ACA Blog

Robbin Miller
Jul 06, 2011

To Serve vs What’s In It for Me?

Dr. Wayne Dyer, notable Psychologist and author of many best seller books, talks about this notion in several of his writings on finding inner wisdom and peace as a human being. When I think of these two terms and how they apply to our profession, I believe they may be two opposing forces facing us as counselors.
I went into the profession in 1989 to serve my clients and to make a difference in their lives. I was always interested as a young child on “what makes people tick” as I read many books on Psychology during my teenage years.

Over the years, I have grown quite curious on why some counselors are entering the field. Are they in it for the money or to serve others or both? Before managed care came about, it was agreed among my colleagues that you can make a decent living as a salaried clinician where productivity was not an issue. However, in the last ten years, the wheels have turned against the profession in serving our clients.

Currently, many clinicians hired throughout the country are either salaried or fee for service with stringent productivity requirements. Like in Massachusetts, if a clinician does not make productivity, he/she will be demoted to a fee for service clinician with or without benefits depending on your employer. Unfortunately, what I am observing and hearing in my neck of the woods, many clinicians are now in the profession under the notion, “What’s In It for Me?” as a result of the current climate mentioned above. The term “How May I Serve?” is no longer a true reality for many clinicians who are entering the field or are seasoned professionals. As a result, many clinicians across the US are in “survival mode” of making a decent living.

What do I mean by “survival mode?” Simply put, some clinicians are doing the following:
1)Double-booking appointments with their clients.
2)Illegal billing such as billing for a whole hour when they see two clients in ½ intervals to make productivity requirements.
3)Doubling their caseloads to earn $ 500.00 bonuses.
4)Illegal billing when they talk to clients over the telephone that are not private pay and are not billable to commercial health insurances and to Medicaid.
5)Illegal billing when the clinicians don’t show up for their client appointments.

What can we do to change the paradigm to “What’s In It for Me?” to “How May I Serve?”
1)Lobbying your legislators to change the way mental health counselors are reimbursed for their time. In Massachusetts, there are champions in the field talking about these issues, but nothing is being done by the two associations (NASW and the Massachusetts Mental Health Counselor Association) to make positive changes.
2)Be creative in finding ways to make a decent living without being unethical in your work with your clients.
3)Write for your local online newspapers like I do to promote the cause.
4)Volunteer on local committees.

My last suggestion is that mental health counselors are still being denied salaried jobs in the healthcare professions where productivity is not so rigid. For example, new counseling jobs for social workers are opening up in Elder Care for Care Managers and Directors that are not advertised for mental health counselors. This is due to Medicare being the major payor of mental health services for social workers only. Also, many school jobs for Adjustment and Guidance Counselors are being taken up by social workers and are not evenly distributed by mental health counselors.

What the profession needs to do is to stop being the “Beta” to the Social Work profession who is the “Alpha” for mental health services. The above ideas can be helpful to you in finding the right job for you if you network with the right people. However, these opportunities are not open to all of us across the country.

I challenge ACA and MHCA (Mental Health Counselor Association) to brainstorm creative ways to become equal “alphas” to the social work profession. Now is the time to do it since many states such as Massachusetts are experiencing severe shortages of qualified mental health clinicians to service the mental health needs of children and families.

I welcome your feedback.



Robbin Miller is a counselor who specializes in mindfulness meditation; Positive Psychology; and Cognitive-Behavioral Therapies; and is also a volunteer cable access producer and co-host of her show, "Miller Chat" in Massachusetts.

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