Are there any publications available to help counselors develop contingency plans for their practices should they become ill or physically impaired?

Thank you for your help.
Janet Black

Greetings Janet,

That’s a really good question. While I don’t know of anything that fully meets the description of what you’re asking, I do have some thoughts and resources.

For the clients: Having a good referral list, as well as an emergency services list, is important. If one was to fall ill, simply having this on hand would help to transfer your clients into good hands (Ideally, the clients’ current therapist would help with the transition process).

For the business: If the owner of a business falls ill, he or she would need to rely on their staff to pick up the ball, while their unavailable. This can be a complicated process. Having enough staff to run the business will be crucial, as well as a well-written operations/procedures manual, that details every single thing that needs to be done to operate with business in the owner’s absence. An excellent resource, that explores this issue is called “The E-Myth Revisited” by Michael Gerber.

Janet, I’m not sure if I fully answered your question, but I hope it’s a start.

If you think it would be helpful to speak with me in person, please feel free to call me anytime at 617-513-5433.

Sincerely,

Thrive Boston Counseling is thrilled to welcome Dr. Jessica Lutkenhouse to our team in Cambridge, MA!

Dr. Jessica Lutkenhouse, Psy.D. is a licensed psychologist and certified health service provider in Massachusetts. She obtained her Doctorate in Clinical Psychology with a concentration in Sport Psychology from LaSalle University and completed her pre and post-doctoral training at The Ohio State University and Princeton University. She has published in professional journals and has presented at several national conferences.

Dr. Lutkenhouse’s style as a therapist is integrative. She is trained in Cognitive Behavioral Therapy and tends to integrate mindfulness and positive psychology techniques in treatment. Dr. Lutkenhouse has extensive experience conducting couples counseling sessions, as well asindividual and group psychotherapy services for adults struggling with anxiety and depression. She also specializes in providing sport psychology consultation to athletes, teams, and coaches wishing to utilize evidence-based psychology to improve performance.

In her spare time Dr. Lutkenhouse enjoys running, yoga, and spending time with her friends and family.

Hello,

I am coming to you because I have been so confused regarding client testimonials.

I have asked over and over and gotten the same information when I ask whether or not clients can give me testimonials. “No, it is a violation of ethics because they see it as using clients for personal gain”.  Now I am very confused because on the your website which is promoted by ACA you are talking about how you use client testimonials all the time.

I would love to be able to use this in my marketing and feel it would be immensely helpful.

Please advise.

Aaron Smith, M.A. [Name changed by editor]
Psychotherapist

- – -

Dear Aaron,

Thank you for your email!

I’m happy to help, and to clear up any confusion.

I believe the article you are referring to is this one: http://thriveworks.com/blog/heavy-duty-strategies-for-silencing-negative-online-reviews  –  This article was published in Counseling Today Magazine (ACA) with a notable revision. According to the American Counseling Associations (ACA), asking for client reviews/feedback violates the ACA ethics code. Hence, the recommendation in the article is NOT advisable.

I cannot say that I like ACA’s position regarding this small issue. In fact, I would like there to be more discussion, and possibly even revision, in the future. However, I see that being a member of the ACA, and practicing under their ethical code, to be of immense value and importance to the profession. I, therefore, respect and abide by the ethical code.

It’s nice to hear that people have been reading the Thriveworks website–so Closely!! I didn’t realize that the article had been posted without the recommend revision of the ACA. I have updated the article, by adding the following text.

Update: This article was published in Counseling Today magazine, with a notable revision. According to the American Counseling Associations (ACA), asking for client reviews/feedback violates the ACA ethics code. Hence, the above recommendation is not advisable. However, I believe the issue of client reviews could benefit from further discussion and debate. Perhaps making clients aware that they are able to write reviews if they choose is an appropriate and ethical alternative. Perhaps not. Please seek advice from your own ethical board.

Aaron, I hope this helps!

Sincerely,

Anthony Centore Ph.D.

—

Hi- 

I myself think this is the WORST code we abide by. I came from the real estate industry and I fed my family based off the testimonials I got from others and so does EVERY other small business owner out there! It’s like marketing 101. 

In today’s digital age consumers are no longer satisfied by looking at a “brochure” and seeing a trustworthy person. They want reviews. They want proof from others. That is why every single industry (even others in the medical field with protected relationships!) allow others to post comments and reviews on sites should they so choose. People review and “like” everything they consume now. So if someone is allowed (because I can’t regulate that) to come to my facebook site and “like” my page isn’t that giving a review and even more so posting their personal information (you can see a persons name when they like your page) than giving an anonymous review? 

Anyway, I am done on my rant about this and will make it my personal mission to get this changed because it is outrageous. I sit on the board for the [name removed] Counseling Association and will see what I can do about getting some guidance for direction for this to be at least reviewed if not changed. I know it will be an uphill battle !

Thanks for the quick reply! 

 Dear Anthony,

I wanted to thank you for writing such an interesting article in the Nov issue of Counseling Today regarding Life Coaches.  I am a recent graduate in Community Counseling and just passed the LPC exam.  

Here in Dallas, a lot of so-called “hypnotist/hypnotherapists” pass themselves off as therapists and life coaches. It’s amazing because they have NO clinical training to practice mental health.  I’m wondering if there are any laws out there to protect the public.

For example, there is a guy in Dallas who is top listed on Google for Hypnotherapy.
The guy claims to be a “board certified hypnotherapist”…but in reality it requires no formal education nor licensure.  If you look at his site, he claims to treat all kinds of clinical issues…including addictions.  There are an awful lot of people out there claiming to by hypnotherapists, but are not licensed by the state to perform therapy.  I’m wondering what I can do as a counselor to change this situation?

Sincerely,

Jeremy Porter

- – -

Dear Jeremy,

Thank you so much for reading, and for your comments about my column!

The issue of licensure you describe in a touchy one. I have an answer for you, but I can’t guarantee its 100% accuracy in your state.

In Massachusetts, where my counseling practice is, the term “Mental Health Counseling” is regulated. However, the term “psychotherapy” is not (and some say the term “counseling” alone isn’t).  Hence, unlicensed providers can hang a shingle and provide “psychotherapy” without breaking any laws. I last looked into this a couple years ago, and a representative of the board of licensure in MA mentioned that they were trying to regulate the term “psychotherapy.” I don’t think that ever happened. Moreover, even if it did, nothing would stop someone from providing “life coaching”, “mentorship”, “listening services”, “life consulting” or who knows what else. 

It seems, you are having a similar experience, with someone providing services under the term “Hypnotherapy.” I can’t speak to the level of regulation the term “hypnotherapy” requires specifically. 

I have heard, that in some states, anyone who is practicing in a way that meet the definition of counseling–regardless of what they are calling it–is in violation. However, I don’t know the specifics regarding this, or how well it is enforced. It seems the person below is claiming to treat additions, depression, etc…. I’m not sure if that puts him into any sort of red zone, or not. I often see websites for acupuncturists, chiropractors, yoga studios, herbalists, and massage therapists who make similar claims–and no one seems to bother them.

I think that the best approach for counselors is going to be one where you emphasize your strengths to potential clients. This might include:

1) Showing the difference in caliber of education and licensure you possess

2) Being eligible to accept client’s insurance (which unlicensed providers can’t do)

3) Patient/Client Privilege – The legal protection of clients privacy licensed licensed counselors have, but others don’t.

Jeremy, I hope this helps!!

Sincerely,

Anthony

 Dr. Anthony Centore

Counselors have run cash practices since the beginning of psychoanalysis. Today, however, a wave of change is occurring wherein clients are, more than ever, demanding that their counselors accept health insurance. There are many reasons for this, but consider these three points:

1) In tough economic times, clients have less discretionary cash.

2) Mental health parity means that counseling is almost always a covered health care benefit.

3) As counseling has established itself as an important medical service, clients now see their counselors in the same light as their family physicians (who have always accepted insurance).

Although these changes have been going on for years, a tipping point has taken place. Today’s clients aren’t sheepishly asking, “Will you accept my insurance?” They’re demanding it.

Private pay or managed care?

Some counselors are in such high demand that they will never need to accept insurance. If you’ve reached this status, congratulations! For the rest of us, however, not accepting health insurance means a significant percentage of potential new clients will simply schedule with the counselor down the block (and these days, there are a lot of therapists from which to choose).

One solution is to get credentialed with insurance companies and bill third-party payers for your services (full disclosure: My company helps counselors do this). An alternative solution is to remain private pay and work hard at creating an extraordinary service for which clients willingly pay out of pocket. Both options are good ones.

Unfortunately, some private-pay counselors are using questionable methods to convince clients to pay out of pocket for care. Two methods are addressed below.

Method one: The superbill

A superbill is a receipt for services that contains the basic information requested by insurance companies (generally from the provider) before payment is rendered. Private-pay counselors can require clients to pay up front for services and then issue clients a superbill receipt. Although there is nothing unethical about this, the way superbills are presented to clients can be misleading. What follows are two quotations (taken from counselor websites) that exemplify how the superbill is often explained to clients:

“I will give you a ‘Superbill’ fee statement for you to submit directly to your insurance company for reimbursement. I will work with you as you work with your insurance company to receive maximum benefits.”

“[Name Removed] Counseling, LLC will provide you with a ‘superbill’ for each date of service. This ‘superbill’ will provide all the information your insurance company requires in order to reimburse you.”

Optimism and responsibility

The preceding quotations are problematic in their optimism. In fact, an argument can be made that they contain a “lie of omission,” which is that, for many clients, superbills are ineffective for obtaining reimbursement. It is always the client’s responsibility to check his or her benefits. However, if counselors oversell the superbill, clients will feel burned when they realize the superbill wasn’t so “super” after all.

Here are three reasons why the statements are too optimistic:

1) Insurance rarely pays a counselor’s full fee. Providers might suggest that their superbills will facilitate insurance to pay their full fee. This almost never happens. A counselor’s full fee is usually double what insurance companies consider their “customary rate.” For instance, although a typical counseling fee might be $140, the customary insurance rate is about $75 ($55 after the client’s copay). Insurance plans, even those with out-of-network benefits, rarely pay above their customary rate.

2) Out-of-network benefits often cover only a percentage of the customary rate. This is a type of “penalty” clients endure for selecting a provider out of their network. For example, an insurance company might pay 80 percent of its customary rate of $75. That’s $60 (less the copay) reimbursed after the client has paid $140 to the counselor.

In addition, some insurance companies have deductibles for out-of-network services that differ from the in-network deductible. Hence, even if clients have out-of-network benefits on their policies and have met their deductibles for in-network benefits, they may have not met their out-of-network deductibles, meaning they might not receive any reimbursement.

3) Many clients don’t have out-of-network benefits. As health care costs increase, many individuals are opting for HMO (health maintenance organization) plans over PPO (preferred provider organization) plans. Generally, this means out-of-network benefits are nonexistent. In these instances, the client will receive no reimbursement after seeing a counselor.

Truthfulness and transparency

A truly transparent statement regarding a superbill’s efficacy would sound like this:

“Although we don’t accept insurance, we are happy to provide you with a superbill. Some clients will receive a portion of counseling fees reimbursed to them from their insurance companies. Many clients will not receive any reimbursement. Being reimbursed our full fee is extremely rare.” 

Method two: Promoting fear

Some counselors who do not want to accept insurance attempt to persuade clients to pay for counseling out of pocket by using fear. Consider the real examples that follow, which are similar to versions posted on many counselors’ websites: 

“For your protection and confidentiality I recommend that, if possible, you pay for your counseling without using insurance. Insurance companies require me to disclose highly personal information about you. The confidentiality and privacy of this information cannot be guaranteed. They also often restrict the number of sessions they will authorize, even if you and I feel you still need help.”

“Please be aware that if you choose to submit a superbill to your insurance company, your private medical information will be released. This may impact your future insurance coverage, rates and reimbursement.”

“To get therapy paid for by your medical insurance of any kind, you will have to be diagnosed with a mental ‘disorder’ of some kind. That will be in the computer database, available to insurance companies and, possibly, to future employers (and to the press if you run for president).”

In summary, the messages some counselors use to scare clients include:

• Your “permanent record” will show that you are psychologically unbalanced!

• Your premiums will skyrocket!

• You might become uninsurable!

• Don’t use the insurance benefits that you’re paying for — it’s too dangerous!

George Ohlschlager, who has written extensively on counseling ethics, describes the issue as “an overblown fear.” He notes he has not encountered a single firsthand (or verifiable real-world) example of a person suffering damages after using health insurance to pay for mental health services. Although conceding that “outlandish things are possible,” he describes the aforementioned fears as “issues of anxiety to be talked about in therapy,” not reasons to avoid using health insurance.

In contrast, a colleague and friend who had seen a psychiatrist for roughly three years for substance abuse and depression was later denied life insurance by the same company paying for his mental health services. It is plausible that the two are related.

Still, a question ensues: What kind of health care provider dissuades patients from using their insurance? The answer: A provider who doesn’t want to accept insurance.

Here’s a truthful disclosure counselors can use to inform clients about health insurance risks:

“Millions of people have seen counselors and used their insurance to pay for services. The vast majority has noticed no change in their personal insurability, or health insurance premiums, as a result. However, such an occurrence is possible. My concern for your health insurance premiums has very little to do with my decision not to accept your health insurance.”

Private-pay and insurance-pay counselors

Running a private-pay practice has its benefits. There is less paperwork, and the provider gets to set his or her own rates of service. With a focus on customer service and a strong reputation in one’s community, building a private-pay practice is achievable — especially if you only desire a part-time caseload.  

Alternatively, getting credentialed with insurance companies is also a good option. Family doctors, chiropractors and even dentists have accepted insurance for years. There are many companies (of which Thriveworks, my company, is just one) that can help you to get on insurance panels, and medical billing can be outsourced so that you can remain focused on your passion — seeing clients.

Whichever route you choose, be open and honest with clients about why your practice accepts (or doesn’t accept) particular payment methods.

Dr. Anthony Centore

Vince Lombardi, one of the most well-known football coaches in history, once said, “A man can be as great as he wants to be. If you believe in yourself and have the courage, the determination, the dedication, the competitive drive, and if you are willing to sacrifice the little things in life and pay the price for the things that are worthwhile, it can be done.”

Coach Lombardi didn’t just say these words – he lived them.  He pushed both the Green Bay Packers and the Washington Redskins to greatness by constantly reminding them that their success hinged on their commitment to hard work and perseverance.

So why are we talking about football in an article that’s supposed to be about happiness? Coach Lombardi’s thoughts on success apply to happiness. Happiness is something that we create, and that creation involves hard work.

Creating a happy life, just like playing on a winning football team, isn’t for the faint of heart – it’s for the brave, the focused, and the tenacious.

Consider this:

• Most “overnight success” stories have years of backstory
• Mothers go through excruciating pain to have their beautiful babies.
• Folks trying to lose weight have to deny themselves the foods they love, and push their bodies with exercise, in order to have the beach bodies they want.
• Many of us have to save money now so we can have a nice vacation or a comfortable retirement later.

In order to find happiness, there are often dues to pay. We sometimes have to grit our teeth and keep our eyes on the prize even when our minds and our bodies scream at us to forfeit the game. Remember Coach Lombardi’s advice and embrace the pain that comes with hard work and know that it will pay off in the end.

Want to know more about leading a happy life? Click Here for 5 tips:  Finding Happiness: How to Become Happier in Life

Life coaches have seemingly done a bit of magic, making dollars appear out of thin air. And everyone’s thrilled, except for counselors, who are patting their jacket pockets and asking, “Where’s my wallet?”

Here’s how the trick is done.

First, remove stigma

Some years ago, persons experienced in sports coaching and motivational speaking began to transition into the one-on-one helping business.

In 1974, W. Timothy Gallwey wrote The Inner Game of Tennis: The Classic Guide to the Mental Side of Peak Performance. Many consider this to be the first major transition from sports coaching into personal coaching. The text, borrowing from humanistic and transpersonal psychological principles, addresses the concept of “the opponent within” and outlines a model for self-improvement that could be applied to a broad spectrum of life situations.

Thomas Leonard, founder of the International Coach Federation, is credited for coining the term life coaching. Although some contend that the name was created to avoid regulated terms such as counseling and psychotherapy, the rebranding offers an advantage. That is, by presenting something different than “counseling,” life coaches achieved a feat that has eluded counselors for decades — they took the stigma out of seeking help.

Second, claim dominance in a new category

The Blue Ocean Strategy is a business strategy wherein a new product or service category is created next to a previously existing category. The goal is to eliminate the competition by creating something new. To create a blue ocean, one must:

• • Raise: Offer something more than the industry standard
• • Reduce: Offer something less than the industry standard
• • Create: Offer something never offered in the industry
• • Eliminate: Remove something usually offered in the industry

For example, at a time when many wine companies were competing to offer the most sophisticated and complex wine, the brand Yellow Tail created a blue ocean by offering:

• • No jargon (eliminate)
• • No importance on aging (eliminate)
• • Less selection: one red, one white (reduce)
• • A simple, modern bottle label (create)
• • Sweeter than usual wine that is easy to drink (raise/create)
• • A low price point/higher value (raise)

Life coaches, using Blue Ocean Strategy, don’t offer help with psychological problems or emotional disorders. Rather, they specialize in helping normal people excel in life. Life coaches explain, “Counselors can get you from unwell to neutral (that is, from -10 to 0); life coaches can move you from neutral to peak performance (from 0 to +10)!”

This message is appealing to persons who don’t want to be identified with a “clinical problem.” It also makes counselors look less competent at growth-focused care.

Third, manufacture credibility

Credibility is added to a field by establishing professional organizations and certifications. For example, the International Coach Federation offers three levels of certification, each of which require training, testing and documented coaching hours. The certifications look professional and polished (the 2,500 hours needed to become a “master coach” appear equivalent to what licensed counselors need to acquire after earning their master’s degree), but upon deeper investigation, the qualitative differences in academic rigor are severe.

Life coaches have been so effective at claiming expertise that even licensed counselors sometimes wonder, “Am I missing something?” In fact, I often encounter counselors who have enrolled in life coaching certification programs themselves.

One of my employees, an excellent counselor named Deborah Brigandi, recently attended a life coaching conference in Boston. Reportedly, the sessions taught basic counseling techniques, renamed and repackaged, without background. She told me, “It’s as if they read the CliffNotes from a counseling program. Every topic addressed was oversimplified, and they didn’t see that they were oblivious to vast amounts of knowledge and research.”

Life coaches often say that they partner with licensed counselors, so Deborah was surprised by what she observed at the conference. “They were really negative toward counseling,” she said. “I was really disappointed!”

Shine a light on life coaching

If counselors can communicate the truth about the life coaching industry, they can reclaim territory that has been lost to life coaches. Here are two thoughts:

1) Show what life coaches lack. Counselors need to communicate to the public the low amount of training and education necessary to hang a shingle as a life coach. For example, I can envision job ads that contrast the qualification requirements for counselors and life coaches:

Become a counselor:

• 6 Years of College Minimum

• 2 Years of Full-time Post-master’s Clinical Work and Supervision

• State-sanctioned Testing for Licensure

• Continuing Education Required

Become a life coach:

• No College Education Required!

• No State License Required!

• Solicit paying clients within weeks!

2) You want the very best life coach? Hire a counselor. Clients are going to continue seeking growth-focused care, and because of that counselors should use the term life coach. Moreover, the professional counselor should be branded as “the original” life coach.

My practice in Boston is called Thrive Boston Counseling and Life Coaching. Many prospective clients call us and say, “I don’t know if I need counseling or life coaching.” We reply, “That’s not a problem. Our fully licensed counselors are also excellent life coaches.”

What more could a client want?

Dr. Anthony Centore

Credentialing Advice: Do you have a choice in which clients you see and which clients you refer?

Question: I have noticed that health insurance companies require signed contracts.  I want to avoid contracts. Does that mean that I must see someone when I would choose to refer them? How does this work?

Answer:Many providers worry about their obligations to an insurance company once they’re credentialed with that company.  Thankfully, helpful information is available for you!  To read the answer to this question and many more, click here: Medical Credentialing

Credentialing Tip: Does more education mean more money from the insurance companies?

Answer:  This is one of the most common questions we get about medical credentialing. Thankfully, helpful information is available for you! To read the answer to this question and many more, click here: Medical Credentialing