Texas Mental Health Crisis: Intern Supervision and Underserved Areas

Texas supervisor training program, speaking, consulting

Texas We Have a Problem

Here’s the thing. In light of recent events I want to speak to all of the problems Texas has when it comes to providing excellent, accessible, and affordable mental health care. I want to outline solutions, propose law changes, and rally the troops. Texas seems to enjoy competing for 49th or 50th place when it comes to quality mental health care in America and this little blog post probably won’t change that. So, as a counselor supervisor, counselor educator, and practicing clinician, I will talk about what I know. This post is about counselor intern supervision and supervisor training.

For those readers who aren’t familiar with Texas rules governing licensed professional counselors:

  • Every Licensed Professional Counselor (LPC) in Texas must spend 3000 hours as a Licensed Professional Counselor Intern under the supervision of a Licensed Professional Counselor Supervisor (LPC-S).
  • There are places in Texas where there are no licensed professional counselors or supervisors (see the white areas in the map below).
  • There are strict limits on the number of supervision hours interns can accrue using technology.

Training more supervisors in rural areas and lifting the restrictions on webcam supervision would be easy first steps to helping Texans gain access to quality mental health care.

Texas supervisor training program, speaking, consulting


Counselors and Webcams

Increasing allowable intern supervision hours via technology is a no-brainer. The Telemedicine Wellness, Intervention, Triage, and Referral Project at the Texas Tech University Health Sciences Center is pioneering the use of technology to screen junior high and high school students, identify those most at risk for committing violence in schools, and intervene before anything happens. Data are already showing that the screenings have helped avert violent incidents and provide students the help they need. Why can’t interns attend supervision using the same technology? Counseling graduates on the fence about where to practice might choose underserved areas if they did not have to travel long distances to receive face to face supervision. Arguments against using technology in mental health are archaic and have become a roadblock to care.

Counselor Supervision Training

Changing the rules about technology and supervision is only a start. Long story short, we need seasoned counselors and counselor supervisors in underserved areas. One LPC Supervisor Course attended by five participants who agree to take on just two interns can impact hundreds of people in need of quality mental health care. Recently I, along with Dr. Christopher Taylor offered a six hour course to twenty participants in El Paso interested in offering their own 40 hour training. How exciting is that? Twenty seasoned licensed professional counselor supervisors near one of the most underserved areas in the state are now trained and willing to provide their own courses. Their impact alone could be a game-changer for interns who feel called to work in underserved areas.

Texas supervisor training, speaking, consulting

Lifting limits on technology and increasing the number of supervisors won’t solve everything but it’s a start. We still need to give interns the ability to bill Medicaid. We still need to convince the military and Tricare to hire licensed professional counselors. And we need to help Medicare understand that refusing to allow counselors to be credentialed under their plans makes them part of the problem. Texas, we need counselors and supervisors more than ever before. And we need them now.

Take the Next Step in Your Counseling Career

Texas supervisor training speaking consulting private practice

When I am speaking at an event or consulting one-on-one with counselors, I find there is always some confusion about the next right steps to take in a counseling career. Most of us started out with a story of strength and a dream to help. We persevered over adversity or we encountered something that we thought would kill us and instead it made us stronger. Most of us leaned on the shoulder of a counselor or therapist and learned we really could be ok. For most of us, turning that story into a career was life changing. Whether we decided to work in an agency, school, or private practice, getting paid to do what we loved to do was living the dream. A few years down the road from that first client, lots of mental health professionals are ready for a new challenge, a change of client ‘scenery,’ and improved income. Private practice, supervising, and supervisor training are just a few things you can think about as you plan the rest of your counseling career.

Agency to Private Practice

For lots of mental health professionals just starting out private practice can seem scary. With a few tricks and systems however, private practice is very do-able. Part time practice can be ideal for full time parents. You can make your schedule as busy as you like. Set a higher rate for your services so you keep your practice low volume and still pay your rent and buy groceries. Those who want a lucrative, high volume, full time practice can also set a rate and a create a schedule that meets their goals. There are many affordable consultants, tools, and boot camps you can utilize to get started on the right foot, stay compliant, and stop wasting time.

Integrating Supervision Into Private Practice

Becoming a supervisor is a wonderful way to expand your skills, give back to the profession, and add another stream of income to your practice. In most states extra training is required. If your state doesn’t require extra training, I’d get some anyway. Most supervisor training programs will teach you what you’ll need to know to stay organized, stay compliant, and mentor your interns. Like private practice, supervision means taking a leap into the unknown, but the rewards are worth it. There are so many ways to integrate supervision into a practice! You can start a non-profit and allow your interns to see clients at a reduced rate. The Ann’s Place Business Model shows you how to barter supervision for interns who will see your self-pay clients who need a sliding fee-scale. This helps your interns, your community, and your bottom line. Or you can take the more traditional route and charge your interns for your supervision services.

Provide Your Own Supervisor Training

Probably the most lucrative of all of these streams of income, is offering your own supervisor training. Costs for these courses can run anywhere from $500 to $1000 dollars per person. With some concentrated effort on the front end, you can enjoy this income stream as often as you can fill the seats. Teaching will enhance your own clinical skills as well and take your practice to a whole new level

Private practice, supervision, and providing a supervisor training are just a few ways you can create a career that will keep growing and changing with you. After all, your story isn’t over. Check out my book on Amazon, “My Next Steps: Create a Counseling Career You’ll Love,” for more ideas, advice from experts in the field, and a step by step guide so you can create the career you fell in love with.

Multiplying Streams of Income


As I meditate on those truths that we hold to be self-evident, I can’t help but wonder what happened to the private practice owner. Most of us who graduated from a counseling program received little to no business education. Because of that, while we are pursuing life, liberty, and happiness we are simultaneously struggling with finances, time, and burnout. I was going to list the Counselor’s Bill of Rights, but instead I came up with the Counselor’s List of Exceptions:

  1. Everyone gets sick and must take time off from work to heal, “Except the private practice owner – if she takes a sick day she will not make money.” 
  1. We will all slow down or retire as we age and become less physically able, “Except the private practice owner – he shall work until he dies because he lives off of everything he makes and the rest goes to taxes.”
  1. Savings accounts will be used to fix things when they break, “Except the private practice owner – since she has no savings (see number 2) she will have to max out her credit cards when the air conditioner finally goes out.”

This is not okay!

A common solution to this very common problem is to develop Multiple Streams of Income. Your other income sources will not only provide cash you can use for a rainy day, they can fund a retirement account, or provide investment capital for your growing business.

Here are examples of some streams of income so your business keeps working even if you need a day off:

  1. Your supportive partner’s income. If you have a partner who supports you in your business endeavor, then his/her income can be the cushion you will need if you have to step away from work, or if an emergency hits.
  2. Don’t quit your day job. If you are trained as a teacher, offer to teach online courses or one day per week at a local university. If you are trained as a musician, offer private lessons or take weekend gigs.
  3. Become a LPC/LMFT Supervisor. Interns must have 18 months to 2 years of supervision and rates can range from $40 to $100 per hour.
  4. Monetize your website. Is there a product you love and would love to offer to your clients? Become an affiliate and offer those products on your website (follow your state’s laws and ethics codes).
  5. Get creative. You can develop courses for parents, offer online continuing education to your peers, or give talks where you sell materials you have developed.
  6. Combine altruism and entrepreneurism. ‘Altrepreneurism’ is a business model used by companies like Tom’s Shoes and employs a ‘givers gain’ philosophy. One example might be to use interns to deliver affordable counseling to your community in exchange for free supervision from you. You receive additional client income when you aren’t in your office and your interns get free supervision. We have a wonderful example of this and you can learn more here on our Ann’s Place website.