The Shrink’s Links: A Consequential, Niggling Detail

Bringing you the best of mental health every week.


Today I’m going to write about something that should be irrelevant and of no concern to you, but may affect you, nonetheless: the licensing of people who perform psychotherapy.

Licenses exist so the consumer can know who to trust and who has the necessary training and experience to do what they say they are doing. Professions usually welcome licensure for the same reason that restaurant might welcome a critic’s review. It endorses and affirms their work and guides customers to their doorstep.

Licensing laws also serve to shut out the competition. New York City releases a limited number of taxi medallions, for instance, so that taxi operators can be assured plenty of business. This, of course, drives up prices and makes it hard to get a cab. Consumers complain and often find undesirable alternatives.

We often hear about how it is difficult to access mental health care. It’s expensive. It can take months to get an appointment at a community clinic. Our prisons are filled with the mentally ill. When people can’t get mental health care, they chose alternatives: alcohol and drugs, violence, anything that gives them short term relief, and it ain’t pretty. Remember that the next time you hear about a school shooting, an overdose, a suicide, a fatal DWI, domestic violence, or pass homeless people on the street. Clearly, there are not enough people providing mental health care. Obama Care and other laws will not help if there are not enough therapists to see all those who need help.

A few years ago, the New York State legislature overhauled the laws concerning licensing of psychotherapy. Licenses had been very hard to come by. You had to go through a social work school, get a doctorate in psychology, or complete medical school and a residency. There weren’t too many of these opportunities in Western New York. Folks, like myself, learned the same material in other settings and got plenty of experience working in non-profit clinics where licenses had not been necessary. The legislature recognized that there were alternative paths to the same level of competency and created several new licenses with rigorous requirements: the LMHC, or Licensed Mental Health Counselor, for one. The legislature got all that right. The trouble is, they screwed up one little detail.

They wrote in the law that we would be doing “assessments”, not making “diagnoses”. There is absolutely no practical difference between making an assessment versus a diagnoses; they both result in the same thing: a brief summary of the problem. However, when insurance contracts are written that patients require a diagnosis, all the lawyers and bean counters in the insurance company (and there are quite a few) insist that diagnosis is what they need to have.
The result of this gaff is that today we have more competent people in the profession, but many of the insurance companies will not pay them. This limits the availability of mental health care.

I’ve been told that the other professions that had previously been licensed: the doctors and social workers, lobbied against using the word “diagnosis” in the language, thus inserting a poison pill into the legislation and ensuring they would get plenty of business. However, I would like to not believe doctors and social workers could be so evil.

I’ve been told that it’s going to take another act of congress (the New York State legislature, to be precise) to correct the problem. We all know what that’s like. Try to get a politician interested in this.

If you are still reading at the end of this post, you must still be interested. So, do one more thing. Contact your state senator or member of the legislature and ask him or her to support A.7608 and S.4977.

The links:



Published by Keith R Wilson

I'm a licensed mental health counselor and certified alcohol and substance abuse counselor in private practice with more than 30 years experience. My newest book is The Road to Reconciliation: A Comprehensive Guide to Peace When Relationships Go Bad. I recently published a workbook connected to it titled, How to Make an Apology You’ll Never Have to Make Again. I also have another self help book, Constructive Conflict: Building Something Good Out of All Those Arguments. I’ve also published two novels, a satire of the mental health field: Fate’s Janitors: Mopping Up Madness at a Mental Health Clinic, and Intersections , which takes readers on a road trip with a suicidal therapist. If you prefer your reading in easily digestible bits, with or without with pictures, I have created a Twitter account @theshrinkslinks. MyFacebook page is called Keith R Wilson – Author.

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