By Shari Tresky, LMHC, Hawai’i.
I joined the Alliance for Professional Counselors (APC) because I believe it is an organization that truly supports all professional counselors, and sincerely cares about the clients we serve. I believe that APC will seek reconciliation within the profession, and will create a unified identity in keeping with our history, in which diversity has always been an asset we defend and promote with pride.
My Concern for Hawaiian Counselors
As a licensed mental health counselor in the State of Hawai’i and a member of the American Counseling Association (ACA), I have became particularly concerned about recent ACA statements made which seek to eliminate counseling psychology as a legitimate degree for licensure as a clinical mental health counselor and to support only counselors from CACREP Accredited programs. Up until the past few months, I believed that the ACA was advocating for ALL counselors, including those of us from counseling psychology programs. However, that appears to no longer be the case. I joined APC in an effort to protect my rights and the rights of every licensed counselor in Hawai’i.
My Background
I graduated from an excellent, 60-credit, MPCAC accredited, Masters’ level counselor training program at the University of Hawai’i at Hilo. The program meets CACREP-equivalent curriculum standards, promotes a strong counselor identity, and teaches according to ACA ethical standards. However, the program is housed in a psychology department and the faculties have psychology degrees. For these reasons, it is not eligible for CACREP accreditation.
This is a fairly new program launched in 2006, and was specifically created in response to an urgent need for mental health professionals in our under-served communities. At that time, the program creators had no idea that future CACREP standards would make it ineligible for accreditation. It took years of advocacy and hard work to get the program approved, and the only way it could have been funded was to house it in the psychology department, which is one of the most popular undergrad programs in the school. This enabled the University to hire new faculty who could teach both undergraduate classes and graduate-level courses in the new program.
The State of Counselor Training in Hawai’i
The UHH program is one of only three clinical counseling programs in the entire State, all of which are housed in psychology departments. None of the clinical counseling programs in the State of Hawai’i are eligible for CACREP accreditation. As a result, our State licensing board is unlikely to agree to any standard that would exclude graduates of these programs.
Hawai’i was the 49th State to approve a professional counseling license, and the counseling psychology programs’ faculty, graduates and students were instrumental in making this happen. Understandably, we now feel betrayed by ACA. It is neither fair nor reasonable to say to these programs, “You have to move from the psychology department and hire several new faculty to meet criteria for a CACREP program.” This is simply not financially feasible for the programs in question, nor is it a practical strategy for any national counseling organization that truly wants counselor license portability in all 50 States.
Additionally, UHH houses the only clinical program in a local, public university and the affordability of training programs support counselor diversity. In Hawai’i, we have a high percentage of working professionals that return to school for additional training. These students are not in a position to leave the State to attend a CACREP program. Culturally, many people value Ohana (extended family) and have a spiritual connection to the Islands themselves, so they would not want to be forced to leave, even if they could afford tuition elsewhere. If people had to move to the mainland or pay exorbitant tuition for an online program, we would have far fewer Native Hawaiian, Pacific Islander, and other ethnically diverse and/or lower income counselors, who benefit from State tuition or prefer to remain in Hawai’i for cultural reasons.
My Disillusionment with the ACA
When ACA had its conference in Hawai’i, ACA staff presented a workshop on the future of the profession. Afterwards, several audience members sat around, in a state of shock and alarm, and discussed our sense of injustice implied by CACREP’s exclusion of our local training programs. Hawai’i has a long history of cultural domination, and many here experience this exclusion as yet another invasion by a mainland institution. The UHH program offers a culturally sensitive environment for Hawai’i’s students, and its presence has increased our diversity. I am concerned about the demise of this valuable program if these discriminatory ACA policies prevail. I am hopeful that the APC will succeed where ACA is failing.
Furthermore, there is a shortage of mental health providers in Hawai’i. In my own practice, 80% of clients qualify for Medicaid and have previously had a hard time finding a provider that accepted their insurance. We have a lot of Veterans in our State and the CACREP exclusion in Tricare is a hindrance to their care. Stigma is another factor that discourages many people in Hawai’i from seeking help, and increasing diversity of counselors tends to reduce that stigma. Since the UHH program begun, the number and diversity of providers has increased. Even with sufficient grandfathering language, if the State adopted CACREP requirements, it would halt further progress in reducing stigma and increasing access to care.
I understand the reasoning for having standardized education requirements, and I support the efforts of counseling associations in advocating for public acceptance of the profession, licensure portability and parity with other professionals. I further understand that advocacy may be a bit easier with one accrediting body that sets the standards. However, it is not worth the costs incurred when such efforts will prevent qualified counselors from serving their communities.
The current ACA CACREP-only, single accreditation standard policy, will reduce the number and diversity of counselors, and impede client access to culturally appropriate care. It is an ethical imperative that inclusive policies be implemented immediately. It is far from impossible to develop qualitative standards while including counseling psychology programs that meet criteria relating to identity, curriculum and ethical standards. National counseling associations cannot control CACREP’s decisions, but they can recognize MPCAC as a second legitimate accrediting organization. The APC has already officially recognized not only CACREP, but MPCAC and CORE as counseling program accreditation bodies. Additionally, counseling organizations need to let go of “gold standard” language which unjustly argues that CACREP is the gold standard in accreditation, and launch an intensive advocacy campaign supporting all licensed counselors. I am optimistic that the APC will support and advocate for all counselors, not only those from programs with one limited standard.
A Call to Support Inclusion versus Exclusion
It would not be impossible, as some seem to believe, to explain the inclusion of counseling psychology within the counseling profession, and the existence of an accrediting body that supports these programs. Other respected professions, such as nursing, have two accrediting organizations, and professionals in the medical field, such as licensed primary care doctors, come from different, but related training programs. For example, both MDs and DOs participate in residency programs in family and internal medicine, and all are eligible to be primary care physicians.
Interestingly, before the acceptance of training diversity, there was a long history of contention between medical programs, with attempts to discredit certain types of training. But the end result was acceptance of the different programs, when no evidence was found for claims of inferiority. Eventually, regulatory bodies chose the good of patients over false and unfounded divisions.
As we often ask our clients: Do we really have to repeat this dysfunctional pattern? Or can we learn from the past and make a positive change?
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