Contemporary Issues in Private Practice: Spotlight on the Self-Employed Mental Health Counselor

By Harrington, Judith A. | Journal of Mental Health Counseling, July 2013 | Go to article overview

Contemporary Issues in Private Practice: Spotlight on the Self-Employed Mental Health Counselor


Harrington, Judith A., Journal of Mental Health Counseling


Mental health counselors (MHCs) are employed in a variety of professional settings, among them community agencies, schools, colleges and universities, hospitals, clinics, treatment centers, government, military, employee assistance programs, insurance or managed care companies, and private practice. Arguably, private practice is the setting where the potential for career gratification and self-direction is most counterbalanced by vocational and financial vulnerability. This article introduces the Special Issue of the Journal of Mental Health Counseling (JMHC), Contemporary Issues in Private Practice, and highlights the paucity of scholarly literature dealing with private practice; recalls the historic challenges between the research and clinical communities related to field-based research and collaboration and accurately quantifying the actual number of private practitioners; and reflects on the recent past and future of private practice counseling.

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Welcome to this special edition of the Journal of Mental Health Counseling (JMHC), Contemporary Issues in Private Practice. As a long-term mental health counselor (MHC) in private practice, I have taken great pleasure in collaborating with the JMHC and its editor, Quinn Pearson. Pearson conceived and promoted the idea for this special issue not only as a contribution to the literature but also as a service to the nearly 7,000 members of the American Mental Health Counselors Association (AMHCA), the majority of whom identify as private practitioners (W. M. Hamilton, personal communication, February 20, 2013).

The selection of private practice as a journal focus seems to be unique. A review of the last 10 years of journals of other associations, including the bundle of American Psychological Association (APA) journals, Social Work from the National Association of Social Workers (NASW), and The Journal of Marital & Family Therapy from the American Association of Marriage and Family Therapy (AAMFT) revealed that none had devoted an entire issue to the topic of private practice, and very few single articles were about private practice. Only a single article among all the APA journals was devoted to private practice, though there were many special issues on other topics; though there were articles devoted to executive coaching, consultation, and psychotherapy, they did not specify a private practice setting (APA, 2013b). In a review of the past 10 years of Social Work tables of contents, only one article was devoted exclusively to the issues of private practice social workers (i.e., Green, Baskind, Mustian, Reed, & Taylor, 2007). While AAMFT's Journal of Marital & Family Therapy published many articles for and about "therapists," presumably applying to couples and family therapists in a variety of settings (treatment centers, hospitals, faith-based organizations, military settings, and private practice, yet not exclusively for private practitioners) only one article (i.e., Crane & Payne, 2009) could be found directly related to private practice, in this case managed care utilization. It is possible that a more comprehensive study that encompassed a variety of other journals would only reinforce the assertion that there have been very few studies related to private counseling practice.

CRITICAL THINKERS AND CLINICAL THINKERS

In conversations with Pearson, the editor acknowledged the dichotomy between the context of researchers, academicians, and educators and that of clinicians and practitioners. Historically, researchers and clinicians have struggled to work collaboratively, to merge the best of their resources. The resources of researchers include labs, personnel, incentives, revenue streams, and expertise in advanced research design. The resources of clinicians include abundant access to study participants and field-trial data and ample clinical expertise. Clinician resources, however, do not synchronize with researcher assets in that productivity in clinical settings is incentivized by hourly units of services provided, behavioral improvements in caseload, symptom reduction, revenue earned per session, capitated services (incentives for less lengthy treatment), and client satisfaction. …

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