A rough start: Things to watch out for

Probably most of us, as we go through university, expect to land a decent job upon graduation. I know I did, and even though I didn’t expect it to be a perfect situation, I certainly wasn’t prepared for what it turned out to be.

Between 10/10/17 and 11/2/17, I had what was simultaneously one of the worst and most useful experiences as a new counselor. In August of that year I graduated with my master’s in counseling, and about a month later I accepted a position as a substance abuse counselor (LCDC) with a local agency working primarily with adolescents. It didn’t take long to see that something wasn’t right.

To make a long story short: If something seems off it probably is, and you might want to head for the hills. Of course, it’s best to try to come to an understanding with an employer as to why its processes are the way they are, but if it keeps stinkin’, that ship is sinking.

The bulk of our population were adolescents who were referred either by local courts or by their school counselors, and one of my duties was to go to municipal courts to either update the judge on current clients, or administer drug tests and conduct preliminary intakes on kids who tested positive for any substance. Distinct memory #1: Clinical Director, in severe state of disappointment, exclaiming, “Damn!” when I informed him no kids tested positive, and we therefore had no new referrals. I asked, “Isn’t that a good thing?” And he replied with something to the effect of, “Yeah, of course, but we’ve gotta keep our doors open.”

Of course, sometimes kids did test positive, and once they showed up at the office I or someone else would conduct a screening and assessment: Distinct memory #2: Being instructed repeatedly to diagnose using DSM-4-TR, and make sure I included a GAF score. I tried several times, unsuccessfully, to explain to a counselor who’d been working there longer that, as he already knew, DSM-5 had been in effect since 2013, and the GAF had been eliminated due to unreliability (Kress et al.). His response – Insurance companies require it for billing. Now, I know that to be untrue, because I’d previously worked as an office manager for a different counseling agency, but I never won that argument and he gave me hell over it until the day I resigned.

Distinct memory #3: Over-treatment is REAL, everybody! And it really can cause more harm than good. I’ve had discussions with other counselors on how maybe everyone’s got something they could work on (self included), and a little counseling couldn’t possibly hurt anybody. But, when I say over-treatment I mean exactly that. Some of these teens were diagnosed with mild substance use disorders, and still they were prescribed treatment five days a week, three hours a day – on two of those days they’d be withdrawn from group sessions for one hour of individual counseling. That’s a total of 13 hours of group counseling and two (2) hours of individual counseling per week… Imagine yourself as one of these kids, going to school from 8:00 to 4:00, then being transported to treatment to be there from 5:00 to 8:00, and finally getting home between 8:30 and 9:00 PM – if you’re not stressed out already, you might be after that routine for the next two to three months, and that could certainly contribute to a decline in your academic performance and healthy leisure time, and possibly lead to relapse. Plus, there was literally no time for them to assimilate what they were supposed to be learning between sessions and implement it in any meaningful way. Several times I brought up this concern, again, to no avail, as I was instructed that the kids needed to follow this treatment protocol for at least a month.

Linked to the over-treatment and lack of healthy leisure time were the behaviors some of these kids displayed during the group or individual sessions. They were, at times, practically unmanageable, and I couldn’t blame them for it – they were trapped and felt like they were being talked at literally all day, five days a week. So, on many days, Distinct memory #4: Babysitting. If you find yourself thinking, “Man, this sure feels like babysitting,” and it’s not at the beginning of treatment during the client’s pre-contemplation stage, something is probably wrong – maybe over-treatment as in this case, maybe something else, but something.

Finally, one of the worst things I can think of, and Distinct memory #5: Inaccurate records leading to billing for treatment that is not provided. I remember when I began leading group sessions some of the kids would straggle in 30 or 45 minutes late, and they would sign-in and enter their arrival time as the top of the hour (e.g., 5:00 instead of the actual 5:45). When I instructed them to write the actual time they arrived next to their signatures they asked why and some said, “Oh, it’s because we always just write 5:00 or 6:00, sir.” I’d just tell them that was incorrect, and that I needed to enter the actual time in the notes. So there I go, writing my notes and entering the actual in/out times, only to later be confronted by the same counselor noted in distinct memory #2 that I was doing it wrong. According to him, we were supposed to enter the arrival time as the top of the hour in the electronic record, print the note, edit the sign-in time on the printed note, and submit documentation that way. And there I go again, trying to tell this guy that (A) this is inaccurate and unnecessary, (B) this leads to billing for treatment time that isn’t provided (billing fraud!) because the office manager billed from the electronic record, and (C) I’m respectfully declining to do as he instructs. So I keep documenting appropriately, and he confronts me again later, along with more of the DSM-4-TR and GAF stuff, until I decide to quit. What this guy wasn’t looking at is that the kids were signing-in at the front desk with their actual arrival time, while signing-in for group with an inaccurate time that probably led to fraudulent billing, and a simple audit by the state could have the place shut down.

I don’t think it’s possible to describe the tremendous sense of relief I felt when I resigned – I hadn’t even had my license one month, and already I was in a situation where I could lose it! Of course, the owner said he had no idea any of this was going on, but I’m not sure I buy that – how can you not be aware of how your business is run? The owner told me I didn’t have to stay for two weeks and that I could leave instanter, so, with the possibility of retaliation in mind, I took him up on that offer.

Some advice, which of course no one has to follow: If things like this happen and the leadership doesn’t respond to one’s concerns, it’s probably best to CYA and get the hell out of Dodge.

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