I have made the choice not to contract
with managed care companies
for my professional services.
Here’s the  8 reasons why . . . .

Conflicts of Interest

As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest.  My primary concern is for my client’s well-being.  Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest.  I do not want to be put in that position.

Managed care companies were created to “manage” and contain escalating health care costs.  Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for my client.  In many cases, therapists who contract with MCC are actually paid to NOT see clients.

Restricted Choice

Often managed care companies restrict the client’s choice of therapist by offering only short term / brief therapy that I refer to as “drive-by” therapy.  Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs.  It is my belief that this often results in my client’s quality of care being compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.

Managed care companies often choose to limit what  therapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.

Professional Expertise

I believe that my client should be able to access the full range of mental health professionals according to client needs.  Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short term therapy rather than to other therapists who may provide better results or offer a different packaging of services.

Contractual Limitations

I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment.  Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit.  Typically “violations” such as these result in therapists being removed from provider panels or censured in other ways.

Privacy / Confidentiality

By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.

Medication

Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy.  Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor.  Again, the appearance is that of being more concerned about money rather than my client’s needs.

Time

Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued.  This is time consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”

Diagnosis and Stigma

Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness for my clients.

My practice is solution- focused on quality of life and personal goals. My work with clients focuses on prevention, exploration, and personal growth rather than simply survival. We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility.  Working with managed care companies is not a choice that I can ethically make.

I Know Better

I have mental health professionals declare on a regular basis that you “can’t survive in private practice without participating in managed care.”  But, I know better. What I know is that you can’t thrive – both personally and professionally – while participating in managed care.

Once I realized the ethical implications of working with managed care companies, I terminated all of my contracts with managed care.  It’s not a decision that is right or necessary for all therapists but it was the best decision that I’ve made to date.

I am now celebrating 10 years of being an insurance-and- managed-care-free  private practice. I’m thriving and you can, too!  All it requires is courage.

If you, too, run a practice without managed-care, I hope you’ll drop in here to chat about your experiences.  And, if you have yet to make the choice to opt out of managed care, I would be happy to help you find your courage and to help you create a path to a fee-for-service only practice.

Tags: Choice, Contract, Courage, Ethics, Managed Care, Packaging

If you are getting ready to start shopping for a clinical supervisor, here are 10 more questions you need to ask before you invite them to work with you.

"Question Mark" by Segozyme

1. What professional associations are you a member of?
   Don’t assume that they are telling you the truth.  Make sure that you verify their membership through your state licensing board.
2. How are you involved in these associations?
   Does she hold an office in the organization?  Remember to verify that your prospective supervisor is as involved as she represents herself to be.
   A supervisor who is actually involved in a professional association (rather than just paying her membership dues), is better able to help develop you as a professional in the field.
3. Why did you choose to join these organizations?
   Was it about the membership fee?  The purpose of the organization?  The benefits of membership?  This can tell you a lot about what is important to your prospective supervisor.
4. Do you expect me to be involved in a professional association?
   If so, then you will want to know which organization and how involved.
5. How will you monitor my client’s welfare?
   Your supervisor may monitor you through a one-way mirror, ask you to audio / video record your sessions for review, obtain self-reports from you, contact your clients, etc.  Most clinical supervisors use a variety of methods to monitor client welfare.
6. How do you insure my compliance with ethical, legal, and professional standards?
   This is a critical task for your supervisor and you want to make sure that she has a solid plan for this to take place.  In doing so, your client as well as you will be protected.
7. What do you expect of me as your supervisee?
   Yes, your supervisor will have expectations of you and the best way to meet them is to go in informed.  A professional clinical supervisor will have a written contract that stipulates your supervisor’s expectations (as well as your own).  Don’t accept a supervisor who does not have this in place.
8. What conflicts typically arise between you and your supervisee?
   Everyone has conflicts.  You want a supervisor who is aware of them and comfortable enough to talk about them openly and honestly.
9. How do you handle conflict when it arises with a supervisee?
   You want to know that your supervisor has basic problem solving skills.
10. How do you address counter transference between me and my client?
    As a new therapist, it is likely that you may not have much experience dealing with this predictable but sticky issue.  You’ll want a clinical supervisor who doesn’t flinch, judge or shy away from helping you develop skills to deal with issues of transference and counter transference.

Are you finding these questions to be helpful?

These questions came from the Institute in Counselor Supervision taught at the University of North Texas’ Counseling Program by Carolyn W. Kern, Ph.D., LPC, NCC and Cynthia K. Chandler, Ed.D., LPC, LMFT.

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Clinical Supervision and Money Gouging

Tags: Contract, Counter Transference, Professional Association, Transference

I received a call this week from a counselor who has recently moved into Colorado.  She asked if I could provide clinical supervision for her post-graduate work.  As we explored that possibility, the conversation turned to her previous experiences with clinical supervision and they were less than ideal.

If you, too, find yourself tempted to settle for a less than ideal supervisor, you are in need of a supervision rescue. Here are some ideas to consider. . . .

There is NO correlation between being a good therapist and being a good clinical supervisor.

Although the knowledge bases overlap, they require decidedly different skill sets.  Teaching, training, and monitoring are necessary for clinical supervision but are not the tasks of a counselor. Thus, the trend to require supervisors to have formal training in supervision.

Poppy Love . . . . #4 -- squaRED by onkel wart / Thomas Lieser

Mental health professionals are trained to initiate and facilitate difficult conversations.

This may be the perfect opportunity for you to discuss and re-negotiate your supervision with your current supervisor.  Perhaps she was unaware of your interest in clinical supervision and is willing and able to change how she supervises you ; or, perhaps she is not skilled in clinical supervision and can help facilitate a transfer for you to work under someone different who provides clinical supervision.  

Be clear about what you want / expect / need and ask for it.

Some therapists find that it works better to get clinical supervision from someone other than their immediate supervisor at work.

What you may not have realized is that if your boss may be functioning as  your administrative supervisor AND your clinical supervisor.  If so, at least some of the time, it is likely that she will have conflicting/dual roles.

You can’t always speak openly about mistakes that you’ve made with someone who has the authority / responsibility to fire you.

Many organizations are open to contracting with an independent  licensed mental health professional to provide weekly clinical supervision to their employees as an employee benefit.

This supervision may be provided to a small group, to you individually, or in some combination of the two. An organization can contract for this supervision at a much lower fee than if you seek out private supervision on your own.  

If your work site does not currently offer this type of supervision, perhaps it’s time to do a little reconnaissance work and then pitch the idea to them.

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Tags: Change, Contract, Dual Roles, Mistakes, Supervision

I feel like I’m slave labor for the agency.  No one tells me how to help my clients.  I’m just left to figure it out on my own.”

My supervisor signs off on my paperwork every week but doesn’t really do anything.  We meet. I describe each one of my cases to him.  And, then we spend the remainder of the hour talking about his family.  THIS is SUPERVISION????!!!!”

How do I get the time I need to actually work with my clients?  The paperwork here is overwhelming and my supervisor is too busy to even discuss it.”

Every year the horror stories roll in . . . .  What’s a new counselor to do?  Having a great experience with clinical supervision doesn’t just happen in a vacuum.  In case your graduate program forgot to tell you, here ARE  nine things you can do to insure that you have the best supervisory experience possible.

1. Interview several potential supervisors even if you think you already know who you want.  Good supervisors will limit the number of counselors that they supervise so that they have ample time to spend with you.
2. Once you ask someone to supervise you, ask for a written contract with that individual that specifies details of your professional relationship.
3. Remember that supervision IS a professional and hierarchical relationship.  Don’t blur those boundaries and don’t tolerate a supervisor who blurs those boundaries.
4. Schedule regular meetings with your supervisor and make them a priority.  Treat them as you would an appointment with any other professional.  Expect your supervisor to do the same.
5. Your supervisor should make arrangements to be available to you in case of client emergencies.  If s/he is unable to do so, s/he should make arrangements for some other qualified professional to be available in her place.
6. In the event that your supervision is not going as you had envisioned it would, you need to be prepared to initiate that conversation.  Go in with an open mind, state your concerns and ask for what you need.
   

   "Perseverance" by Marcus Smith

7. If you have attempted to discuss the issue with your supervisor and are not satisfied with her response, you may seek consultations with peers.  However, until the licensing board in your state or and attorney tells you otherwise, you are required to abide by the directives of your supervisor.
8. If you are unable to satisfactorily resolve your differences with your supervisor, you may have the option to seek a new supervisor.  However, note that some states limit the number of supervisors that you may use to satisfy licensing requirements.  Check with your specific state to be sure of the rules related to this.
9. Most important of all, if you should need to leave your supervisor behind due to a conflict, take the time for self-evaluation.  Learn what you can about you and about this situation.  It is not something that you want to repeat.

How is your supervision going?

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10 Question You Must Ask Your Potential Supervisor

Tags: Boundaries, Consultation, Contract, Emergency, Relationships, Self-Evaluation, Supervision

In 2002, I took my first course on clinical supervision. Based on the information gained in that course and my own personal experience, here are 10 questions that you should ask anyone that you may consider hiring for your clinical supervision:

"Answering Questions" by Jan / garlandcannon

1. What are your credentials?
   If s/he says s/he is licensed, verify it.  In Colorado, you can do that here for free.
2. How long have you been licensed?
   Require a minimum of 5 years.
3. What is your academic background?
   Make sure your supervisor graduated from an accredited program.  For counselors [in the United States], that accreditation should be CACREP.  Does s/he have a Ph.D. or a Master’s Degree?  In what area — counseling, psychology, social work, human resources, etc.?  Why did s/he choose the program s/he chose?
4. Do you have formal training in supervision?  If so, how much?
   Trends in supervision are changing and the professional standard is rapidly shifting to require formal training in clinical supervision before you can provide it to mental health professionals.  In many states, like Texas, your clinical supervisor MUST have formal training in order for you to count your supervision hours toward your eventual licensure.
5. How long have you been providing clinical supervision?
   Again, make sure you get your money’s worth.  Require a minimum of 5 years experience in clinical supervision.
6. Can you provide references for your clinical supervision?
   This is very important.  You want to talk to past employers, previous partners, supervisees, and others who can give you information about professional behavior, personality conflicts, problems, concerns, ethical dilemmas, etc.
7. What can I expect from supervision under you and what therapeutic skills will you teach me?
   This should be discussed and spelled out in a written Contract of Supervision.
8. Do you consider your supervision style to be that of a teacher, consultant, counselor, or evaluator?
   Your clinical supervisor should be ALL of these.  You should expect to learn new information, new therapeutic skills, new ways of conceptualizing your clients, and new resources from your supervisor.  You should be able to consult with her about any clinical concerns.  Although you will not be counseled about your personal issues, your supervisor will help you become aware of the ways that your personal issues get in the way of your clients’ best interests.  And, first and foremost, your clinical supervisor will evaluate your level of performance at all times. S/he will give you feedback about your strengths and ways to strengthen your performance as a counselor.
9. How will you evaluate me and how will you provide that information to me?
   You should expect to receive verbal and written feedback at regular intervals throughout your supervision.
10. How would you like me to provide you with feedback about your style of supervision?
    You want a supervisor who is eager and open to receiving feedback from you about your experience and needs for supervision.

As noted above, these questions came largely from the Institute in Counselor Supervision taught at the University of North Texas’ Counseling Program by Carolyn W. Kern, Ph.D., LPC, NCC and Cynthia K. Chandler, Ed.D., LPC, LMFT.

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Tags: CACREP, Contract, Feedback, Goals, Supervision