New Attack on Exempt Practitioners

Pirate Treasure MapOn Thursday I attended the third meeting of the Licensure Exemption Workgroup, whose purpose is to eliminate the licensing exemption for counselors and family therapists.

The idea is to introduce legislation for this in the 2017 full session of the Oregon Legislature, not the current 2016 short session.

Oddly, this attack on the counseling exemption is not being spearheaded by the counseling board (the Oregon Board of Licensed Professional Counselors and Therapists, OBLPCT), but by the psychology board (OBPE).

Why would the psychology board muscle onto another board’s turf? Because that’s what they do.

Rewriting History

The psychology board published a backgrounder on the licensing exemption that strives to explain it without understanding it first. You see, rather than contacting the counselors who are familiar with the counseling exemption, and who know its history, how it works today, its pros and cons, and its supporters and detractors, they chose to study only its legislative history, in isolation, without talking to anybody . This aversion to human contact is typical of the OBPE.

And it allows the OBPE see what they want to see. Which I can summarize roughly as follows: “The exemption only exists because of the inattention and incompetence of the Oregon State Legislature and the counseling board.” Specifically, they claim to have discovered  that “the law is being used today for an entirely different and unintended purpose” (page 4).

But is it?

In a word, no.  They would have discovered this if she had contacted—well, anyone, really, but especially the counselors who have been involved with drafting the exemption, shepherding it through the legislature, and tending it over the years.

Broad Support for the Exemption

If one reaches out to the experts in the exemption, what do they say? They say that, regardless of what the psychology board thinks, Oregon’s counseling community supports this counseling exemption.

For example, in the February 2014 minutes of the counseling board (the OBLPCT), all of Oregon’s three organizations for counselors and family therapists (ORCA, OAMFT, and COPACT) came out strongly against the removal of the exemption: “Representatives of the associations spoke strongly against removing the exemption from the law.” There’s no reason to think their position has changed.

In addition, just this month, the issue came up on the excellent Oregon Counseling Association discussion group,  and the consensus was:

  • The exemption was created deliberately, and nothing about it is accidental.
  • The exemption serves a valuable purpose.
  • While the wording of the exemption surprises people on first reading, it works as intended.
  • The exemption works well in its current form.

The Licensure Exemption Workgroup

The Workgroup has members from three boards: the psychology board (OBPE), the counseling board (OBLPCT), and the clinical social work board (OBLSW). The nominal chair is Charles Hill, the executive director of the psychology and counseling boards, but in reality Fran Ferder, chair of the psychology board, is in charge.

The first two meetings were largely monologues by Ferder, who lectured the non-psychologists in the room about their own exemption, about which they know far more than she does. They endured this with admirable fortitude.

Rationale for Repeal

At the core of Ferder’s arguments is her simple faith in credentialism: that people with lesser degrees are inferior therapists to people with higher degrees, and only people with higher degrees should be allowed to practice.

Remember, Ferder is a PhD psychologist, and the people she’s trying to recruit only have master’s degrees. Thus, her rationale is nothing more than one long extended insult. She was oblivious to this for the first two meetings, mentioning college degrees constantly, but she seems to have caught on. In the third meeting she began saying “training” and “certification” instead. But I suspect the damage is done.

Ferder made no appeal to scientific evidence that people with certain college degrees do good, while everyone else does harm, because no such evidence exists.  Nor is there evidence that licensees are better therapists than non-licensees. Sixty years of research into therapeutic effectiveness has consistently demonstrated that therapy works, and works well,  but we don’t know why it works, or even how it works. Differences between groups of therapists with different credentials (or none) are small and often statistically insignificant.

Ferder also threw in the usual line that people who see exempt practitioners have no recourse under law. Not true! That’s what the court system is for: so you can sue people who have wronged you—or have them sent to prison, depending on the nature of their offense.

The final argument is that exempt practitioners “don’t have a written code of ethics.” But of course they do: it’s called “the law.” The courts are happy to use the law to distinguish right from wrong, and award damages or prison sentences accordingly.

The Proposed Changes

I don’t have a written version of the proposed change, because none has been made public. The gist is to cripple the exemption so it only exempts people who are “not diagnosing, assessing, or treating mental disorders.”

What do they mean by this, exactly? It’s hard to say, since the discussion at the meeting was diffuse, with no examples. But here’s what they don’t mean:

  • They don’t differentiate between major and minor mental illnesses.
  • They don’t differentiate between clients who have an actual diagnosis and ones who don’t.
  • They don’t differentiate between clients and practitioners who buy into the medical model of mental health and those who do not.

A Recent Example of OBPE Thinking

Last December, I testified in defense of an exempt counselor accused of the “unlicensed practice of psychology” on the grounds that she was practicing counseling. (I am not making this up.)

The prosecuting attorney made a big deal out of the possibility that some of the defendant’s hypothetical clients might hypothetically have a diagnosible mental illness. No actual clients were considered. Based on this fantasy, the judge allowed a $5,000 fine. (I am not making this up, either.)

With this example in mind, let’s consider mission creep—how many ordinary problems have become “mental disorders” over the years. For example, as a hypnotherapist, people come to see me when they want to stop smoking. Flipping through the DSM-V, we find Tobacco Use Disorder. Egad! He’s practicing psychology without a license!

Except that, in Oregon, the law defines this thing called “counseling.” It even defines counseling and psychology almost identically, so that almost everything that counts as “the practice of psychology” is also “the practice of counseling.” And I’m covered by the counseling exemption, so it’s perfectly legal for me to treat Tobacco Use Disorder.

The psychology board wants to eliminate this exemption. Not to protect the public, since actual harm to actual clients doesn’t seem to matter. (The psychologist accused of stealing the records of a rape victim from the UO counseling center didn’t get a larger fine than the exempt counselor with her hypothetical clients.)

Time to Reach Out

I’ve attended all the Licensure Exemption Workgroup meetings so far. In all these meetings, they ask for public comments at the end. In both of the first two meetings, I pointed out that ORCA, OAMFT, and COPACT were all on record as favoring the exemption, while Ferder assumed that no one was in favor of it. It was important for the Workgroup to reach out to these organizations to reconcile these viewpoints.

In the third meeting,  most of the time was spent on the necessity of reaching out to stakeholders, and reaching out to them soon. Everyone in the room knew my name, knew that I’m a stakeholder, and knew that I’m a hypnotherapist. When members wondered aloud if there was a hypnotherapy organization that should be contacted, they all knew that I knew the answer (National Guild of Hypnotists). And, with their brand-new determination to reach out to all stakeholders right way, and with the meeting running early, there I was. Carpe diem. No sooner said than done. Right?

So Charles Hill seized the opportunity with both hands—ending the meeting abruptly to prevent this from happening.

I suppose he thought he was insulting me. Of course, is was as much an insult to the workgroup members as it was to me, and they didn’t like it much. As soon as the meeting closed, Doug Querin, the vice-chair of the counseling board, walked over and introduced himself, asking for my card, and promising to be in touch, adding me to his list of stakeholders to reach out to.

So what happens next? We drive a stake through the effort’s heart, that’s what. While this measure may dissolve under the weight of its own foolishness, let’s not take that for granted. I recommend:

  • Contact your state legislators and voice your opposition. They know that there are a lot of alternative and exempt practitioners in the state, and these practitioners have the support of the public. But there are few psychologists and the psychology board has few friends.
  • If you’re a practitioner, contact the relevant organization and let them know about the issue, and join the organization if you haven’t already. For example, I’m a member of the Oregon Counseling Association (which accepts unlicensed folks as associate members) and the National Guild of Hypnotists. Such organizations have lobbyists to protect practitioners from infringements.

4 thoughts on “New Attack on Exempt Practitioners

  1. Robert – enjoyed your article and your passion! My assumption from your article is that as far as the OBPE is concerned, the exemption is gone – they’re using the “workshop” to craft language to do this effectively – they don’t want to have to return in a couple years because some alt practitioner escaped their net.
    Thanks again for keeping abreast of this and other issues concerning alt practitioners in Oregon.
    Joseph

  2. Thank you so much for this! Here is a link to the proposed language, if anyone is interested: http://www.oregon.gov/oblpct/Laws_Rules/Exemption_Draft_Language.pdf

    At first blush, the change is alarming because I read nothing that says whether persons already in a business affected by this will be required to close their doors (or pay dearly in lost clients, time, and tuition to go back to school for a degree that satisfies the change) should this pass.

  3. One of the things the Oregon Board of Psychologists must do, like all boards, when making new rules, is to state whether they have consulted with small business, and to estimate what the impact may be on small businesses. The statement is to be included in their 2-page “rule” proposal. THIS board (OBPE) almost NEVER consults with small businesses and instead – get this – writes, “Small businesses were not directly involved; however members of the Board who developed these amendments represent small businesses.” I have drawn their attention to this many times to no avail. As of today, 10-20-2016, the OBPE site shows one proposed rule at present and those exact words can be found on page two under Statement of Need and Fiscal Impact. http://www.oregon.gov/obpe/statutes_rules/PermOAR_Notice_9-27-16.pdf

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