Clinical Alternatives
With a strong need for competent mental health practitioners in most US communities, there are now other models of clinical psychology authorization. Some states acknowledge Licensed Mental Health Service providers (LMH), while Licensed Professional Clinical Counseling (LPCC) is gaining considerable credibility in many states. Both of these licenses require at least a Masters Degree in Psychology with a clinical focus. One other alternative to traditional master’s and doctoral-level credentialing is now found among those seeking a sub-professional license as a Psychological Associate (PA). Much like the MFTs, these who are PAs have obtained a Masters Degree in a clinically related field of psychology and passed a licensing exam (after a rather lengthy internship). PAs do clinical assessments and conduct psychotherapy sessions. Like the MFTs they find very few restrictions (other than lower credibility accompanied by lower fees).
Those with degrees in art therapy (Bachelors or Masters), vocational therapy (Bachelors or Masters), or recreational therapy (Bachelors) are welcome in medical settings, as are those with an advanced (Masters or Doctorate) degree in Rehabilitation Counselling. Mental health facilities that treat drug abuse patients will seek out Licensed Clinical Alcohol and Drug Abuse Counselors (typically with a Masters Degree). It should be noted that some mental health jobs are available for those with an AA or BA degree in a mental health-related field. They can work as Psychological Associates (PA) (after completing a PA licensing program) or as aides on the wards of residential mental hospitals.
Pastoral Counsellors
Then there is the matter of human service professionals—called pastoral counsellors–who are working in religious institutions. Like those working in educational institutions, these professionals are often grudgingly accepted by their counterparts with “regular” work in secular institutions. These pastoral counsellors who have obtained a pastoral counselling degree (usually at the Masters or Doctoral level) are reluctantly accepted in large part because they provide a significant amount of the psychotherapy in the United States. Pastoral counsellors are chosen by their clients because of the alignment of their own religious beliefs with those of their pastor. It is also a matter of cost. Pastoral services are typically offered at no charge or a very low fee is charged to members of the counsellor’s congregation. Therapy costs are low or even non-existent because the Pastor receives a regular salary derived from parishioner donations. It is disturbing to note that a significant amount of pastoral counselling is being done by pastors who have received no training in the use of psychotherapeutic services, nor education regarding forms of psychotherapy.
I have consulted with a major religious organization in the United States to address this specific issue. In this particular church, a large amount of time is devoted by pasters in small congregations to these pastoral services. Part of the challenge concerns not just preparation in the provision of clinical services but also dual relationships (discouraged or forbidden in many mental health fields). One of the pastors whom I interviewed noted that he was working as a pastoral counsellor with one parishioner who had anger management issues. This volatile gentleman also served on his parish board and often erupted during board meetings. Quite a dilemma!
