Call to Action
Counseling for Counselors:
How do we help the helpers?
A request for funding to fill the monetary barrier to mental health services for self-employed licensed counselors
Executive Summary
Population: Self-employed licensed mental health professionals in need of counseling services for themselves.
Problem: Now, more than ever, mental health workers are susceptible to compassion fatigue and vicarious trauma which can lead to similar symptoms as those seen in traumatized clients. Unfortunately, as a result of barriers that exist in our country’s healthcare system, accessing much needed mental health services can be difficult and sometimes impossible from a financial perspective for this population.
Request: Funding to bridge the financial gap associated with unmet deductibles, the discrepancy between an in-network provider’s hourly rate and the amount an insurance company is willing to reimburse, and the discrepancy between an out-of-network provider’s hourly rate and the amount an insurance company is willing to reimburse. This funding would allow self-employed licensed mental health professionals in need of mental health treatment to access mental health services at no cost to them.
Background and Rationale
Most mental health professionals go into this line of work out of a desire to assist others in living full, healthy, and balanced lives. For us, it is both a gift and an honor to work in this profession. As counselors, we are privileged to provide psychotherapy to individuals, couples, and families who have experienced trauma as a result of sexual, physical and/or verbal abuse, witnessed horrific events such as those associated with war, mass shootings and acts of terrorism, and lost loved ones unexpectedly. We also treat clients who are currently struggling with mental health disorders and who are engaging in substance abuse, domestic violence, self-harm, or other means to cope with their distress. We educate clients about their symptoms, teach them how to regulate their nervous systems so that they can feel more in control of their bodies and selves, and help them process some of the most troubling times in their lives. A considerable amount of emotional energy is required if a counselor is going to do his/her job well. In order to do our jobs, we must connect with our clients on a deep and empathetic level. We have to “get into the yuck” and be right there with our clients as they safely make sense of their pain. This work is intense, emotional, and demanding.
When professional counselors are overtaxed by the nature of their work, they may begin to show symptoms that are very similar to traumatized clients. According to the American Counseling Association (ACA), compassion fatigue occurs as a result of empathizing with clients over time. It can be described as “the accumulation of stress that comes from working as a mental health counselor coupled with burnout.” Charles Figley, founding editor of the Journal of Traumatic Stress, describes compassion fatigue as the “cost of caring” for others in emotional pain. The ACA describes vicarious trauma as “the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.” Compassion fatigue and vicarious trauma can adversely impact a counselors’ physical and emotional health as well as cause strain on their relationships with their family and friends. Additionally, compassion fatigue and vicarious trauma can lead to secondary depression and secondary traumatic stress disorder.
The body of literature that has explored the negative impact of providing mental health treatment on counselors provides suggestions for preventing and managing vicarious trauma and compassion fatigue. These suggestions include pursuing a hobby, spending time with loved ones, taking time off of work, engaging in interests and activities outside of the work environment, and recruiting the support of significant others. However, the current emotional climate of the nation, as well as the economic realities of our nation’s response to the COVID-19 pandemic, renders these suggestions largely inappropriate and ineffective in mitigating the impact of compassion fatigue or vicarious trauma for many mental health counselors.
Self-employed licensed mental health workers are already vulnerable and susceptible to compassion fatigue and vicarious trauma, and the incidence and prevalence of these phenomena are intensified by the reality that we are all experiencing collective trauma at this time. Presently, many of us are experiencing heightened distress because in addition to being worried about the safety and well-being of our clients, we are also worried about our own families and loved ones. Simultaneously, we are torn by our responsibility to adhere to our ethical guidelines, one of which is to contribute to society by devoting a portion of our professional activities for little or no financial return (pro bono publico). Anecdotal data indicates that many self-employed licensed mental health professionals who have had their income substantially reduced are, nonetheless, working longer hours, for free, in accordance with our ethical principles, as we attempt to meet the needs of individuals, couples, and families in crisis.
Counselors are not immune to trauma and now, more than ever, licensed mental health professionals must have access to mental health services in order to effectively treat the populations we serve and to continue to play an instrumental part in contributing to the well-being of society at large. The assumption might be made that counselors do not need counseling, or that counselors have easy access to mental health counseling services. However, there are two main barriers that exist in our country's current healthcare system that prevent many self-employed licensed mental health counselors from getting the mental health services needed in order to prevent or manage compassion fatigue or vicarious trauma. These are (1) the limited number of network service providers and (2) the financial impediments for both in-network and out-of-network providers.
Limited network providers
A provider network is a directory of healthcare providers who are contracted by an insurance company, and provide healthcare services at a reduced rate to those enrolled in plans offered by that insurance company. If there is a discrepancy between what an insurance company has contracted to pay an in-network provider and that provider’s actual rate, it is the clients’ financial responsibility to partially, or often entirely, bridge that financial gap. On the other hand, when a healthcare provider is not contracted with an insurance company, the provider is considered an out-of-network provider. If a client sees a provider who is out-of-network, the client is entirely financially responsible for the providers’ full rate, but the client may be eligible for partial reimbursement once a predetermined deductible is met.
This is a significant barrier as there are relatively few clinicians who specialize in the treatment of other clinicians afflicted by compassion fatigue or vicarious trauma. In addition, many of the clinicians who do have the expertise needed to provide mental health services to other clinicians do not take insurance. Reasons for this include low reimbursement rates, concerns about client confidentiality, and not having enough unbillable hours in the day to complete the amount of paperwork that is required for insurance billing (unless we choose to contract with a billing service, which is, itself, another expense).
Financial impediments
In the event that a self-employed licensed counselor is able to find an in-network provider, the issue then becomes how much the counselors’ insurance company is willing to pay towards the hourly rate for that provider. The hourly rate for licensed mental health providers in private practice ranges from $100 to 300 per hour, depending on geographic region and degree, with specialists and doctoral level providers being on the higher end of that range. Using myself as an example (assuming there is an in-network provider with the expertise required to treat a clinician with a decade of experience treating trauma survivors), my insurance company will only pay $65 per session.
The barrier of financial impediments is exacerbated when self-employed mental health counselors consider an out-of-network provider due to the obstacle of meeting a deductible (in my case, $7,000) before being able to receive partial reimbursement (in my case, 50% of the hourly rate). We also must face the reality of being financially responsible for the provider’s full hourly rate.
Historically, there have been meaningful efforts to fund mental health programs, but these efforts were to benefit clients - not the mental health workers who are treating these clients. As mental health workers, we are advocates for clients getting the proper care they need, but what about help for the helpers? The barriers in our country's healthcare system outlined here prevent many self-employed licensed mental health workers from accessing the mental health services needed to treat compassion fatigue and vicarious trauma. Unfortunately, these conditions could prevent many self-employed licensed mental health workers from providing the highest standard of care to clients. At best, this is irresponsible and, at worst, dangerous.
The COVID-19 pandemic has illuminated deficiencies in a broad range of contexts and professions and the need for affordable mental healthcare for practitioners is one of them. The objective of this call to action is to raise awareness of the emotional and psychological impact on mental health providers during a time of collective trauma and to generate funding to bridge the financial gap between deductibles and/or partial reimbursement limitations, allowing self-employed licensed professional counselors to easily and immediately access therapeutic services with no out-of-pocket expense.