By Jenny Westberg, Portland Mental Health Examiner, Dec. 19, 2013

Mari Simms (not her real name) is a Portland therapist with impressive qualifications. She has a doctorate in clinical psychology, and a master’s degree from an authorized program in Oregon where she is now on the faculty. In practice for almost 30 years, her work has also included supervision and training of students. She is part of an international body of practitioners who provide counseling, teach seminars and workshops, and work with organizations and businesses in the fields of conflict resolution and leadership.

Yet despite credentials, degrees, and three decades of professional experience, Simms does not have an Oregon license. Under the Oregon laws governing Licensed Professional Counselors and Licensed Marriage and Family Therapists, she would have to do hundreds more hours of supervision, study for an exam, and likely take more coursework in order to be licensed. She may continue to practice, however, provided she does not say or imply she is a Licensed Professional Counselor.

Becky Eklund, the executive director of the Oregon Board of Licensed Professional Counselors & Therapists, explains, “There is a phrase in the law that says if someone does not meet the education requirements for licensure, then they can practice without a license. The board has supported legislation in the past that would eliminate that education exemption from the law. To date, the proposed legislative changes have not been approved.”

For Simms, having spent 10 years in school and achieving two advanced degrees, the requirements for licensure put her in a difficult spot. To be licensed, she would have to redo a lot of the work she had already completed.

After a decade of academic work, Simms says, “It would have been a step back for me and a financial investment” – a big one.

Upsides, Downsides

There are drawbacks to not having a license, however. In most cases Simms cannot bill insurance. Some people may erroneously assume she is less skilled than a counselor who’s licensed – an assumption that’s even held by people who should really know better. For instance, an article by Mentor Research, posted on OregonCounseling.org, states flatly: “Unlicensed and unsupervised counselors or therapists are usually incompetent and may do more harm than good – or no good at all.”

There are also drawbacks to requiring everyone to be licensed.

Raina Peters (not her real name) completed a rigorous program of study, but her school is not accredited by a board-approved regional or national accrediting body. She is allowed to practice under the exception Eklund would like to shut down.

Peters would like to preserve the flexibility in the law “to allow new techniques to be offered to the public.”

She adds, “I really see the benefits of licensing and see how it is essential to regulate and protect clients, but I also see the disadvantages in the way it ‘locks out’ alternative and emerging modalities which might be overtly interested in creating an alternative to mainstream restrictions – like for example using touch in a therapeutic context. “

Unfortunately, the same exemption that denies a license to some eminently qualified professionals allows others to set up practice, regardless of how dubious their qualifications might be.

Licensing affords clients and potential clients some certainty. Every licensed counselor holds a graduate degree from a board-recognized school, has passed an exam, and has done supervised training. They must give each client a professional disclosure statement that explains their approach, credentials and client rights. In addition, licensed counselors are bound to a code of ethics spelled out in the Oregon Administrative Rules, and can be disciplined by the board if they fail to conduct themselves accordingly.

“Most people assume that professional counselors and marriage and family therapists must be licensed,” Eklund says. But with the law as it stands now, “It is up to clients to find that information.”

“Nowhere to Go”

Eklund continues, “Some unlicensed counselors and therapists belong to national associations, and those associations respond to complaints about their members. However, other unlicensed counselors and therapists are not accountable to any agency or organization.”

The board only regulates licensed providers, and has no power to discipline those without a license. Unless an unlicensed practitioner has another affiliation that provides accountability, there is nowhere for consumers to complain, and no consequences for providers who cause harm, breach confidentiality, or take advantage of their clients.

Eklund says, “That leaves clients with nowhere to go.”

Simms counters the idea that a licensed counselor is an ethical one. “I do not think a license prevents unethical behavior and I don’t think there’s a study that can prove it.”

She also has a different take on the consumer protection issue. “The free market empowers consumers,” she says. “People connect with practitioners they want to see due to word of mouth or good work. The consumer has all the power here, as we should.”

And she says she was appalled to find that, out of all the requirements to be licensed, there is no requirement for an applicant to have done any therapy themselves.

How to Choose

As for the exam licensees must take, Simms says most people she knows who have taken it “find that the information is memorized for the exam and then forgotten. It is not useful.”

So, where does all this leave you if you’re looking for a counselor or therapist?

You may or may not want to limit your search to licensed counselors. The licensing board offers a list of questions to ask, which, obviously, favor licensees. There’s another helpful article, including positives and negatives to look for, at Metanoia.org.

All told, the most important factor is probably not a license, but your relationship with the therapist: empathy, rapport and the ability to build a working alliance. Find someone you’re comfortable with – and that’s something only you can decide.