Virginia Regulatory Town Hall
Department of Health Professions
Board of Counseling
Regulations Governing the Practice of Professional Counseling [18 VAC 115 ‑ 20]
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10/21/19  3:50 am
Commenter: Sharon Watson LPC, LMFT, LSATP, NCC, ACS

ABSOLUTELY IN FAVOR - Additional support points and clarifying misinformation

I am writing to address previous responses, correct some misinformation, and add additional support for allowing residents to take direct payment from their clients.  I have been in the field for 30 years, licensed as an LPC for 25 years, and supervised residents for over 20 years in Virginia in exempt and non-exempt settings.  I have been a provider of the 20-hour Clinical Supervision Training required for becoming a supervisor and have trained many supervisors over the years.  Here are my points:

1.  In Virginia a resident is allowed to have a private practice if they are under Board approved supervision with a Board approved supervisor and if they identify themselves as a Resident in Counseling under supervision and by whom.  This petition is not about whether or not a resident can have a private practice.  Suggesting to a graduate that they can't or shouldn't have a private practice is giving misinformation.

2.  There are not enough jobs available, including working in an established practice, so for many graduates there is no alternative but to start a private practice, even if they would rather not do so.  In terms of one response that suggested Virginia should do something about the job opportunities, I agree that it would be great to have more funding for mental health, but that's a future goal and shouldn't be a determining factor in making a decision about residents' ability to take direct payment now.

3.  I require my residents to carry their own malpractice insurance.  My malpractice coverage doesn't change with additional residents, so it's possible that the increased malpractice costs discussed in previous responses are for taking on employees (residents or interns) and not for those residents who are contractors or simply rent space in a practice.

4.  The risk to a supervisor (i.e. vicarious liability) is the same whether or not the resident takes direct client payment.  That's why a supervisor does due diligence in choosing who to supervise.

5.  Accounting isn't an issue if your residents are your employees or if payment goes through the front desk of a practice.  But because in Virginia a resident's supervisor is not required to be on-site and virtual supervision is allowed, the issue is for supervisors who are not supervising residents within their own practice. They must therefore set up bank accounts to accept client payments and then transfer the entire amount back to the resident.  The gyrations of having payment pass through the supervisor is unnecessary when both the resident and supervisor are following the regulations by identifying that the resident is under supervision.  And why shouldn't the payment go to the resident - they are the one providing the service?  I believe it's more confusing to clients to be told they must pay a supervisor and not the counselor with whom they have made the therapeutic alliance.  And in response to the idea that withholding a resident's client earnings in order to be sure they report their hours is holding their earnings as ransom and a misuse of a supervisor's current requirement to take client payments.

6.  I suspect the shortage of supervisors is more due to the unwillingness to take on the time-consuming process of making multiple bank transfers to send client payments back to their residents (giving them the income they earned) rather than concerns about increased risk having a resident in private practice.

7.  I believe there is a confusion between payment and competency.  Payment for services is a mechanical issue and has nothing to do with counselor competency.  In fact, some graduates seeking supervision may have already taken the licensing exam and be an NCC.

8.  How are graduates to get experience if they don't see clients?  It puts residents in a Catch 22 situation if they can't get a job without experience but can't get experience without getting a job.  The purpose of being supervised is to allow graduates to identify themselves as residents, practice, and be supervised so they can learn the skills to be a good therapist.

9.  There is concern expressed that a resident in private practice may lack skills, but that's why they are under supervision.  It's important to note that in some exempt settings graduates are practicing as counselors without Board approved supervision, may have a supervisor who isn't even licensed, are required to see the next client who walks in the door whether or not they have expertise in the client's issues, and are often in very intense and difficult situations with typically seriously mentally ill clients.  The supervisor of a resident in private practice on the other hand can guide the resident in taking only those clients within the resident's skill set and who can be appropriately managed in the private sector.

10.  The suggestion that the regulations are there to protect residents and supervisors is a misunderstanding.  The regulations are taken directly from Virginia law and are meant to protect the public.

11.  Regarding Virginia being the standard bearer in the profession: yes, indeed, Virginia was the first state to license counselors but there are other states with equivalent requirements and in fact some with stricter requirements.  This is an opportunity for Virginia to again be in the forefront by taking into consideration the changing technological landscape and take advantage of the opportunities this brings.  Paper checks made out to the supervisor and signed back over to the resident are a thing of the past now with instantaneous payments and cash transfers.  Dictating that a resident not take direct client payment doesn't make our regulations better, it just keeps us from adapting to the present.

12.  Regarding the statement that no other profession allows residents to take payment is actually incorrect regarding our own profession because in some states residents are allowed to take payment. In my research, of the 18 states that have responded to date, 5 allow residents to take client payment, 7 report it's not regulated or not addressed at all (which means the resident can take payment).  It's important to note that the Virginia Board doesn't regulate insurance reimbursement for residents because it's outside their purview.  Which begs the question of why they regulate another form of payment.

13.  The implication that allowing residents to take client payments in their private practice will make graduates more willing to break the law by practicing without a supervisor or license is inappropriate.  If a graduate is practicing outside of the regulations, that is what should be policed and reported.  The bottom line is, if you see something, say something.  If you see someone practicing illegally, report it.  That's how we protect the public.  The public isn't protected by not allowing a resident, who is practicing according to the regulations, take direct client payment.  It's unconscionable to penalize residents adhering to the regulations because of individuals who might not be. 

14. In response to changing this regulation meaning there would be no difference between a residency and a private practice is a misunderstanding.  The answer is they can be one in the same. A residency can be done in a supervisor's practice, in a private company, in an exempting setting, or while running a private practice.

In summary, I hope this addresses some of the concerns voiced by some and supports all of those in favor of changing this regulation.

CommentID: 76599