In Maryland, counselors are not required to have a license or certification QUESTIONABLE PRACTICES

July 03, 1994|By Mary Corey | Mary Corey,American Psychological Association, Maryland Board of Physician Quality Assurance and mental health professionals. Guide to those who help and to those who regulate Sun Staff Writer

It took Judy Applefeld some 20 years to face her problem: She trusted no one. Ironically, the therapist she wound up seeing proved the person she could trust least of all.

After a productive 15 months of therapy, she watched her counselor's demeanor change dramatically. The therapist began hurling insults at Ms. Applefeld, grew sarcastic and even once ridiculed another client in a session.

Incredulous, Ms. Applefeld consulted other counselors who told her this behavior was clearly out of line.

In retrospect, it also seemed odd that the therapist didn't have a degree posted and that Ms. Applefeld's treatment was not covered by insurance.

She called the state Board of Professional Counselors to complain. It turned out she had no recourse: The therapist wasn't certified.

They call themselves counselors. In Maryland, anyone can adopt that title. And a slew of people, from psychics to clergy to job recruiters, has done just that. Unlike 24 other states, Maryland doesn't require licensing or certification for counselors.

A license, conferred by the state, controls a person's ability to practice. Psychiatrists, psychologists, social workers and nurses must be licensed in Maryland. Certification, which can be obtained through the state or professional organizations, merely gives someone the right to use a certain title, such as "certified professional counselor."

Currently, counselor certification -- which requires at least a master's degree in a professional counseling field, three years of experience and passing a national exam -- is voluntary here.

Unlike lawyers or doctors, who are required by law to pass exams of their governing bodies before they can practice, counselors are not compelled to prove any expertise before setting up shop.

"I wish someone would explain to me why people who work on your house have to be licensed when people who work on your head and spirit and soul don't?" asks Ms. Applefeld, 40, an interior house painter who lives in Waverly.

Although there are 1,300 "certified professional counselors" in the state, Aileen Taylor, administrator of the Maryland Board of Professional Counselors, believes it's impossible to determine how many people are in the counseling field.

"We have so many unqualified people," says Ms. Taylor. "They all are counseling and most of them have no education at all."

What complicates matters even more is the crowded mental health field. Time was, if you needed help, you visited a psychologist, psychiatrist or clergyman. But as therapy has lost its stigma and the pop psychology movement has flourished, more people are seeking guidance and more professionals -- from certified nurse psychotherapists to licensed social work associates -- are offering to listen.

The upshot for patients is that at a time when they're feeling most vulnerable, they must be sleuths to research a professional's credentials and watchdogs of their own emotional and financial fate.

There are some safeguards. Psychiatrists, psychologists, social workers and nurses are regulated by separate state boards. But while there are many competent and caring professionals in the field, an advanced degree and license are no guarantee of expert treatment.

Complaints are lodged against licensed therapists to various boards every year. While the numbers are small, they indicate consumers' growing reluctance to accept what they consider substandard care.

In the last two years, the state board for psychologists has received more than 75 complaints about the 3,000 licensed psychologists in Maryland.

And so far this year, six psychiatrists -- of the more than 1,000 in the state -- have received sanctions, ranging from a written reprimand to the revocation of a license. By comparison, only one psychiatrist was disciplined in 1988.

"In general, people trust professionals less than they used to," says Michael Plaut, an associate professor at the University of Maryland School of Medicine, who chairs a state task force to study sexual exploitation by therapists. "We're a more consumer-oriented society."

But J. Michael Compton, executive director of the state Board of Physician Quality Assurance, which regulates psychiatrists, says, "The problem with psychiatrists is that where you'd chew out your auto mechanic, you won't do that to your doctor. For years, physicians in general were looked upon as gods. . . . Now people understand they're human beings and have problems like anybody else. They're not superhuman."

In an effort to deal with increased complaints and consumer skepticism, many boards have streamlined their complaint forms and added members to deal quickly with abuses, which most often involve sexual misconduct, unprofessional behavior and fraud.

While complaints to the state psychology board used to take as long as three years to be settled, chairman Sherod Williams says they are now completed within 12 to 15 months.

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