What training do you need to serve military families?

Take NASW s survey now. The answers to ten quick questions will tell the Vermont Military Family Community Network what the training needs are for LMHCs who want to or are working with service members and their families. Please reply before June 15, 2010. Click here to take the survey.

Who We Are

The Vermont Mental Health Counselors Association is the professional association for licensed Clinical Mental Health Counselors in the state of Vermont. Our purpose is to provide support, advocacy, and education for mental health professionals statewide. We are also committed to community education around issues related to mental health treatment, prevention, and general public awareness of the role of the mental health counselor. VTMCHA has also actively educated state authorities, legislators, and lawmakers about the role of the counselor, good mental health care, and the importance of its availability to all in the state of Vermont. We have been vital in representing the concerns of our profession to lawmakers, regulators, insurance companies, and government officials through representation on the Act 129 Board and the Council of Mental Health and Substance Abuse Professionals.

VTMHCA is the state chapter of the American Mental Health Counselors Association (AMHCA), an affiliate of the American Counseling Association (ACA). Through this association, VTMCHA maintains a link to national and federal issues, such as:

  • Advocacy for LCMHC to be recognized as Medicare providers
  • Follow-through on legislation passed to allow LCMHC to be fully recognized by the Veteran’s Administration and Tricare
  • Educating Senators and Congress-people about the importance of mental health treatment on parity with physical health
  • AMHCA employs a full-time lobbyist who communicates with state chapters directly. Our national association wants Vermont’s input, and is an active presence on Capitol Hill.

VTMHCA is devoted to providing affordable, high-quality continuing education courses to professionals in the field of mental health. Twice a year VTMHCA sponsors lectures and workshops focused on clinical practice.

We invite you to click around on our web site, contact us with any questions, and consider becoming a member, whether you are an active professional, a student new to the field, or a passionate retiree!

It’s My Turn... Psychotherapy—State of the profession

By Scott Earisman, LCMHC, LADC

With so much attention now focused nationally on "The Healthcare Debate," and with Vermont in the forefront of changes to the healthcare system, I thought that it is time to look at the part of that system that delivers mental health and substance abuse services.

Nationally, it is estimated that up to 70% of visits to primary care doctors have a psychosocial component that may best be treated by a psychotherapist. Psychiatric medications account for roughly 60-70% of all prescriptions written by those doctors. (C.J. Peek, at the Bridging the Divide conference, 11-16-09.) Roughly 10% of all Vermonters covered by the private managed care organizations are receiving care for mental health or substance abuse reasons. (2009 Insurer Mental Health and Substance Abuse Report card.)

In terms of the capabilities of the profession, we are developing a powerful theoretical, clinical, and scientific foundation. Integrating elements of neurobiology, cognitive science, trauma studies and attachment theory, and backed by rigorous research, the therapeutic relationship can now be "a developmental crucible within which the patient's relation to his own experience of internal and external reality can be fundamentally transformed." (Wallin, 2007, pg. 3.)

The realm of psychotherapy now includes help for chronic pain, weakened immune systems and inflammation. We can direct neural plasticity in creating healthier brains and minds. Our clinical knowledge about love enables us to heal marriages and families, and foster the type of relational security that enhances long term sobriety.

That psychotherapy works for depression, anxiety, and substance abuse is no longer in any doubt. Our outcomes are robust, and the profession continually moves towards greater refinement of technique and theory. In 2008 in Vermont, 90% or more of managed care members seeking mental health or substance abuse care report that the y were helped "a lot " (60-70%) or "somewhat" (20% plus )by the counseling they received. (2009 Insurer Mental Health and Substance Abuse Report card.)

We accomplish this using one primary tool, that being the person of the therapist within the therapeutic relationship. We use our knowledge and our experience, and more essentially, our ability to be fully available, empathic, and reflective, to help our clients create these therapeutic changes. When we are successful in guiding the relationship so that our clients feel safe, emotionally understood, and fully supported, then our clients are successful in healing their wounds, their anxieties and depressions, grieving their losses, and regaining the feeling of being present, powerful and valuable.

The second reality is that the therapist described above is soon to be, if not already, an endangered species. In 2001, when I entered private practice, a licensed mental health counselor seeing 5 clients having a range of insurances (BCBS, MVP, Medicaid, CBA, and Cigna) would have grossed $300.12. At the end of 2009, that same work would gross $302.11. So as a therapist who accepts most insurance, my costs are up 30% and my income is flat. Therapists practicing in the previous decade will note that this is a continuation of a trend starting with the advent of managed care in the early 1990's.

We are paid significantly less than similar professions. Our typical reimbursement is about $55.00 per 50 minute session. Occupational therapists make roughly $75 and physical therapists $80 to $90. Registered dieticians make $75 to $90. (Extracted from BISHCA Provider Reimbursement Report, Volume 2, 2008)
Mental health and substance abuse have a special carve-out within the Catamount Program, paying us significantly less and on a different scale (the scale of whatever MVP and BCBS want to pay) than every other provider and profession. Fletcher Allen Health Care also delegates mental health to Cigna Behavioral Health, with whom provider satisfaction is significantly worse than with the other managed care organizations, (2009 Vermont Health Care Satisfaction Survey) and who haven't increased provider reimbursements at all in the 9 years I have been in practice.

So, income is flat, expenses increase, parity is a joke in terms of fair reimbursements, and the physical therapist who exercises your shoulder is paid more than the professionals who treat your mind, your brain, and your relationships. The gap between what I have trained and know how to do, and what I actually am capable of with my 7th client of the day or 33rd of the week, is ever-widening. I am my best tool, and I am tired and angry and poor. I can't come close to affording for my family the insurances I accept, and those premiums have doubled since 2001 while my reimbursements from those same healthcare organizations are unchanged.

The very essence of the therapy is the mentalizing, mindful, and empathic therapist within the relationship, and the possibilities for healing go deep and wide. Access to these possibilities is seriously threatened, however, by the financial dead-end that the profession has become for so many of us.

Just to be clear, at our best we are not victims. I know that I can do other things to pay my bills. I am available for most of my clients most of the time, and like most of us, often very good.

I would like to see us be paid equitably and on par with equivalent professions. I would like to limit the number of client we have to see to the number we can reasonably attend to, and still be able to pay my middle class bills. I would like to see us be paid for our specialties and our advanced skills, so that the cost of the specialized education can be recouped. I want this group of licensed and dedicated professionals to be able to afford to stay in business and provide the life-transforming services that psychotherapy can provide.

What I think that we need to do, therefore, is to be ever moving towards the first and exciting reality, while working steadily and effectively to change the second. Here are some ideas:

  1. Attend one workshop every year from a nationally known "expert." Consider developing, through ongoing training, an advanced specialty. We need to be really good.
  2. Find one way to educate our clients about all that we can do. Many do not know. Make articles about the type of work you do, or what other therapists are doing, available in your waiting room.
  3. Reflect on what you accept for payment, from whom, and if any of it is objectionable, make your feelings known. Some therapists have left the "worst" insurance panel or panels, and some call their provider relations rep and ask for reimbursement increases. Take some action in line with your values and situation.
  4. Using information from this letter, VTMHCA website, your practice, and wherever, open a dialogue with your elected state legislators. Discuss access to quality care, parity, and how case loads can affect the type of collaboration that the Vermont Blueprint for Healthcare recommends.
  5. Get active in VTMHCA by paying dues, attending annual meetings, getting a colleague to join, visiting and using the website, etc. We are making a real difference, and you can be a part of that. When we create the change we want and need in this profession, you will be able to know that you helped.

VTMHCA welcomes your input, views and positions. Please submit any writings you would like to share with the mental health community to Heather Pierce.

VTMHCA needs your support. Join Now

VTMHCA is a state chapter of the American Mental Health Counselor's Association, which is a division of the American Counseling Association.

 

Council of Mental Health Counselors and Substance Abuse Professionals (the "Council")

The Council of Mental Health Professionals of Vermont is a group of representatives from each of the Mental Health Associations ...read more.

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CPH & Associates

CPH and Associates administers occurrence coverage malpractice insurance for Counselors, including Marriage & Family Therapists, Mental Health Counselors, Psychologists, Social Workers, LCSW, LPC, LCPC, School Counselors and many others.

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