NYS Licensed MHC's are now eligible to diagnose clients.

Discussion in 'General Distance Learning Discussions' started by Jan, Aug 14, 2022.

  1. Jan

    Jan Member

    NYS passed legislation providing specially trained Licensed Mental Health Counselors, Marriage and Family Therapists and Psychoanalysts the privledge to diagnose clients. Prior to this legislation these mental health professionals were only permitted to provide a psychosocial assessment but not a clinical diagnosis. The inability to diagnose clients limited the scope of practice of these professionals when in fact many were well trained to provide diagnoses. It also placed them on a lower rung than other mental health professionals, including Clinical Psychiatric Social Workers, who have historically been providing disgnoses independent of requiring a Psychiatrist's oversight.

    In addition, the inability to diagnose limited these mental health professionals' reimbursement from insurance companies.

    It appears that the pandemic revealed the inordinate need for more mental health professionals to provide counseling/therapy services due to shortages caused by the trauma, anxiety and depression of this crisis.

    In order to diagnose, licensed professionals interested in performing this service will need to present additional coursework and therapeutic work experience to NYS to obtain a certficate enabling them to diagnose clients. The specific requirements for this privledge need further clarification.
    Johann, LearningAddict and Dustin like this.
  2. Dustin

    Dustin Well-Known Member

    I've never understood why LMHCs were prohibited from diagnosing while LCSWs could. Especially because you can take a macrosocial course load and get enough supervision hours to get licensed while not having nearly the base in diagnosis and assessment that someone with an MS in Counseling or similar does.
    chrisjm18, SweetSecret and Johann like this.
  3. Jan

    Jan Member

    The basis for this prohibition and resistance emanated in large part from the Social Work Lobby that wanted to secure their supremacy, along with Psychiatrists and Clinical Psychologists, in the mental health hierarchy.

    In addition, the failure and resistance within the profession of counseling, primarily stemming from PH.D's in Counselor Education within academia, to evolve and promote a Professional clinical doctoral degree in counseling, along the lines of a Psy. D or DSW, has resulted in the counseling profession being perceived on the lowest tier of the mental health pyramid.
    Last edited: Aug 14, 2022
    Johann likes this.
  4. Johann

    Johann Well-Known Member

    That's really unfortunate - both for counsellors and their clients. From my own experience, for helpful results, counselling is certainly not "low tier." And counselling from someone specialized in that discipline can, at times, be way more helpful than counselling as practised by a psychiatrist. (Back in the day. I've had experience as a client / patient with both.)

    Low tier? Contrary to the perception, which I'm sure Jan is right about, LMHCs are definitely NOT low-tier on ANY pyramid. Pardon my un-psychological language, but that perception is just .... nuts. I hope those at the helm of the counselling profession don't let this state of affairs end here.

    Thanks, Jan, for a couple of illuminating posts. And thanks, Dustin, for asking exactly the right question.
    Last edited: Aug 15, 2022
    Jonathan Whatley likes this.
  5. Johann

    Johann Well-Known Member

    I should have added - it's good to know that NY State has come up with a turnaround. No doubt it'll take a bit of time before everything is clear and the further education requirements are sorted out etc. Perhaps now that things have got this far, those who steer the counselling profession will be able, in due time to influence change in other States. (And hopefully make that professional, clinical Doctoral degree, that Jan mentioned, a reality.)
  6. SweetSecret

    SweetSecret Active Member

    I have more thoughts on this than I can list. I think there could be both good sides and bad sides to this. There are a lot of people who are undiagnosed who being diagnosed would it help them access other lifestyle because they would qualify for more assistance. However, I am starting to see more and more discussion about certain things like personality disorders that maybe need to be dropped from the DSM. I have worked in rehab centers where are the clinical directors would deny somebody based on particular personality disorders, which is obviously very sad because that leaves people without being able to get help but they need. If they don't disclose a diagnosis and end up in court then they look like the bad guy, but if they just close the diagnosis that might not even be true then they can be denied services. It's a double-edged sword.
    Jonathan Whatley and Dustin like this.
  7. Jan

    Jan Member

    Johann, in line with your awareness of the value of counseling, unfortunately doctoral level Counselor Educators appear to be seeking to maintain their positions of power by not promoting the creation of the professional clinical doctorate in counseling. Practically every mental health and allied health profession offer such doctorates, including Psychology, Social Work, Nursing, Physical Therapy, and even the profession of Physician Asssistant, now termed Physician Associate ( a Job title the AMA is vehemently contesting).

    By claiming that the master's degree in Clinical Mental Health Counseling suffices, and does not require a step upwards with a doctorate, has undermined the recognition of the Clinical Mental Health Couseling profession and limited opportunities for personal and professional growth of practitioners in this specialization.

    Furthermore, there is currently a dramatic decline in Psychiatrists providing psychotherapy, and instead focusing on providing psychotropic medications. One of the rationales for doing so is that Psychiatrists are one of the lowest paid medical specialities, and by seeing more patients per hour for shorter visits, without offering psychotherapy, they can bill insurance companies for more reimbursements. Secondly, due to the pandemic, many Psychiatrist's are experiencing psychological burnout due to the inordinate demand for psychiatric services from overwrought patients.

    Lastly, Psychiatrists who do offer some form of psychotherapy, ascribe to the short term cognitive behavior therapies due to pressure from insurance companies to do so. Although this form of therapy can be very helpful for specific patients, it doesn't replace longer forms of psychdynamic therapy for certain patients who require this approach.
  8. Jan

    Jan Member

    I would appreciate if you could clarify the content of your post. It would be helpful in order to respond accordingly. Thank you.
  9. Dustin

    Dustin Well-Known Member

    I don't know your background so I apologize if this is information you already know, but Rogerian/humanistic therapy often de-emphasizes diagnosis because it can cause the client to get fixated on themselves in the context of the symptom checkboxes, instead of as a multi-faceted person. Being able to diagnose is, as you noted, important for insurance reimbursement reasons and potentially for treatment planning. At the same time, there is significant stigma of the Axis II (or their new name in the DSM V) personality disorder diagnoses (BPD especially) that can make people wary of getting diagnosed. Once you have a diagnosis of PD, it can be very difficult to get treatment.
    SweetSecret likes this.
  10. Jan

    Jan Member

    Thank you for the clarification.

    Certain diagnostic labels can potentially stigmatize a patient and result in their feeling devalued. This applies to specific Axis 1 as well as Axis 11 diagnostic categories. Although there are insurance reimbursement and liability issues necessitating a diagnosis, in order to guide a viable treatment plan a working diagnosis may be necessary.

    However, as you stated, regardless of whether the clinician abides by Rogerian Humanistic theory or any other, their priority should be to form a collaborative, empathic therapeutic alliance with another human being, not an inanimate diagnostic object, regardless of diagnosis. If not, it would be in the client's best interests to seek a therapist who possesses those humanistic characteristics that is their right to expect.
  11. AsianStew

    AsianStew Moderator Staff Member

    Diagnosing clients is one thing, prescribing medication or providing a specific treatment plan is another. I think this is alright as an "early" diagnosis of patients as an "initial step" of patient screening, since most of these MHC's have a Masters level education or higher. However, having said that, clients/patients should seek a "secondary" diagnosis as the final say to what type of medication or treatment plan they should follow.
  12. Jan

    Jan Member

    The fact that a licensed masters level mental health professional diagnoses a client and develops a treatment plan implies that if a client presents with a specific diagnosis beyond their scope of expertise, or requires an additional psychiatric/neurologic workup or psychotropic medication, that this information and objectives will be incorporated in the initial treatment plan, followed by a referral to an appropriate medical professional for further evaluation and treatment.
  13. SweetSecret

    SweetSecret Active Member

    Exactly as stated, I have mixed feelings. Dustin hit the nail on the head, although I was trying not to use specific examples. People should be able to get help that they need help without a system to label them. Some professionals are trying to get around the stigmatization by not telling clients their own diagnosis. This can often make the situation worse as client spiral into wondering what is wrong with them, or dealing with situations where their mental health is brought into court records and they have no clue what is in the mental health records. Also, I was alluding to, and Dustin pointed out, knowing the diagnosis means having to sometimes disclose it in situations that cause a person to not receive services they need because clinical directors do not want to deal with them.
  14. In most states, any licensed mental health professional (LCSW, LMFT, LMHC, LCPC, etc.) can diagnose.
  15. Neuhaus

    Neuhaus Well-Known Member

    All of this really implies much more cohesive process than there actually is.

    The fact of the matter is that LMHCs do not require referrals. You can go to one directly. They can bill insurance. Insurance requires a diagnosis code. Counselors in New York have always assigned a diagnosis code based on their interpretation of what the patient presents unless some other clinician referred them.

    If you show up to an LMHC for therapy they develop a treatment plan even if you never saw another clinician at any level. This has always been the case and the sky has not fallen.

    Nobody is going to psychiatrists or psychologists for a diagnosis and then going to an LMHC for them to carry out the doctor's marching orders.

    An LCSW is also a masters level clinician and they have had the ability to diagnose for many, many years.

    This isn't a massive upheaval. This is a symptom of New York having one of the most needlessly complex systems of mental health professional licensing with so many different licensing classes it boggles the minds of people from other states.

    I could see some controversy around psychoanalysts as the requirement there is, essentially, a psychoanalysis diploma from an approved school and a masters in any field. However, those psychoanalysis diplomas are no slouch. They are absolutely equivalent to at least a Masters. And most of the people who are getting that qualification were trained in an allied field (medicine, nursing, social work etc) before undertaking it.

    This change is not degrading other professions and it is not going to cause harm to patients.
  16. Jan

    Jan Member


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