CACREP Versus CACREP-Unaffiliated: A New Divide?

Below are summarized some of the important issues in the national accreditation debate:

At a time when our profession seeks unity in professional counselor identity, we cannot simultaneously promote the view that one kind of counseling graduate program is superior to the other without engendering ill will and tension. Disseminating the viewpoint that CACREP programs are superior, and others should be phased out, is not only invalidating to CACREP-unaffiliated counselors, but it will likely harm them professionally, especially when this viewpoint is conveyed to federal agencies and insurers by an organization with the presumed credability of a national accrediting body.

We believe that graduates of counselor education, counseling psychology, and allied programs are instilled with a professional counselor identity, whatever their degree title. They must acquire the requisite professional knowledge to pass national examinations and state law tests. The scope and title of their licensure is clearly laid out to them by their state regulations. The notion that some licensed counselors  think of themselves as psychologists is clearly an overstatement by those promoting a narrow vision of professional counselor identity. In reality, they cannot think of themselves as psychologists in any legal or professional sense, since they are prohibited from representing themselves in this way by state law.

From a philosophical point of view, those arguing for a narrowed vision of professional counselor identity claim one cannot simultaneously align with counseling and psychology, counseling and clinical psychology, counseling and art therapy, to name a few. These advocates have called having too many professional identities facetiously, “Professional Identity Disorder.” We do not see drawing from multiple allied professions a disorder, but an important strength, marking intellectual curiosity, expansive thinking, integration of knowledge and, most importantly, creativity. To live professionally and intellectually within one professional box will lead to narrow treatment options for clients and inferior treatment.

Over the years, our profession has survived many threats from rival mental health professions in its struggle for recognition and independent status. But it has never faced a serious threat emerging from its own professional community, which makes this one both unprecedented and regrettable–as it holds the potential to divide the profession at a time when unity is needed for our advancement in a changing healthcare marketplace.

CACREP must exercise care in its advocacy,  or it will undeservedly mislabel many counseling programs as “unaccredited” in the eyes of the public and important stakeholders, when the official position of ACA is that accreditation is voluntary. If CACREP wishes to bring unity to our profession, it must develop positive relationships with the programs it seeks to accredit; and it must truly listen to the reasons why many programs are reluctant to pursue its accreditation, so that it can become an accrediting body that accommodates the needs of its member universities.

CACREP has made the assertion that it did not directly lobby the Institute of  Medicine (IOM) and TRICARE for the exclusion of mental health counselors who did not graduate from CACREP programs.  This may be technically correct prior to the 2010 IOM report which recommended  restrictions on the ability of mental health counselors to become paneled with TRICARE.  However,  CACREP (as well as NBCC and ACA) did in fact give informational presentations on  their standards to IOM prior to their report’s release and answered multiple questions.  Neither CACREP-unaffiliated nor Counseling Psychology Programs were given the same opportunity to present their perspective nor attest to the quality of their programs.

Regardless of the truth of CACREP’s no lobbying claim (prior to the report), the 2012  letter from CACREP to TRICARE is evidence that CACREP’s intention is to  question the suitability of CACREP-unaffiliated mental health counselors to practice under TRICARE.  In this letter CACREP asserts that TRICARE  should only accept licensed counselors who graduated from CACREP programs.  CACREP suggests subtly that this is for the protection of the public — implying that the training within CACREP-unaffiliated and Counseling Psychology Programs may not be adequate.

See letter here.

Furthermore, CACREP and AMHCA have pressured university programs to adopt CACREP by suggesting that their graduates will increasingly be unable to work on behalf of TRICARE, MEDICARE, or private insurance clients, or even obtain licensure!

These two organizations have made it very clear that they support this agenda when they state that they endorse IOM standards and the need to work with state licensing boards on their adoption.  Please see their letter here.

CACREP asserts that they are trying to strengthen the profession and endorse generous grandfathering standards at least 7 years out and which should include grandfathering when crossing state borders.  However, once insurers and state licensing boards  adopt CACREP only language, it is beyond CACREP’s control how each jurisdiction or insurer will implement grandfathering. A case in point is the Veteran’s Administration (VA). Despite CACREP’s official position on generous grandfathering, the VA offers no grandfathering. Here are some other important considerations:

a. Grandfathered state licenses are severely impaired when TRICARE,
MEDICARE, and private insurance panels in the future are lobbied to exclude CACREP-unaffiliated counselors.  Grandfathered state licenses are increasingly useless in an employment environment in which employers have been led to believe that only CACREP degrees are worth hiring.

b. Giving lip service to the grandfathering idea and burying “support” for
it in a position paper on the CACREP website is not a strong or meaningful endorsement of CACREP-unaffiliated counselors when much of the messaging of  CACREP seems to disparage the value of CACREP-unaffiliated counseling degrees.

Many outstanding Counselor Education Programs are not accredited by CACREP, or were not during most of their institutional history. Here are a few prominent examples: Johns Hopkins, Harvard, Columbia, George Mason, Towson, University of Maryland, and Seton Hall.

State Licensing Boards  generally strive for high standards.  Some regional variation is desirable as people in different states may have different values and needs, such as in Maryland where the state board believes it could be beneficial or practical for half of one’s clinical supervision to be provided by a social worker, psychologist, marriage and family therapist, art therapist, or psychiatrist.

CACREP claims that the Federal Government looks to consistent national
standards in the selection of mental health counselors for TRICARE, and so
chose CACREP accreditation to insure this consistency.  They claim other mental health professions adhere to national accrediting standards. However, what is left unstated is that other mental health professions — when national standards were found to be desirable — introduced them in a much more constructive way to allow veteran practitioners to continue their work. Inserting CACREP accreditation as a screening device for TRICARE provider status makes little sense when so many outstanding mental health counseling and counseling psychology programs are not CACREP accredited. In the current context, CACREP becomes merely an arbitrary filter, excluding many outstanding mental health counselors.

Professional Counseling graduate programs draw upon multiple sources of wisdom — our teachers are psychologists, social workers, and allied mental health professionals as well as professional counselors.  CACREP favors core faculty with doctorates in counselor education and in so doing may promote professional “insularity” rather than “multidisciplinarity”–when the latter is the direction enlightened healthcare professi0ns are moving to integrate multiple clinical perspectives and work together collaboratively.

Exclusionary membership has never been a core counseling value, and that is why our graduate programs have faculty from various professional backgrounds who are united by their admiration of our field’s humanistic tradition of healing. Some in academia retort that APA accredited psychology graduate programs exclude counselor educators from their faculty, so why shouldn’t CACREP programs favor counselor educators?

Counselor Education programs should strive to be better, as our entire profession evolved out of a desire to offer a more compassionate approach to mental health services. Our graduate programs in counseling should try to transcend the pettiness, the artificial divisions, the unproductive turf battles, and the narrow focus of other mental health training programs to truly embody the kind and humanistic vision that our profession strives for. We don’t want to be like everyone else, we want to be kinder and embody the compassionate human beings who can truly heal others.