Daily Archives: September 26, 2010

Shameless Plug for the American Counseling Association (ACA)


The ACA offers members a very comprehensive set of benefits.  Founded in 1952, he ACA is the largest organization of professional counselors.  They offer the opportunity network with over 43,000 members through their website… http://www.counseling.org/ They also have designed and maintained a number of different “Interest Networks” that provide networking collaboration opportunities.  Sample networks include Grief and Bereavement, Advances in Therapeutic Humor, Multiracial/Multiethnic Counseling Concerns, and more!  They offer a podcast series for continuing education and professional development, as well as publish the ACA Online Journal of Counseling & Development (JCD)… the ACA’s quarterly flagship journal.  They have an impressive online collection that includes everything from the last 10 years (back to 2000).  They provide both ethics consultation via phone and via email, as well as offer a new 6 credit online ethics course that can fulfill continuing education requirements.  Members are encouraged to attend the ACA Conference & Exposition, at which more than 500 education sessions are conducted.  They offer a career center, as well as a “marketplace” where you can get group rates for a variety of services and products.

Fees associated with membership are as follows… Professional/Regular is $155, while a new professional (graduated within the last 12 months), student, or retiree is elible for a reduced rate ($89).  On the whole, it would appear to be a pretty good value just on the basis of the name recognition and credibility it brings to the table.

The ACA Insurance Trust (ACAIT) promotes and administers insurance and services “at competitive rates.”  The professional liability insurance program is administered by Healthcare Providers Service Organization (HPSO).  Liability (malpractice) insurance is now included in membership for ACA Master’s level students through an underwriter called American Casualty Company of Reading Pennsylvania. This policy will pay for defense against covered claims and provide professional liability limits up to $1,000,000 per claim, up to $3,000,000 annual aggregate, subject to a master policy aggregate.

Ethical and Legal Issues in Diagnosis


There are certainly some potential issues that need to be addressed when balancing desires of managed care and the ethical diagnosis and treatment of individuals entrusted to our care.  First among my concerns are situations where an individual is in obvious need of treatment but the necessary treatment falls outside of managed care coverage.  This may occur because they do not fit the standard illness category or because treatment recommendations fall outside of what the managed care organization deems the best course of action.  “Many insurance carriers will not pay for treatment that is not defined as an ‘illness’ for which treatment is medically necessary.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 427)

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This may tempt a clinician to engage in some unethical and inaccurate diagnosis practices in effort to get the client the help they need.  I believe most clinicians would do this out of what they consider to be the best interest of the individual clients themselves.  However, “the road to hell is paved with good intentions.”  (Kristian Delaney, personal communication) “Under no circumstances should clinicians compromise themselves regarding the accuracy of a diagnosis to make it ‘fit’ criteria accepted by an insurance company.”  (Corey et al., 2007, p. 427-428)

Personally, I see some benefits to managed care that I think we as practitioners sometimes choose to neglect.  Honestly, even if therapy was covered just by my insurance, EAP (managed care) usually provides 6 sessions every year with zero deductible.  We use them every year without fail, and there are some situations where we use them “just because they are there…”  If they cost us anything, even a deductible… we probably wouldn’t utilize the sessions.  Although I think the short sessions do frustrate some practitioners, especially those who have to deal with extremely complex situations in as little as 6 sessions… I think the primary source of frustration is the paperwork!  From what I gather, submitting paperwork for reimbursement to some of these managed care organizations (Magellan, etc) is a real pain.  I don’t understand why they have to make it so difficult… I don’t think there’s any situation where we should spend more time on paperwork than we do with clients.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Evidence Based Practice


Evidence-based Practice (EBP) is based on three pillars: “looking for the best available research, relying on clinical expertise, and taking into consideration the client’s characteristics and preferences.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 446)  The suggestion is that we, as practitioners, should strive to provide minimum amount of treatment that gives maximum benefit in the least amount of time… as supported by the managed health care system that has been “the driving force in promoting empirically supported treatments (EST).”  (Corey et al., 2007, p. 443)

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Where the EST system falls short is the fact that there can be a wide variation in presentations within one specific categorical diagnosis.  I agree with the premise that “this approach is mechanistic and does not take into full consideration the relational dimensions of the psychotherapy process.”  (Corey et al., 2007, p. 443)  What if, for example, the recommended treatment modality is obviously not sufficient to effectively treat an individual client?  What if, at the close of the 5th or the 6th session, the client has made little or no progress as a result of the ESTs?  Despite the focus on “best available research,” there is no single identified treatment method that works for everyone.  When EST fails, is the system flexible enough to recognize its shortcomings?

The concept of EBP and EST are in fact theory laden, but I question whether ever practicing clinician subscribes to that theory.  It is generally acknowledged that a practicing clinician should anchor his or her methodology to a theory… but if that theory differs from the 3rd party payer, I suspect that the clinician would be better off working outside of the managed care system.  My question is this… is that even possible today?  Can you effectively run a private practice and not accept EAP or managed care as a 3rd party payer?  If we choose not to accept those types of clients, isn’t that discrimination in its own right?

I am in support of the general underlying premise of EBP and EST, lowering costs and raising the quality of care should be something we should all aspire to.  However, I fail to see how force feeding a theoretical system on practitioners is in any way conducive to raising the quality of care… it would appear that it is 100% focused on lowering costs.  After all, lower costs are quantifiable (measured in $), and the relative quality of care is subjective.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.