional counselors under this act may style themselves as licensed professional counselors and use the letters “L.P.C.” in connection with their names. It shall be unlawful for an individual to style oneself as a licensed professional counselor, advertise or offer to engage in the practice of professional counselor or use any words or symbols indicating or tending to indicate that the individual is a licensed professional counselor without holding a license in good standing under this act. [underline indicates new change in this paragraph]

Who decides what “engage in the practice of…or use any words…” constitutes? Obviously, one cannot intentionally lie but does the term therapy indicate a license?

2. There are many who provide pastoral care who are not ordained clergy. They have graduated from seminary-based programs that are not professional counseling programs. Yes, the current standard makes clear that it does not seek to limit the work of those acting under the legal auspices of a religious institution (i.e., are ordained by the church). But, should the state regulate those who provide biblical counsel but are not ordained? As long as these individuals make clear (informed consent) what it is they do and what they do not do, shouldn’t they be able to make a living? Research indicates that lay people can have tremendous success in helping those with depression and anxiety.

I’m all for protecting the public. But while licenses limit who gets to perform certain duties, it does not eliminate unethical or harmful practice. Further, much of psychotherapy is art as well as science. Artists can learn their trade in a variety of locations. What we need to do is to make sure the public can clearly identify the kind of counseling (and limits of) each counselor does. Second, those who provide biblical counseling ought to have some authoritative body. It would be great if they were recognized and “licensed” by denominations or organizations (e.g. the AACC who is trying to do this).

But I would hate to see the many seasoned, unlicensed counselors lose their ability to ply their trade.

That raises a question of analogy. Can anyone make a legal living cutting hair for a fee without a license?

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Ethics Codes and Christian Counselors


Last night was the last class session of my ethics and practicum orientation classes. In both places students were discussing matters related to mandated abuse reporting, dual relationships, and attitudes towards state and professional ethics codes.

Evangelical or conservative people tend to have several responses to ethics codes that I want to highlight here.

1. Fear. Actually almost every student has this reaction. The rules can be complex and their are vague rules about everything (barter, dual relationships, advertising, competency, etc) which may even seemingly contradict other rules. While they have been written to protect the client, following them often leads to both client and counselor having vulnerable feelings (i.e., abuse reporting rules) and feeling a bit out of control.

2. Rejection (or dismissal). One’s feelings about government regulation and whether submitting oneself to a secular agency (licensing board, professional organization) may tempt the counselor to think little of the codes. In particular, the heavy emphasis on avoiding dual relationships where possible seems wrongheaded to many ministry minded individuals. It would seem that sterile counseling relationships (no touch, no informality, no friendship, keeping mental health records, etc.) run counter to the values of brother/sister relationships in church settings.

3. Fastidiousness. Maybe this is really just as number one. But some respond to ethics codes by being ethics junkies. They fastidiously keep every iota and in so doing tend to suck the humanity out of the counseling relationship.

A better way?

The first time you face something completely new, fear is common. With repeated contact, comfort can develop. At least that is what I told myself after my 3rd statistics and research design class. Remembering that these rules are designed not merely to catch you doing wrong but to help protect you and your clients might help. The more you talk about them with others (including the spirit of the rule, not just the letter), the more you will relax.

Also, paranoia is not a good character feature for counselors. Thus, if you have a tendency to see the government as all bad all the time…if you think alarmist conservative talk radio is right from God’s mouth to your ear…if you look at every psychological ethics rule as anti-Christian, you may not be right for this field. In fact, such feelings may induce pride, arrogance and forgetting that the number one goal is avoiding client exploitation and increasing client protection (yes, even from themself).  Further, 1 Peter 2 reminds you to submit to your authorities and governments–even if they are harsh…so you can silence ignorant talk and not use your “freedom as a cover-up for evil.”

Finally, don’t forget to be human. Cross your t’s, dot your i’s but do it while showing concern for the person in front of you. Some of your ethical standards may seem foreign to others. A kind explanation can do wonders.

Hey, and don’t forget to seek out consultation and/or supervision. There is NO reason you should be going this path alone.

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Biblical Seminary Summer Offerings


Every summer we have a summer counseling institute where we offer electives for current students, alum, and other interested parties (graduate counseling credit counts for required CEUs!). This summer we have three fabulous offerings!

1. **ON-LINE** Models of Counseling(2 credits) by Dr. Bryan Maier. From 7/6 to 8/31. This class has NO on-site time. If you have ever wanted to study the historic models of counseling from a Christian perspective this class is for you. Bryan really understands the basics of these models, offers great insights and careful thinking. Plus, Bryan’s material includes narrated PowerPoints and short videos made to stimulate your thinking. 

2.  Theology of Suffering & Disability(2 credits) by Jerry Borton and Kevin Kain. Class meets two weekends (7/10-11, 7/24-25). Jerry works for Joni & Friends and both Jerry and Kevin have intimate understanding of Cerebral Palsy. This is not, per se, a counseling course but open to all who want to think biblically about suffering and disability and apply that to their counseling or ministry practices.

3. Counseling Victims in the Criminal Justice System(1 credit) by Jenn Zuck. Class meets one weekend (August 7-8). Jenn has tremendous experiences working with victims of abuse and crimes in the justice system. Sadly, the church has not supported these individuals as it could have (I have heard several Christian prosecutors tell me that they have yet to see a pastor come in support of the victim, but many times observed the pastor supporting the alleged perpetrator). If you don’t live in the area, consider a visit. Class meets Friday night and Saturday. Philadelphia is a great town to visit!

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Things that scare counselors…


There are certain things that scare counselors. Some things are real, others are mere fantasies. Some are big scares others are smaller ones. When I teach ethics and we talk about liability, the tension in the room increases. When I teach about suicidal clients and the need for a proper response, the tension increases.

What do I fear? Not remembering a client’s name when I run into them in the public. I don’t think that has ever happened but I fear it nonetheless. More real is the fear of doublebooking, of walking into the waiting room and seeing two clients there for the same time. Now, that has happened to me and sometimes it has been my own fault. Even when it isn’t my fault, my stomach does a flipflop.

But now I have a new experience…being approached by a US gov’t official who flashes a badge and requests to speak to me in private about a matter. I had the feeling that one gets when the police car behind you starts flashing their lights. What did I do? Am I in trouble?

It turned out well however. After verifying his credentials and the release of information in hand, I learned a friend of mine was seeking national security clearances for his job. A couple of questions and the officer was on his way. Pheww…I’m not in trouble.

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Last Practicum Monday: Christian counselors in a secular world


Today marks the end of the 2007-8 school year for our MA Counseling students. Some have completed their final credits and others are half-way to their diplomas but I’m sure all are glad the school year is over.

Our students here do fieldwork in a variety of settings: churches, christian private practices, nonprofit social services (hospice, pregnancy centers), and secular or state/federal financed mental health facilities. Those who work in secular settings are often faced with questions about their faith from colleagues and supervisors. Are they going to try to get their clients saved? Will they leave their faith at the door? And students struggle to know what to do with helping clients in some ways (new communication skills) but not being able to help them in deeper ways (putting trust in God during difficult times). Just how should Christians working in secular mental health agencies function? 

First, I very much believe that Christians should be in all aspects of society if they have any hopes of being salt and light in the world. Far too frequently we sequester ourselves from the world and then wonder why they persist in using caricatures of us.

So, if we are going to be in the world but not of it, how might we do it as counselors in a secular setting? I suggest 3 things to consider as we interact with supervisors/colleagues, clients, and our own self:

1. When dealing with an  Agency/Supervisor/Colleague

  • Get to know your context and its/their history with Christians and Christianity
  • When you hear slams or other suspicious questions be sure to explore the “back story” and validate, if appropriate, the bad experiences with naive or offensive behaviors by Christians
  • Discern who you might be able to have a reasonable conversation with regarding the nature of faith and psychology, philosophy of science, ethical care of people (including the exploration of their faith traditions), and the fact that all counseling is evangelistic to some construct of health). In this conversation be sure to using starting points that the other will understand (e.g., ethics, empirical evidence, concerns, etc.) just as St. Paul does at the Areopagus.
  • Communicate that you do not see your job as coercing anyone. You are not responsible for our clients behavior, neither are we for their beliefs. When we raise questions about faith it is to provoke their thinking a bit further

2. When dealing with clients

  • Be sure to ask early in clinical work about faith traditions, current practices, and experiences. These questions fit with what the AMA suggest as important for healing, as community and spiritual resources are quite powerful in the medical literature
  • When given an opening (e.g., questions about God, faith, etc.) pursue gently NOT with statements but questions that may reveal further beliefs, fears, wants, desires, demands, etc.
  • Further, ask how they came to believe what they do believe
  • Point out inconsistencies in belief/behavior; raise possibilities, pros/cons, potential places for hope that may lead to further discussion of God’s handiwork in their lives; Point out places where they seem to recognize their inability to love enough, tolerate enough (gently of course)
  • Be wary of the habit of “telling” others the truth. Many times clients already know the “right” answer. Exhortations may be useful at times but more often than not they cause individuals to become passive–even when they agree with your point.
  • Be ready to answer their questions about YOUR faith with honesty (e.g., what does belief in God look and feel like when everything is caving in?). Be sure not to sugarcoat the Christian life. Be ready to talk about your hope in a broken world (not just for eternity but for now)
  • And if you do talk about your faith, immediately turn it back to them for them to react, explore, challenge, etc.

3. To ourselves

  • Answer the following questions
    • Can I work with integrity within this system?
    • Is giving a “cup of cold water” (e.g., better communication skills) enough for right now?
    • Can I defend what I do say about the Christian faith in my sessions?
    • Am I giving the impression that I believe that there are many ways to God?
  • Develop a theology of mercy ministry akin to God’s providing rain, sun, and health to the just and unjust alike

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How long should you keep clinical records?


The APA has updated and republished their “Record Keeping Guidelines” (2007 American Psychologist, 62:9, 993-1004). In this they discuss 13 separate guides (e.g., content of records, responsibility for records, confidentiality of records, retention of records, disposition of records, etc.).

How long should psychologists keep their records? This guideline suggests the full record is kept for a minimum of 7 years after the last service contact (for adult clients). Why should a psychologist destroy records? Some records might contain out-of-date assessment data that is either no longer valid or superseded by better tools. Some records might include information that was based on a very limited context and could be used against the client (e.g., 15 year old is seen for criminal activity but this information comes out at the age of 50…).

But consider the other side of destroying records. I once saw a client at a counseling center who was returning after 12 years for more counseling. This person had been in counseling for 3 years with a previous counselor who was no longer with the agency. Rules had allowed the disposal of his record. When I told him I could not review his prior record (he had asked that I do so) he was surprised and hurt that we did not keep his record. He felt that we had violated his trust in some way and that the good work that he had done was minimized. He felt the agency didn’t care about him and should have handled his history with more kindness.

So, how would you feel to go to your old therapist and find that your records no longer exist? 

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Winning the [jury duty] lottery


In Friday’s mail I got my first ever summons to show for jury duty. Immediately I had two opposing reactions. On the one hand, I was a bit excited. I’ve always taken an interest in the forensic psychology and its relationship to our legal system. How do juries really work deciding guilt/innocence? How do guilty folk defend and use their legal right to make it look like they are innocent. On the other hand, I was feeling like I couldn’t take time out of the Fall to do this. I have classes to teach…

Here’s a question: Can I be an unbiased juror? I work with victims of abuse, victims of crimes. Does that bias me against those accused of the same? Would I tend to believe the testimony of a police officer solely because of his position? (Actually, I was asked this question and the reverse as well). If a person didn’t take the stand in their own defense or even present a defense, would I hold that against them? 

On these last two questions, I had to really consider my answer. I guess I do tend to believe the police are telling the truth. I haven’t had an officer twist my words, accuse me falsely, plant evidence, stop me because of my race, etc. Part of me does believe that officers don’t have reasons to lie. Also, would an innocent person refuse to take the stand in their own defense. I know attournies might recommend this so that the person won’t be cross-examined in order to avoid other embarrassing information. But, I guess I do tend to believe that people ought to be willing to say what happened.

I decided to put aside my beliefs and say that I won’t overestimate an officer’s testimony and that I won’t hold it against a defendant if they do not testify.

Now I have to wait to see if I get chosen or rejected. Which one will be the winning ticket?  

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