Today's Topic



Practicing Therapy without
a License:
The Right to Work?

Natalia J. Garland

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Social workers are required to have a Master's degree in social work and a license from the state in which they practice. Is this fair, or even necessary? What about people who have a natural talent for helping others, but who lack opportunity to fulfill the educational requirements? Are the counselling professions losing some of the best potential workers because of educational and licensing requirements?

Let's divide today's topic into two discussion areas: (1) educational requirements, and (2) licensing requirements. To the best of my knowledge, there are still some states where you can practice counselling without meeting any requirements whatsoever. You might not be able to call yourself a psychotherapist, but you can market your craft as some sort of counselling service. Of course, you are not eligible for insurance reimbursement and must rely on a cash-paying clientele.

Regarding career preparation, my conviction is that social workers should be held to high educational standards. Natural talent cannot suffice. There are too many complexities in human behavior, too many theories and therapeutic approaches, such that natural talent alone cannot navigate the profession. Anyone practicing any form of counselling also needs to be educated in ethics, confidentiality, interpersonal boundaries, and self-disclosure. Another advantage of formal education is the opportunity to do fieldwork under the supervision of a qualified professional. Having a good fieldwork experience is invaluable preparation for the real world, and it can supplement any weaknesses within the university's course offerings.

State licensure, however, does not guarantee social work effectiveness. Getting your state license is generally a matter of completing graduate school, taking the licensing exam, perhaps getting letters of recommendation, and having a certain number of years of work experience--depending on the type of license you are seeking. Now, anyone who has gone through college and graduate school can get a minimal passing score on the licensing exam. But, passing an exam does not mean you are a good person.

The advantage of licensure seems to be in the area of consumer protection. It enables patients to inquire about the status of or to file complaints against any social worker. It enables the state licensing board to track social workers and to take action against malpractitioners and lawbreakers.

Unfortunately, there are social workers who are incompetent (despite their formal education), who violate interpersonal boundaries (despite their fieldwork training), or who commit crimes such as welfare and insurance fraud. My guess is that it is easier for state boards to intervene in cases of criminal conduct than in cases of therapy malpractice. The former is obvious, while the latter can sometimes be difficult to prove. Nevertheless, patients need an arena in which they can bring forth questions and complaints.

Licensure, however, can be costly and complicated. Perhaps you live in a state that requires license renewal every two years. There are forms to fill out. There is a renewal fee of, let's say, $300.00. There may be a requirement to provide documentation of a certain number of continuing education units. There may be requirements to get your completed forms notarized and to submit a fingerprint clearance card. Then, the only useful result of all this effort is that the state can track you. The social worker receives absolutely no benefit from licensure other than eligibility to work.

In other words, you must pay the state in order to make a living. What does the state do with all that money? How much money does the state need to protect consumers? Why should law-abiding, ethical, competent social workers have to pay a right-to-work (a right which some argue is already guaranteed by the U.S. Constitution--the First Amendment right to assembly--and by the Taft-Hartley Act) fee which is apparently used by board members to review license applications and to investigate complaints? If a social worker is non-compliant with laws, rules, and regulations, then why is that individual not totally responsible for restitution? Why do you and I and the majority of social workers have to pay for the misconduct of the few?

There must be a better way for the state to protect consumers. Licensure is really unnecessary. A simple registration system would be adequate. Social workers, and all other types of counsellors, should be asked to voluntarily register with the state. It should be a simple matter of keeping the state updated with your name and address, educational accomplishments, and place of current employment. This information should be posted as public record. Registration should not cost more than $25.00 for processing. This should be a one-time fee. If you need to update your information, it should not cost more than $5.00 to $10.00 for processing.

Consumers could then decide for themselves whether to hire your services. If you did not voluntarily register with the state, that might indicate to the patient that you have something to hide, or that you just object to any government control over your profession. If you are registered, the patient could check your qualifications and legal status. Registered or not, the patient (or employer) would make an informed decision about you and would have a way to file a public complaint if necessary.

The state would not have the right to determine the requirements for practicing any form of counselling. This means that those with limited or no college education could proclaim themselves as therapists. If registered with the state, however, the non-degree workers could be tracked. The disadvantage is that incompetent non-degree workers could give all professionals a bad name, but probably no worse than incompetent licensed workers. The advantage is that consumers, rather than the state, have the ultimate decision-making power. Consumers are regarded as having enough intelligence to make the best choice for themselves.

If all registration information were kept updated and posted on the internet or published annually in a booklet, then consumers and employers could check on anyone practicing any variation of counselling. The state would also be responsible for listing any crimes or malpractice committed by any practitioner. Crimes (such as welfare or insurance fraud) would be defined by law. Malpractice would be defined by the employer in agency situations. Private practitioners would be responsible for creating and posting their own mission statement and code of ethics in their offices (or perhaps adopt the N.A.S.W. code). Patients would be given copies of these statements and codes to read and sign before accepting treatment.

Some might argue that state licensure gives the profession of social work more respect and political clout. This would be difficult to prove. If true, however, then the profession has paid a high price to place itself in the ranks of doctors and attorneys: it has abdicated its authority to state government boards. Public respect for the profession has always been a hindrance, but this is due to the stigma of mental health problems and not to a lack of government approval. As for political clout, the N.A.S.W. is politically active--and seems to be aligned with the liberal left.

My strong belief is that anyone practicing psychotherapy should have a diploma in psychology or social work. It is education and experience, not licensure, that qualifies social workers to help others. But, I think there should be an option, such as an apprenticeship, for those who would incur severe hardships from the educational requirements.

There could be an employment category of social worker assistant. These workers would be required to have an Associates Degree. Any motivated person can complete a total of two years of education at a local community college. Then, these workers could obtain jobs assisting formally-trained professionals. Their job duties would be similar to the fieldwork assignments which all social work grad-students are required to do, except that they would continue for an extended period of time. Let's say that after 12 years of steady employment as social worker assistant, these workers would be eligible to get jobs as professional social workers, equal in status to the current category of M.S.W.

An alternate route to professionalism, apprenticeship in contrast to formal education, could enrich the profession by inclusion of workers from different economic and cultural backgrounds. Workplaces would become like the 'teaching hospitals' in which training and education is a part of the job and on the job. People with natural talent would be given focus and supervision, while professionals would necessarily have to keep their knowledge base updated in order to be useful to both patients and social worker assistants.

When I began my career in counselling in the 1980's, in the State of New York, licensure (or certification as it was called in those days) was an option. Moreover, there was no distinction between licensed social workers and licensed clinical social workers. Many social workers voluntarily took the licensing exam and got their state license. My opinion is that the license was more of a status symbol, since you could work for any agency as well as open your own practice with only your M.S.W. Also, I believe many social workers internalized the license as a personal goal--never imagining that someday it would become an instrument of government control and revenue, and a bureaucratic nuisance. (Written 07/24/06 - Revised 08/16/10)

[NOTE: For other essays on similar topics, see Social Workers in Loan Debt (written 05/12/08), C.E.U.'s and M.S.W.'s (written 05/22/06), Ye Olde Social Worker (written 08/19/02).]

Until we meet again..............stay sane.

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Copyright 2006 Natalia J. Garland