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Private Practice Counseling FAQ's

Starting your own counseling practice?

Here is a list of common issues and questions regarding starting and managing your own counseling practice. Click on the topic/question below for more information.  If you would like to contribute a question please contact us.

Business support services for your counseling practice:

We have a “therapy village”, a community of referrals! All persons listed here are recommended by other counselors who have used them and recommend them to other counselors.

Finding resources & books when starting your private practice:

There are many sites on the internet aimed at helping counselors/therapists start their private practice. We suggest using this phrase "the business of counseling: Planning and establishing a private practice" in the Google search engine and you'll find many results. Also, visit the American Counseling Association Website.

Is private practice insurance needed?

Whether you are employed or self-employed in private practice, you need professional liability insurance.

Office share with other counselors:

Part-time office space can be an expensive starting point for a new practice but here you may find shared space that helps keep monthly costs down. Counseling Washington promotes office space listings that have full and part-time space available for rent. Counselors and Therapists or counseling-related entities are looking to sublet their space to professionals such as you.

What address should be used for your business address?

We recommend that if you rent part-time office space, do NOT use that address for your mailing address. When many counselors use the same suite of offices, the US Post Office often will not accept change of address notices. The counselors remaining in the space after you are gone are expected to forward mail to the departed counselors. But they don't know you or have your new address. The State of Washington, health insurance companies, and other essential business contacts may continue to send mail to your former part-time business address for years without you being aware of it until it gets you in trouble. If you are unwilling to use your home address as a business mailing address, get on the waiting list for a post office box.

Create a “Client Disclosure Information Form"

Before you start seeing clients you will need to prepare a Client Disclosure Information Form and have copies printed to give to the client and to put in the client file--after they have read and signed them.

Licensed Associate?  Looking for supervision?

As a self-employed registered counselor in private practice and working toward licensure, you need supervised hours and may need to pay a licensed health care provider for supervision. Counseling Washington has a list of qualified licensed supervisors to choose from. Some licensed counselors still chose to pay for supervision and professional consultation.

Planning to use a name other than your own full legal name?

Our recommendation is not to however, it is your choice. Go to this site to register your trade name.

For more information on starting a business, see Doing Business in Washington State.

You will find the following:

  1. Start a Business - Plan a business, steps for starting a business, find business registration requirements and more.
  2. Licenses, Permits and Inspections - license your business or yourself, check a business or license status.
  3. Licenses, Permits and Inspections - license your business or yourself, check a business or license status.

How can I get onto the insurance company panels of preferred providers for reimbursement?

You can go through CAQH, a Universal Credentialing Data Source. [The following is adapted from "Private Practice in Counseling" a column by Robert J. Walsh and Norman C. Dasenbrook in Counseling Today, a American Counseling Association monthly publication, in the June 2006 & August 2006 issues, and updated by this webmaster December 2007.]

The Council for Affordable Quality Healthcare, 1-(888) 599-1771, provides a way for licensed counselors to "submit their credentialing information to CAQH once, and it will then be made available to more than 100 insurance and managed care companies." [NOTE: To go through this process, you must already have your CAQH number, which is obtained by being approved as a provider by at least one of the participating insurance companies!]

Identification Number Is Needed: "A counselor who is already a provider for any of the insurance or managed care companies listed on the CAQH website can call CAQH and see if s/he already has a provider identification number. If so, CAQH will send that counselor a 'welcome packet' with information on how to apply...."

Or, With Your ID Number in Hand: "Go to the CAQH website and complete the credentialing process online. If you have trouble completing it online, call (888) 599-1771 and have the credentialing packet mailed to you. Once completed, fax the necessary information to CAQH at (888) 293-0414...use the fax cover sheet provided by CAQH instead of your own....Once processed, you should receive a fax or e-mail that your new status with CAQH has been provided to all participating insurance and managed health care companies."

If You Don't Have the ID Number, “Go through Aetna's Credentialing Customer Service Department at 1-(800) 353-1232 and ask to be referred to CAQH to receive an identification number. Aetna also has a "Behavioral Health Professionals Application Request" form that you can complete and submit online. Because Aetna is so willing to accept applications, there is a big processing backlog (think 6 months.)

Some other insurance providers are faster but have higher requirements, including requiring a particular number of years of experience beyond licensure. United Behavioral Health requires two years of post-licensure experience and CIGNA requires at least 3 years. Both are very fast to process applications to become a network provider.

What can an unlicensed person with a Master’s Degree in Counseling is allowed to do in the state of Washington.

Counseling opportunities for a graduate who hasn't completed the experience hours for full licensure:

  1. You could get a job as a counselor in a licensed mental health agency as an Agency Affiliated Counselor. (Not a recommended option.)
  2. You and apply to be a licensed associate counselor (3 categories) probably Licensed Mental Health Counselor (LMHCA).
  3. As a LMHCA you have the option to do private practice counseling under supervision (that you would pay for yourself), OR you could get a job as a LMHCA in a licensed mental health agency and the agency would provide supervision so you could get your hours for full licensure as a LMHC. (Best option, if you can find a job.)

Links to application forms and to more information is on the Washington State Counselor licensure requirements web page.

I should also alert you that the future for careers in counseling is not good at this time.

The ideal system for producing new, highly qualified counselors would be for graduates of Master's Degree in Counseling programs to be employed in mental health agencies, where they would be paid, get free supervision, exposure to a broad range of clients and client problems, and earn the experience hours needed for full licensure.

The updated counselor credentials law (2008) with its revised credentials has continued to produce a very unhealthy climate for graduates of master’s degree programs. Unfortunately, in the history of counseling in Washington State a former category of "Registered Counselor" made it possible for anyone, regardless of training or other qualifications, to do counseling for a fee in Washington. While officially abolished 7/1/10, many of the negative qualities have been preserved in the new credential, Agency Affiliated Counselor (AAC). Many of the old Registered Counselors were able to remain in employment positions in mental health agencies by applying for the new counselor category of Agency Affiliated Counselors. AACs, as they are called, lack the qualifications to become licensed counselors. They must only gain employment in a licensed mental health agency; they qualify for the Agency Affiliated Counselor credential. There are no safeguards for the public, other than that the AACs are supervised.

As of December 2010, there were 6,428 Agency Affiliated Counselors in jobs that I believe should be going to fully licensed counselors and licensed associate counselors. I would expect that the number of Agency Affiliated Counselors has increased substantially since then.

Most the current AACs are former Registered Counselors who were employed either by the state or by licensed mental health agencies, and lacked the qualifications to become a licensed associate counselor. The AAC category was a solution that kept them employed, rather than turning them out of their jobs. But just as with the old "registered counselor" category, there is no time limit on applications. That means as old Agency Affiliated Counselors retire, new Agency Affiliated Counselors with questionable qualifications are hired and made AACs to replace them. This makes it extremely difficult for Licensed Associate Counselors to find a job with a licensed mental health agency.

Unless all the counseling associations in the state (mental health counselors, clinical social workers and marriage and family therapist) unite in a common purpose to pass corrective legislation, this unhealthy condition will continue forever in the State of Washington. Legislation is needed immediately to prohibit the acceptance of any new Agency Affiliated Counselor applications by the Health Department. The old AACs can continue to work, but as they require they will be replaced by fully licensed counselors or licensed associate counselors. We must be agents of change to provide conditions to provide employment and supervision opportunities for the new licensed counselors of the future.

It is imperative that Washington State legislature take action to insure that the citizens of the state have the best counselors we can produce, and to help career counselors who have sacrificed so much in time and money to enhance their counseling skills and obtain their graduate degrees.
[Floyd Else, MA, Webmaster]

What are "indirect counseling experience hours" and where are they mentioned in the WAC?

The rules do not limit the services that can be counted as part of the total post-graduate supervision experience, nor do the rules discuss or define “indirect experience.”

In order to qualify for licensure as a mental health counselor, an applicant must have completed the following supervision requirements:

  • Minimum of 36 months of full-time counseling or three thousand (3000) hours of postgraduate mental health counseling under the supervision of an approved licensed mental health counselor or equally qualified licensed mental health practitioner in an approved setting.
  • At least of 100 hours must be in immediate supervision with an approved licensed mental health counselor or equally qualified licensed mental health practitioner.
  • At least 1200 hours must be direct counseling with individuals, couples, groups, or families.

"Mental health counseling" means the application of principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups, and organizations, for the purpose of treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes, but is not limited to, the assessment, diagnosis, and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health.

The post-graduate experience is intended to prepare you to practice as listed above, any experience that aids in that, may be counted towards the post-graduate supervised experience, so long as you are under the supervision of an approved supervisor.

Webmaster's interpretation: The answer to the original question is "No." The term "indirect hours" is an invention of the practitioners and supervisors and is not a part of any official regulation. However, it is a useful tool to describe those hours of counselor activities in support of direct counseling experience such as time preparing a client chart, writing in the client chart, telephone calls to and from the client, time preparing invoices or reports for the client. Your records should clearly indicate whether the counseling hours were to individuals, couples, groups, or families. Note: an hour of group counseling is one hour of direct counseling experience, not an hour credit for every person in the group, but you may have additional indirect hours for recording group attendance and participation notes in each participating client's chart.

Recommendations: Each time you meet with your supervisor (after every 20 hours of direct counseling) you should present a report listing the clients seen during the reporting period, the number of direct counseling hours and the number of "indirect counseling" hours relating to each client served. Sign and date your activity report. Give the supervisor one copy for his/her records and have the supervisor sign your copy to acknowledge receipt. This is recommended to create a duplicate copy of your supervised counseling experience hours as backup in case of fire, flood or other disaster that might destroy your supervisor's records.

Are there forms to fill out for the supervision hours and if yes, where can I get them?

Yes there are official supervision forms to track hours that the state will require you and the supervisor to record. It would be prudent to become familiar with what each person is responsible for by perusing our section on responsibilities during supervision for licensure.

Is there any peer support such as with case consultation?

Licensed counselors and registered counselors in private practice often meet together and go over client cases in a case consultation peer group where they get the benefit of clinical feedback from fellow therapists as well as a forum for discussion of common private practice problems. Case consultation peer groups provide opportunities to network and to get input from the experiences of other professional counselors.

What is the federal “Red Flags” Rule?

The Red Flags Rule is a federal law the FTC has begun to enforce starting August 1, 2009, requiring certain businesses and organizations, including many doctors’ offices, hospitals, and other health care providers -if they are “creditors”, to develop a written program to spot the warning signs or “red flags” of identity theft.

Note"Health care providers who require payment before or at the time of service are not creditors under the Red Flags Rule. In addition, if you accept only direct payment from Medicaid or similar programs where the patient has no responsibility for the fees, you are not a creditor. Simply accepting credit cards as a form of payment at the time of service does not make you a creditor under the Rule." See article above for more details.

 

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