Kristi Cash White: Hey, everyone. Welcome back to the podcast, Are Your Notes Finished Yet? Conversations For Today's Mental Health Professionals. I'm Kristi Cash White. Today I'm happy to introduce to you Dr. Victoria Kress. Dr. Kress is the director of the Clinical, Mental Health, and Addictions counseling programs at Youngstown State University.
She served as a governor appointed member of the Ohio Counselor, Social Worker, Marriage and Family Therapist Board. She has been the recipient of numerous awards during her career, most of which are related to her leadership, advocacy and mentorship initiatives. She received the CACREP award for excellence in advocacy, the Ohio counseling association awards for counselor of the year. She is past president of Chi Sigma Iota International, and the Ohio Counseling Association. She has published over 120 peer-reviewed journal articles and book chapters, and has co-authored five books on counseling, both adults and children.
Thank you so much for joining me today. It's so nice to meet you. And to have this time together, just to talk for a few minutes.
Dr. Victoria Kress: Well thank you much for having me. I love talking about our wonderful profession and I'm excited to be here.
Kristi: So you have substantial involvement in advocacy in the counseling field. Having served as a board member for the Journal of Counselor Leadership and Advocacy and the director of advocacy for the NBCC. So let's just start with talking about what professional advocacy entails for counseling and why that's important.
Dr. Kress: I think professional advocacy is essential to the health of our profession. If we're not taking of our health, who is? I can assure you, I've been around and other professionals, aren't thinking about our best interests as a profession. So it's essential that we do that where we're very much the new kids on the block in terms of helping professionals.
We have not been around as long, not nearly as long as other helping professions. And we're struggling to find our footing in the professional arena to be taken as seriously as other professionals and to enjoy the rights and privileges that other professionals face and it truly is a battle. It truly is a battle that that those of us who are in the trenches and doing the work around this can tell you is so important.
There's so much work to be done. So to me, you advocacy is really about, arguing and pleading for a cause or a proposal. And I know you want to speak specifically about the topic of professional advocacy, but I find that as counselors, we're really good at advocacy with our clients and different populations and groups, and we need to apply that same passion that we have for our clients and different social justice topics to our profession.
We cannot advocate for our clients if we are not strong and healthy and taken seriously particularly in the legislative arena.
Because we cannot advocate for our clients if we are not strong and healthy and taken seriously particularly in the legislative arena. And I can tell you that we're not; I can speak to many experiences I've had, that highlight there's ongoing threats. That's a little bit about what advocacy is and why I think professional advocacy is so important.
Tensions with other helping professions
Kristi: You mentioned that it's not taken as seriously as some of the other helping professions. I have a peer who's in New York who has talked about these really big rivalries that have been established between counselors and social workers, or psychologists and social workers or counselors. I haven't experienced that so much in my own work here in Oregon, but I know there's a lot of distinctions that happen in the field the different groups.
What are the factors that lead to counseling having this "backseat" in the professional world is seen as not being taken as seriously.
Dr. Kress: I think you bring up a really important point, which is there are in many arenas there is a contentiousness across helping professions. One of the things that I talk about is that it's important that we work together within our own profession on advocacy issues. And where can, it's also important that we across the aisle and we work collaboratively with other helping professionals. Sadly though, that does not always happen and we see instances the board in state, after state and arena, after arena, where that is not the case where there's there's a perception, I think of counselors, being a threat to resources other helping professionals enjoy. I think there's a perception that our training and qualifications don't put us on par with other professionals. This access to resources and negative perceptions of counselors in our training, can create quite few problems.
As an example, a few years ago, here in Ohio, the psychologists were looking at limiting counselor's ability to provide autism treatment. There's a great deal of money in autism treatment and intervention in Ohio. And they were simply trying to limit our ability to work with that population so they could have access to those resources. And this is something we see across the board. We certainly saw this last year in Michigan, where the psychologists led the charge to limit counselor's ability to diagnose and treat. It's quite involved and we don't have time to get into it now, but I have documentation of evidence, cold, hard facts that shows psychologists and psychiatrists were speaking against counselors and our ability to diagnose and treat. There's one quote where the psychiatric profession says something along the lines of, "counselors aren't trained to deal with life and death mental health situations, such as clients suicide", which just makes me laugh because I write books on this.
We all know this is not true. There are these threats that we face across different states from other professionals and it really impacts us. I was on Capitol Hill doing some lobbying work for one of my state senators. And I was talking with her about Medicare and counselors training and access to care, and as short as a provider as, and I thought making a really beautiful case as to why counselors should be provided with the opportunity to be reimbursed by Medicare and help people who need help. And she looks at me and she said, "if you asked me the problem, isn't the counselors should be reimbursed by Medicare. The problem is that we should train more social workers to provide these services." Yeah, I bet I was meeting with another legislator kind of Capitol hill talking about Medicare reimbursement.
It was a, this was a staffer. she said, " I know about counselors and who you are because I'm a psychologist. And what I know is that you all are trained in kind of school counseling and warm, fuzzy counseling techniques, but you're not actually trained in how to diagnose and treat. And I don't think you should be receiving Medicare reimbursement."
Kristi: there's really a disconnect there with reality.
Counseling has substantial training & standards
Dr. Kress: This is just a couple of years ago. this is what we face, legislators don't understand who we are, what we do, what our training involves. Here in Ohio, we have to take 20 hours of treatment and diagnosis courses. So we have significantly more than PhD level psychologists or social workers have.
And I don't like to get into comparing us to other mental health professionals. That's actually a really bad habit. You shouldn't do that with legislators in particular, but what does matter is what our training is. And our training is very well-defined. You know, We have CACREP as our accrediting body.
They have standards that they've laid out. These standards have been introduced by our profession and they're regularly vetted by our profession. These form the foundation of what most of our counselor licensure laws. And they provide a really good path and good guidance for how we should be training counselors and and what we need to learn to become licensed as counselors.
it includes things like diagnosis and treatment. And these are the things that are licensure laws and the things that are required for third party reimbursement. So we have ample solid foundation for doing this work, but we need the public to understand that, we need stakeholders to understand that, we need other professionals to understand that, we need particularly need legislators to understand that.
How a lack of national standards hurts counselors and clients
Kristi: Absolutely. Yeah. There's, is a lack of clarity in the counseling field. It's hard enough, I think for consumers and maybe legislators and others, to understand the difference between counselors, psychologists, psychiatrists, social workers, all of that.
But then when you get into the counseling field, there's all the different state licensing, basically the initials after our names, you've got LPC, LMHC, LCBC. But with so many variations, even then for pre-licensed professionals. So licensing title is just an example of the absence of national standards for mental health or for counseling.
How do you think having a lack of national standards impacts the counseling field? And do you think that is a good route to have - some kind standardization of how we title ourselves as counselors.
Dr. Kress: Oh, yes, absolutely. With the 2020 initiative that counseling had, we definitely moved closer to this. This is something that I've been preaching for so many years, is: the answer to our profession's health — and the way I think we should move forward — is with unified standards. Obviously each state has their own licensure laws, so each state has their own jurisdiction and they have their own laws that they set. But as much as we can move towards unified standards, I think this is particularly important. you know, our profession really struggles with identity issues. And when I talk with people in our profession, there, there are people like me who talk about professional identity. And we think this is really important. And you have got organizations in the profession like Chi Sigma Iota, for example who has, at its foundation, a belief in a strong professional identity, grounded and well established standards within the profession.
So we have the people like this, but then we have people who say "well, I'm all about being inclusive". And I think what happens is they mix up inclusivity around social justice issues with inclusivity within our profession. I would argue that our want and desire to be inclusive to other professionals within our own profession has really harmed us.
And it's part of what makes it so confusing, like you said, to identify who we are. I would say this, what is a profession? We really have to boil it down to this question. What is a profession? A profession is a group of individuals and it's discipline who adhere to ethical standards, who hold themselves out, they're accepted by the public as having a special knowledge or skills, right? That's derived from research, education, training. A profession also has a unique history and context. We have these things as a profession, these boundaries that we put around who we are as professionals.
And then you think about the definition of identity and identity is the fact of being who or what a person or a thing is, The fact of being who or what a person or a thing is. So you can't have a profession without a professional identity, right? Any profession you talk to, any professional you talk to they necessarily have to define themselves with some type of boundaries or limits.
So to me, it's essential that as a profession, we define who we are.
Dr. Kress: and who we aren't, because if we don't do those things, other professionals — with their own interests — will define us for us. And that's not what we want. I really think that this inability to clearly define who we are and who we aren't has been real wrestle for our profession and something, I think that's really harmful to us.
It's very confusing to outsiders. We need to grapple with this.
If we can't define who we are as a profession, how can we expect other people to know who we are and to support us?
Obstacles to a shared professional identity
Kristi: What's the roadblock there? Is it that we can't agree on a definition for identity? Or is it that we're just not having a conversation enough? What is keeping us from being able to have a shared understanding of what our professional identity is.
Dr. Kress: That's such a good question. I think it's really complicated. I think there's not enough spaces for us to come together to have really hard conversations. I think that's something that all of our professional organizations and associations need to wrestle with, and it's not easy. These are not necessarily easy conversations.
People at the table have their own personal histories and contexts. That's part of the conversation. I think that's okay. But what we need to do, I think is come together more and have some of these hard conversations. And then have transparency around where we're at with these conversations, because my experience that's not always the case.
I think part of why it's difficult is because early in our profession we weren't as clear about what a counselor is and who a counselor is, and what our educational standards were. Things were much more open, but over the years we have grown, we've come very far over the last few decades in terms of, all of our states have licensure laws.
It's complicated. And I would be remiss if I sat here and act like it was a really easy thing to do, but I think we've come far enough now that we can, we should think about moving forward. And I don't think it helps us to dilute our professional identity. We should be moving forward with defining it and setting boundaries around it.
Kristi: Absolutely. That was a great reminder that we're still a young profession right? I got my master's degree in 1999. I didn't have to have a license here at Oregon. It was, I think 2014 or something like that before that became a law here. And so that hasn't been that long.
This is still fairly new but it feels hard not to be impatient sometimes as we see things going by us and, like you said, not getting the benefits and the help that could happen by having this identity.
Dr. Kress: Oh, yes. And there's no other profession that welcomes counselors. If I wanted to become a social worker or a psychologist, I'm as a counselor, not able to do that. It feels confusing to me, you know, I think in the spirit of inclusivity, we forget that every profession necessarily has limits and boundaries around it.
It's something that we need to continue to wrestle with. My passion is really legislative advocacy and advocating for our profession, because I think the law is everything. I know it's everything. And we can't do that effectively if we're not clear about who we are.
Kristi: And we have to be okay with those boundaries. Right. It's okay that social workers have their boundaries where they are. That were different that were doing different work. It overlaps in a lot of ways,
Dr. Kress: Oh, absolutely.
Kristi: But, being okay with that and then a healthy communicative relationship with these other professions. It feels like there's a little bit of perhaps fear that we'll continue to be in conflict. And so instead of engaging were sitting passively by as a profession I think that's really important.
Dr. Kress: I think an effective legislative advocate really looks to collaborate with others when they can. Here in Ohio, I was doing some Medicare advocacy work, getting co-sponsors and I reached out to the family therapists — they're also not able to be reimbursed by Medicare — and I said, " we're, taking this initiative, why don't you get on board with us, let's reach out to these legislators together because we're more impactful and powerful together". I think there's opportunities where we can try to work together as much as we can.
And sadly, that's just, that's not always the case. But where we can, I think it's important.
Licensing portability and telehealth
Kristi: Yeah, absolutely. So, in the last couple of years, this is a little shift in topic, but the last couple of years, as we went online for a lot of our profession went to having to do tele-health. Licensing portability became a topic that was even more pressing than ever as we have clients that may be going out of state to stay for a while or that kind of thing.
On March 8th, I believe it was Alabama joined Maryland and Georgia and signing the interstate counseling compact, which needs ten states for implementation.
What are your thoughts around licensing portability? Do you feel like that is one of these conversations that we need to move forward for our profession?
Dr. Kress: Oh, absolutely. I think we all agree that licensure portability is essential to the health of our profession there's access to care issues. There's a shortage of counselors nationally. And so portability is a wonderful, important way to support the profession but also provide access to care and services.
And as you mentioned, I think the pandemic's been a real game changer in terms of highlighting how valuable telehealth can be and how important it is. So I think it's really exciting that things are moving forward. I predict it's going to move forward very rapidly. I don't care if you're a Democrat or a Republican there's no one fighting and say that there should be barriers to licensure across the state. So I predict the legislators all continue to support these initiatives. The one thing that I would caution is it's important that as we're going in and creating laws around the compact and around counselor portability, we be aware of unintended consequences, which can always happen. So as we're putting through laws around the compact, are there other laws that could be slipped in that we may not necessarily want, that could impact our practice? So this is a caution that I think is important that we consider.
Building allies and standards across state lines
Dr. Kress: When I was on the Ohio licensing board, when we rewrote the last iteration of our law we moved to integrating CACREP. After us, Kentucky had a similar move. And so I reached out to them and I said, "Hey, you're doing this, we're doing this. We're really on the same page in terms of our educational and training standards, let's do a reciprocity agreement".
And so we went into, I think it was the first reciprocity agreement in the country. This focus on unified standards really help pave the way reciprocity so that people could go across the state borders and get licensed very easily. So there's different ways you can approach these topics of assisting counselors and being able to practice from state to state. And I think it's a really exciting development.
Kristi: That's great. That's so nice to hear such a positive movement towards that direction cause does feel like an area that shouldn't be as hard as it has been. Just allowing there to be so much more access for counselors across lines, because we're in such demand right now, especially.
How to promote change at the local and national level
Kristi: So with all of this that we've talked about so far today, this may be the most important part of our discussion, which is what can counselors do to promote advocacy on a national, state, local level, wherever they're at? And what's the cost if counselors don't get involved? What do we see as holding us back if we don't have more people start to become vocal advocates for our profession?
Dr. Kress: Yeah. That's a question that honestly, Kristi, I lay in bed at night and I think about. It keeps me up sometimes. We have a lot of work to do within our profession.
There's so many places where counseling can grow. Obviously Medicare is a huge issue. That we can't be reimbursed by Medicare drives all counselors salaries down. To say that again, it drives all counselors salaries down that we can't be reimbursed by Medicare. It impacts how seriously we're taken. When you talk with legislators, they want to know well, who else is accepting you? Does Medicaid accept you? to Tricare?
So that we can't be reimbursed by Medicare automatically, It takes away a bit of our credibility in these legislative arenas. We have states like Alabama, for example, where counselors can't be reimbursed by Medicaid. So Medicare and Medicaid are the two biggest payer sources. This is a problem.
All counselors to be able to in 2022 be reimbursed by medicaid, but sadly that's not the case, so there's tremendous work to be done there. And sadly I don't see our professional associations doing that. It's an atrocity in my opinion. I don't think it's a real hard push into these states and to support counselors and being reimbursed by Medicaid.
So there's issues with federal grants where counselors still are not included. I've been told within Indian health services that we're still not included. I'd have to fact check that, but that there's many different federal programs and areas where counselors are not included and where we're not at the table.
The role and value of grassroots efforts
Dr. Kress: We need to be at the table. We need to be taken seriously. And we need to, as counselors, we need to know what these issues are. You need to know where our pinpoints are and where there's opportunity for growth. And we need to challenge ourselves to grow at being effective advocates. I know counselors, we all have advocacy spirits, and we're really passionate about advocacy issues, particularly social justice advocacy issues, but it doesn't change things to sit at our computers or on our phones and to share things on social media. Grassroots efforts are tremendously impacted by organizing in effective ways. And again, we saw this in Michigan last year where they set up a Facebook group, counselors got in it, they were passionate, they were sharing education and information.
But sitting at our computers and sharing things on social media does not create meaningful change. What creates meaningful change, is understanding the legislative process and getting involved in that or knowing who to go to, to create effective change.
There's many ways that we can be effective change agents, but we need to educate ourselves on these strategies. We need to understand that we cannot advocate for our clients or social justice issues if we are not taken seriously as a profession, if we are not at the table.
Right? We hear people talk about systemic racial, injustice issues, like critical race theory and how to get involved in that. Sharing this on social media is not changing anything. You need to go school board. Better yet, you need to run for your school board positions and get on your school board. We hear people talk about police violence. Sharing that on social media isn't changing anything. You need to go to your local officials, you need to go to your mayor, to your township trustees, to your local police departments and provide education and training as a counselor on things like implicit bias and different issues.
There's so many ways that we can be effective change agents, but we need to educate ourselves on what some of these strategies might be, and we need to, this is really important. We need to understand that we cannot advocate for our clients or social justice issues if we are not taken seriously as a profession, if we are not at the table.
Legislative threats to the counseling profession
Dr. Kress: We see issues going on all the time where there are threats to our profession. We have this issue in Tennessee with our ACA ethics code and we have an issue going on in Alabama right now with legislation that's passed the Senate that would basically make it so that school counselors, the national school counseling model cannot be used in their schools.
We have issues where we are not being taken seriously as a profession, and we need to be effective in showing people who we are and what our value is. Nobody cares what we think if we're not powerful as a profession.
We don't see these kinds of threats to other professions, or at least I'm certainly not aware of them. I see them repeatedly against the counseling profession. So how do we get our footing? How do we make legislators know who we are, that our voice matters, that we're reputable, that we're taken seriously.
These are things we need to continue to fight for. So we have to know what the issues are. We have to be well-versed in being effective, legislative advocates. you know, We have to understand that we can't advocate for our clients unless we're also advocating for our profession. And that means defining our profession and putting boundaries around our profession.
Kristi: That's so encouraging and inspiring and it feels so much more urgent think we have. Let it be for a lot of us. I know you have had it as an urgent agenda for a long time. So first steps for a average counselor out there, inspired by what you're saying and says, "okay, what do I do?" So does that mean involvement more in their state level ACA organization? What would you say is a good first step?
Dr. Kress: I love that question. What a great question. I think a really great first step is to be involved in all of our professional associations and to be aware of the issues and to know the issues. Our professional associations, like NBCC and ACA, they have legislative alerts that you can sign up for.
So sign up for these legislative alerts and when they send them out, make sure that you click the button to contact your legislators. It remembers your information and it takes less than 30 seconds to click on these alerts. But it's so important. When I worked at NBCC, we did a blast to, I believe it was 62,000 board certified counselors across the country for Medicare. And we sent this blast out like four times to all of our board certified counselors. Do you know how many people actually clicked the button and responded? Less than 800 people.
Dr. Kress: If we're not taking our own self seriously, how is anyone else going to take us seriously?
And what the legislators say to me, as they say, "Vicky, you say, you care about this, but no one's sending us emails or contacting us about this". So signing up for those legislative alerts is really important. It's also important to get to know your legislators, and their staffers are there representing you. So get to know them, let them know who counselors are, let them know who you are, let them know what your work is. The most effective way to do that is face to face, emails, phone calls. These can also be helpful. And be your resource for them as well. Can you help us identify speakers? And how could we structure this? And what can we do?
Those are just a few of the ways to get started, but just education, knowing how to be effective putting your energy into this, reaching out to people who know the issues, who can update you and educate you. on. And get involved in leadership for goodness sake.
We desperately need good counseling leaders. And at like you mentioned that the state level our, our branches . There's so many opportunities through your local Chi Sigma Iota chapters at your universities. That's a great way to start to build your leadership skills.
There's so many places where you can get involved and just reach out to me. And I can trust you. I will get you involved in leadership roles. We need you all at the table, helping to propel us forward.
Kristi: Thank you so much for this conversation. I feel like this has been super educational, but also, like I said, inspiring and encouraging, and I really hope that this spur anyone to take those next steps to get any more involved because we need to come around this area of having a professional identity, that's been sorely lacking in our field and getting involved in the conversations, even if it means just you and your other counseling coworkers, get together for lunch.
Talk about what are the issues. Let's not just sit by and hope things get better, but actually think what can we do? Thank you so much for your time. This has been incredibly helpful.
Dr. Kress: Thank you. Kristi, for making space for this conversation. It's it's important and it doesn't happen enough, and I really appreciate you understanding how important it is.