Using PHD/PsyD title in state not licensed in

[Shrink1982]

So, because some have assumed so in the past, all will assume so? So, who cares about future patient's possible misinterpretations and possible wasted time? I'm sorry man, but that is a very disrespectful way to treat patients.

No, I am not saying all will assume so. What I am saying is hat if someone ASSUMES I am a psychologist, I will deal with it as I have in the past.

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[Shrink1982]

Unfortunately, the ethics code would not say "If my patient doesn't understand what I wrote on my website, it's not my problem". You seem bent on doing whatever you want, but I think the potential for harm has been established.

No, the potential for harm has not been established. Not one person has succeeded in proving where harm is a factor in all of this.

 

[WisNeuro]

You're saying that you know that people have assumed incorrectly in the past, and that's their fault for not knowing and/or reading up enough. Still reeks of misdirection. If it's caused so many problems in the past, apparently, maybe that should have been a clue that what you were doing is a problem.

 

[Therapist4Chnge]

I am more than qualified to provide a S/H assessment, so I don't really see what this has to do with the doctor title.
And your second point is lost as well. This could happen whether or not I have a doctorate. And I don't know too many psychologist that utilize an MMPI-2 on a regular basis. I work for a large group practice and the psychologists don't do any psychological testing unless it is an unusual circumstance. I really have totally missed your point.

It has more to do with the licensure level than title, as in many states certain evaluations/decisions require different levels of licensure. For instance, in my state only a psychologist or physician can file an expert evaluation for seeking guardianship. A similar requirement is made for involuntarily committing a person (72hr hold), as well as adding/removing S/H pre-cautions for patients who are admitted to the hospital on non-psych units. Title can be whatever, but the licensure (and level of licensure and type of licensure) is what matters in the end.

 

[deleted343839]

So your ethical reasoning process comes down to "well, a lot of them are going to assume I'm a psychologist anyway, and there's no hard data showing that it really harms anyone, so..." Or am I missing something?

 

[smalltownpsych]

When I come across providers who have doctoral degrees in psychology and operate under a lesser license it is a red flag for me and I always look more closely at their credentials. All of the ones that I have interacted so far with have had questionable ethics to say the least. I just think the whole thing is kind of sketchy. It's like someone with an MD after their name that is operating under a Nurse Practioner license. If you can't see the validity of that analogy, then there is nothing really more to say.

 

[Shrink1982]

There are few ways this can be problematic, though the first thing I thought of was assessing risk of suicidality/homicidality. You have a doctorally-trained and doctorally-licensed provider (psychologist or psychiatrist) and you have a doctorally-trained and (mid-level) licensed provider. Both may do a S/H risk assessment, but training can vary GREATLY between providers. The former is guaranteed to have doctoral training specific to the licensure and clinical practice of the associated degree, while the latter does not. There are Ph.D.s in Social Work that focus on macro level research, policy, etc…yes those classes and dissertation were at the doctoral level, but how exact does the title and licensure guarantee the same level of training? What can be guaranteed is the minimum level of training for the licensure (i.e. the floor), though not the ceiling. The floor in this case is MS training, which as you have previously pointed out is different than doctoral training.

When evaluating for S/H I want someone who is best trained to do this evaluation. Most states specify training requirements and differentiate by licensure level and not necessarily title for this very reason (amongst other reasons). Yes there are psychologists who have Ph.D.s in I/O, Experimental Psych, etc…but they aren't licensed w/o equitable additional training. Some states allow for licensure at the MS level, though these tend to be psych-assistant positions w. supervision/oversight by a psychologist…so not quite the same scenario.

A second related scenario is someone comes to a clinician for a psychiatric evaluation.
Door #1: Doctor Smith…psychologist
Door #2: Doctor Jones…social worker

Dr. Smith does a clinical interview and administers formal psych testing (e.g. MMPI-2, etc).
Dr. Jones does a clinical interview and administers a couple of self-report questionnaires.

They both provided a "psychiatric eval" and go by the title doctor, but they have different licensures (and scopes of practice)….is the a difference in their evaluations? Which provider is at greater risk for misdiagnosing the case? Is one patient at a greater risk for misleading the evaluator and avoiding hospitalization?

These aren't perfect scenarios, but I think it gets at some of the issues.

Which psychologists are you talking about? I routinely refer my patients to social workers in the community who are excellent psychotherapists, and I have good working relationships with the social workers in my clinic. I work in a department where most of the other faculty are physicians, and I am thankful every day that I have my job and they have theirs. Admittedly, I was on the fence about med school versus graduate study long ago, but my experience working alongside physicians has validated my decision time and time again.

I suppose if you look hard enough you will find someone who matches the trope you are describing. I suppose I could have soured on the medical profession a long time ago as I have plenty of grist for that particular mill. But I find it more conducive to my well being and professional happiness to cultivate relationships with all kinds of professionals who care for patients, learn what I can from them, and nurture my identity as a psychologist.

You've gotten a lot of opinions here, most of which seem to be well intentioned even if they're not warm and fuzzy. We as psychologists look as these issues through the lens of our own ethics code, and to expect differently of us would be unfair. Why you would pursue a PsyD with no intention of becoming licensed to practice psychology is, quite frankly, beyond my comprehension, but I'm not here to examine your motives. If you are as transparent with your clients, your colleagues, and the general public as you are being here, then you are falling within the letter of the law, but you may still very well be looked upon as a [benign, somewhat confusing] outlier in the professional community.

My only concern is that, despite your transparency, clients who choose to take time out of their day and the money out of their pockets to see you may be vulnerable to a "bait-and-switch" situation once you disclose that the doctorate holder sitting across the room from them is not actually a licensed psychologist, unlike 95+ percent of the other PsyD holders who are in clinical practice. Some people won't care, others will, and some will cut their losses and enter treatment with you even though you're not the type of professional they expected. As others have suggested, it's really on you and your conscience as to whether you can be OK with that.

Most patients are referred to me by colleagues, former patients, and insurance. They have no idea what my profession is when they walk in the door. When I explain I am a clinical social worker and psychotherapist, the only thing they seem to care about is that I have the skills to help them with their problems. You must see a different lot of patients than I do because I have never had one that really got the difference between the professions. They don't care enough to get it. They just want a trained professional to help them. And I have never had someone leave because they wanted a psychologist and got a clinical social worker. Some assume I am a psychologist as they really don't understand the differences between the professions but none have been like, "Oh, you aren't a psychologist. Damn, i really wanted a psychologist because they have all that extra training." However, I do have patients ask me for medication from time to time.

 

[smalltownpsych]

It has more to do with the licensure level than title, as in many states certain evaluations/decisions require different levels of licensure. For instance, in my state only a psychologist or physician can file an expert evaluation for seeking guardianship. A similar requirement is made for involuntarily committing a person (72hr hold), as well as adding/removing S/H pre-cautions for patients who are admitted to the hospital on non-psych units. Title can be whatever, but the licensure (and level of licensure and type of licensure) is what matters in the end.

It is the same in my state unless the social worker has completed additional training and state certification to testify in involuntary commitments. The last state I was in would let just about anyone do it. The requirements for a guardianship eval in our state is not legislated so in theory any one could be involved and it has to be initiated by a physician, but in practice they usually want some cognitive testing so we will usually get a call.

 

[Shrink1982]

So your ethical reasoning process comes down to "well, a lot of them are going to assume I'm a psychologist anyway, and there's no hard data showing that it really harms anyone, so..." Or am I missing something?

My ethical reasoning is a psychologist isn't necessarily in a better position to treat a patient. Therefore, even if they assume I am a psychologist and I explain that is not the case, I can still treat this person. So, I can't see where the harm comes in to play. If I stated I was a counselor (which is not a protected term in my state) and was not licensed in any capacity, I can see the harm in that. I have an independent license to treat patients. Perhaps you believe psychologists are better equipped to work with patients. I would have to politely disagree with you.

 

[Therapist4Chnge]

For a more practical example…a divorced couple seeks independent opinions about their son's psychiatric stability, since they cannot agree on one provider they both want. Parent #1 finds you via your website and secures your services. Parent #2 gets a referral to a local psychologist in the community. The evals are done. Parent #1 and Parent #2 exchange reports. Parent #1 doesn't trust Parent #2 and looks up their clinician through the state licensing board. Parent #2 does the same for similar reasons, but is confused by what they find. More confusion ensues.

 

[WisNeuro]

You can harm them by delaying their treatment and wasting their time and money if their intent was to see a psychologist and they realized that is not what you are.

But that's their fault because they were too stupid to read enough or just didn't care, right?

 

[Shrink1982]

For a more practical example…a divorced couple seeks independent opinions about their son's psychiatric stability, since they cannot agree on one provider they both want. Parent #1 finds you via your website and secures your services. Parent #2 gets a referral to a local psychologist in the community. The evals are done. Parent #1 and Parent #2 exchange reports. Parent #1 doesn't trust Parent #2 and looks up their clinician through the state licensing board. Parent #2 does the same for similar reasons, but is confused by what they find. More confusion ensues.

I still fail to see your point. Certainly, someone can secure me to do this with my current credentials.

 

[Shrink1982]

You can harm them by delaying their treatment and wasting their time and money if their intent was to see a psychologist and they realized that is not what you are.

That is what is great about a telephone screening. Be sure you are what they are looking for. No money lost and not much time.

 

[Therapist4Chnge]

My ethical reasoning is a psychologist isn't necessarily in a better position to treat a patient.

Treat a patient for….? Not everyone can do everything for everyone. I can't really speak to differences in therapy training because that isn't what I do in my day to day practice, so I'll defer that to others.

 

[Shrink1982]

Assuming you have the competence to do so and the services they need are within your scope of practice (as regulated by your license).

This would be true in any situation. I have met many psychologists that I wouldn't trust to mow my yard.

 

[Shrink1982]

Treat a patient for….? Not everyone can do everything for everyone. I can't really speak to differences in therapy training because that isn't what I do in my day to day practice, so I'll defer that to others.

I agree with you 100%. It isn't about the profession but about the therapist's capabilities. If I don't feel I have the training to work with a person, I find them someone that does.

 

[Shrink1982]

Given how often you claim to be mistaken for other types of providers (including a psychiatrist), I wonder if maybe you aren't doing the best job of explaining your role and license and how it differs from that of other types of providers, either during your phone screening or in person.

I had a patient the other day, whom I explained my credentials. He still asked if I could rx a sleeping med. This wasn't the reason for the visit but he assumed because I am a therapist, I could rx something. Some don't have a clue about the mental health profession.

 

[Shrink1982]

They aren't trained to mow your yard, so I don't see what that has to do with anything.

My point was my experience as well as research studies have shown there isn't a difference in the quality of treatment between different mental health professions. I have known some crappy psychologists, along with a host of crappy therapists from every background. Assuming one will get better treatment from a psychologist is not supported by research.

 

[Therapist4Chnge]

Patients and referrers (though less so) can often be clueless about scope of practice, so it is important to be as clear as possible whenever possible. I think what many are pointing out is the understandable confusion between the title "Doctor" being paired w. a mid-level licensure. From a technical standpoint it is correct, but in usage it can be quite confusing.

 

[Shrink1982]

And it's your job to make sure they understand your role, and continue clarifying it if necessary. Saying the patient doesn't understand anyway is a cop-out. This is your job.

I never said it wasn't my job

 

[Shrink1982]

I really don't see the point in continuing this thread as we are never going to agree. I am done.

 

[463951]

Most patients are referred to me by colleagues, former patients, and insurance. They have no idea what my profession is when they walk in the door. However, I do have patients ask me for medication from time to time.

I find this extremely troubling. Patients have no idea what your profession is when they walk through the door? And they are asking you for medication? You are assuming that if a patient does not ask you about your credentials, then they have a complete understanding about what your credentials are. This is harmful to patients who are assuming you are a psychologist. If I were one of your patients and found out you were not a psychologist at the very first visit, I would be extremely pissed off at you for wasting my time. Imagine the anger of a patient who has seen you five times and finds out you are not a psychologist. But they should have asked you about your credentials, so it's their fault?

 

[Therapist4Chnge]

To be fair, he wrote earlier that he reviews his credentials before therapy begins (post #101).

I'd still be concerned w. the commonality of patients coming in that don't understand why they are there. I know when I see this it is typically a result of the diagnosis (head injury, so recall is a crapshoot at best), though I'd guess psychotherapy would be more straightforward?

 

[psych1962]

So, I am new here. Just browsing threads and came across this. It is interesting to me, having been in the field for nearly twenty years, that this sort of bantering is happening. I get the point that having a PsyD and LCSW can be potentially misleading but I also see how this could be easily rectified by being up front with clients. The earlier arguments that one must have a "doctoral license" in order to advertise as a Dr. is new to me. I have been a psychologist for quite some time and have never come across this sort of argument. IMO, if you have the doctorate, use it. Make sure you are clear about your license.

This sort of thing is a problem in the field, especially amongst newer psychologists. I am ashamed to be amongst a group of professionals that would act in such a manner. Let us set our egos aside for a moment. If someone is working to get more education, that is great. We should encourage that not sway an individual into believing they are doing so in order to misrepresent himself or herself.

 

[WisNeuro]

I for one am proud that such a stance is occurring. With the watering down of standards, we should be encouraging more stringent application of certain titles and degrees for consumer protection, not loosening them. I'm all for more education and training, but I am also a fan of transparency and representing yourself accurately and minimizing consumer/patient confusion.

 

[psych1962]

I for one am proud that such a stance is occurring. With the watering down of standards, we should be encouraging more stringent application of certain titles and degrees for consumer protection, not loosening them. I'm all for more education and training, but I am also a fan of transparency and representing yourself accurately and minimizing consumer/patient confusion.

Except you will never be able to regulate an academic title. Also, it seems the LCSW in this thread was quite clear about transparency.

 

[WisNeuro]

No, but we should be more careful about using academic titles in clinical settings where they may be misunderstood. He was somewhat clear about his transparency. He was also clear that the issue caused considerable confusion with his patients and others in the past.

 

[smalltownpsych]

So, I am new here. Just browsing threads and came across this. It is interesting to me, having been in the field for nearly twenty years, that this sort of bantering is happening. I get the point that having a PsyD and LCSW can be potentially misleading but I also see how this could be easily rectified by being up front with clients. The earlier arguments that one must have a "doctoral license" in order to advertise as a Dr. is new to me. I have been a psychologist for quite some time and have never come across this sort of argument. IMO, if you have the doctorate, use it. Make sure you are clear about your license.

This sort of thing is a problem in the field, especially amongst newer psychologists. I am ashamed to be amongst a group of professionals that would act in such a manner. Let us set our egos aside for a moment. If someone is working to get more education, that is great. We should encourage that not sway an individual into believing they are doing so in order to misrepresent himself or herself.

So you have been in the field for 20 years and haven't seen mid-levels tack on bogus doctorates in order to mislead patients? Not saying that is what happened here, but the fact that it is not a licensable degree raises my suspicions as to credibility of the degree. I have seen this occurring manytimes which is why have posted about the social worker with the PhD in parapsychology from an online program or the LPC who has a PsyD from another online school Cal Southern U who would let people think he was from USC. I believe in protecting the profession and practice of psychology from those who would blur the lines and to use your own words, I am ashamed that you don't.

 

[psych1962]

No, but we should be more careful about using academic titles in clinical settings where they may be misunderstood. He was somewhat clear about his transparency. He was also clear that the issue caused considerable confusion with his patients and others in the past.

From what I read, he doesn't have a Psy.D yet, so not sure how it could have caused problems in the past. There was a lot of reading but from what I gathered, he stated clients have come to him assuming certain things. I am not all together surprised by this as I have had clients request psychotropics from me, however, I am not a prescriber. I have never advertised myself as a medical doctor but clients don't always know the difference.

 

[psych1962]

I also find it amusing that some have stated that using the Dr. title is misleading when the reality is most consumers assume Dr. = physician. Are we not, in many ways, misleading clients to some extent when we refer to ourselves as doctors, knowing very well many of them will assume we are physicians? Do you not think it is possible you might have a client who comes to you, as a doctor, assuming you can prescribe to only get pissed when he realizes you cannot give him what he wants?

 

[WisNeuro]

May be a different system, but the majority of mental health providers I work with are of the Phd/PsyD ilk. Vets are pretty savvy to the system and I rarely encounter the confusion of Dr with MD only. Most are pretty aware. Also, I'm a consult service that needs a referral, so patients don't come to me without a fairly specific reason. Last, they're licensed at a level that only doctoral level providers can obtain, kind of apples and oranges to me.

 

[smalltownpsych]

I also find it amusing that some have stated that using the Dr. title is misleading when the reality is most consumers assume Dr. = physician. Are we not, in many ways, misleading clients to some extent when we refer to ourselves as doctors, knowing very well many of them will assume we are physicians? Do you not think it is possible you might have a client who comes to you, as a doctor, assuming you can prescribe to only get pissed when he realizes you cannot give him what he wants?

Yes. As you well know, this happens all the time and even some of the providers here at the hospital get confused at times. Most of the other psychologists here are neuro guys and gals so this will occur much less with that type of referral for obvious reasons. All I have stated are my own perspectives on people who get these degrees who often appear to be trying to take an easier route to get the same credibility as a psychologist.

 

[WisNeuro]

No one is protesting the use of Dr. in general. If this person is at a dinner party and introduces them self as Dr. so and so, that's fine, the problem occurs when they present that in a clinical situation in which it is very likely that that will be misconstrued since they are not licensed as a doctor in any way whatsoever.

 

[psych1962]

So you have been in the field for 20 years and haven't seen mid-levels tack on bogus doctorates in order to mislead patients? Not saying that is what happened here, but the fact that it is not a licensable degree raises my suspicions as to credibility of the degree. I have seen this occurring manytimes which is why have posted about the social worker with the PhD in parapsychology from an online program or the LPC who has a PsyD from another online school Cal Southern U who would let people think he was from USC. I believe in protecting the profession and practice of psychology from those who would blur the lines and to use your own words, I am ashamed that you don't.

I just don't see that happening in this case.

 

[psych1962]

Licensed as a doctor? Last time I checked it occurred the other way around.

 

[psych1962]

Yes. As you well know, this happens all the time and even some of the providers here at the hospital get confused at times. Most of the other psychologists here are neuro guys and gals so this will occur much less with that type of referral for obvious reasons. All I have stated are my own perspectives on people who get these degrees who often appear to be trying to take an easier route to get the same credibility as a psychologist.

I wasn't aware that the various other behavioral health providers needed "the credibility as a psychologist." From my experience, their credibility isn't inferior to that of a psychologist's. I don't think deciding to get additional training at the doctoral level is a problem. And from what I have read, it seems this is more about a power struggle than anyone's concern about patient safety.

 

[psych1962]

I suppose this is a bit personal to me as my daughter is an LMHC and has decided to get her doctorate from CalSouthern which was just referenced above with some distaste. I wasn't all that familiar with online education in psychology but from what I can tell, she is enjoying her studies and is learning a lot. I would have preferred it if she had attended Columbia, like her old man, but what she is doing makes sense to her. I think we have to be careful not to judge too quickly. Her path fits well with her goals. If she wanted to become a licensed psychologist, I don't think it would be the best route but with their recent RA accreditation and the affordable tuition, I can't see a reason to keep her from doing what she wishes (not that I could if I wanted to).

 

[smalltownpsych]

I just don't see that happening in this case.

Not so egregious as the examples I mentioned from what it appears, but still makes me question the credentials. The way I see it, the PsyD degree is specifically a practice degree for a clinical psychologist. That is why I went to an APA acrredited school and an APA accreditied internship, and passed the EPPP ; all so that I could finally accomplish my goal of being a clinical psychologist with all the rights, privileges, and responsibilities pertaining thereto (to use the language from my degree). My reaction when another mental health provider is getting a non-licensable PsyD for educational purposes is a negative one.

I suppose this is a bit personal to me as my daughter is an LMHC and has decided to get her doctorate from CalSouthern which was just referenced above with some distaste. I wasn't all that familiar with online education in psychology but from what I can tell, she is enjoying her studies and is learning a lot. I would have preferred it if she had attended Columbia, like her old man, but what she is doing makes sense to her. I think we have to be careful not to judge too quickly. Her path fits well with her goals. If she wanted to become a licensed psychologist, I don't think it would be the best route but with their recent RA accreditation and the affordable tuition, I can't see a reason to keep her from doing what she wishes (not that I could if I wanted to).

I totally get this. A very close friend of mine who has looked to me as a mentor and is an LPC is attending an online doctoral school. I have talked to her about the pro's and con's of this, and am much more sympathetic to her situation as an individual. I have had my own ethical dilemmas on how to communicate with her about this issue.

 

[Shooter]

Completed PsyD and had an LPC license w/psychometric privileges for a while. Competent to legally do the same crap every psychologist does out there, except for using the "psychologist' label as it is protected by state law (until my silly 'psychologist' license arrives). The APA ethics code is a torture joke in the courts. State/territory/jurisdictions laws prevail, stay ethical and follow best practices. -Cheers..

 

[deleted343839]

Completed PsyD and had an LPC license w/psychometric privileges for a while. Competent to legally do the same crap every psychologist does out there, except for using the "psychologist' label as it is protected by state law (until my silly 'psychologist' license arrives).

As a matter of fact, as an LPC you most certainly would not be competent to do what I do in my career. Not remotely. So, congrats, consider yourself a player in the watering down of the profession.

 

[Lurking Oracle]

No one is protesting the use of Dr. in general. If this person is at a dinner party and introduces them self as Dr. so and so, that's fine, the problem occurs when they present that in a clinical situation in which it is very likely that that will be misconstrued since they are not licensed as a doctor in any way whatsoever.

If I were at a dinner party and someone introduced him/herself as "Doctor" (regardless of degree or job), I would probably want to be seated at another table. Narcissists are not good dinner company.

 

[erg923]

Completed PsyD and had an LPC license w/psychometric privileges for a while. Competent to legally do the same crap every psychologist does out there, except for using the "psychologist' label as it is protected by state law (until my silly 'psychologist' license arrives). The APA ethics code is a torture joke in the courts. State/territory/jurisdictions laws prevail, stay ethical and follow best practices. -Cheers..

you have a Psy.D.

 

[WisNeuro]

If I were at a dinner party and someone introduced him/herself as "Doctor" (regardless of degree or job), I would probably want to be seated at another table. Narcissists are not good dinner company.

Very true, in public I only use the Dr. prefix on my airline miles and hotel rewards programs in the vain hope that I'll snag an upgrade. I have gotten a free first class upgrade once, so I'm going to fool myself into thinking that it worked.

 

[Shooter]

As a matter of fact, as an LPC you most certainly would not be competent to do what I do in my career. Not remotely. So, congrats, consider yourself a player in the watering down of the profession.

So when my psychologist license arrives sometime next month, I will suddenly have that competence? Nopes.

It goes back to training, supervised experience, and state law.

There are more states allowing trained/supervised master-level licencees to engage in psych-testing. More states allow trained psychologists to prescribe.

Trying to devalue others to save face does not reflect well on your (our) profession.

 

[WisNeuro]

I'm going to take a stance on the psych and neuropsych testing by those without adequate training. I've seen some of the attempts there, and they're pretty bad. This is definitely an area where that advanced training is necessary. I have to clean up the messes from ill-trained people dabbling in neuropsych all the time. Very little in the way of understanding even basic psychometrics, the utility of reliable change calculations, and using appropriate tests and norms. I've had to send a message or two to practitioners to either desist, receive more training, or the next time I see a report like that, the next message is going to the licensing board.

 

[MCParent]

So when my psychologist license arrives sometime next month, I will suddenly have that competence? Nopes.

I do not understand what you're raging against. No, you do not get to decide for yourself that you are competent. That's what the purpose of licensing is.

 

[WisNeuro]

I do not understand what you're raging against. No, you do not get to decide for yourself that you are competent. That's what the purpose of licensing is.

Any why most hospitals have specific credentialing and privileging boards.

 

[bmedclinic]

I do not understand what you're raging against. No, you do not get to decide for yourself that you are competent. That's what the purpose of licensing is.

Technically, I think being licensed is "minimal competence" according to our ethics code.
However, ethics are clearly on the out in this thread, so disregard my post.

 

[Shooter]

I do not understand what you're raging against. No, you do not get to decide for yourself that you are competent. That's what the purpose of licensing is.

Wrong. Your license alone does no equal competence.

While you may have a license allowing you to conduct testing, it does not make you competent to perform custody evals, neuro tests, etc. It's an easy way to lose your license (but not your current level of competence).

Competence 101: based on education, training, supervised experience, consultation, study, or professional experience.

Feel free to read previous posts to familiarize w/ all the interesting drama.

 

[ClinicalABA]

So when my psychologist license arrives sometime next month, I will suddenly have that competence? Nopes.

Of course not- nobody has or would argue that. Your training and experience are what (should) give you the competence. The license provides proof of a minimum of training and experience (with implied competency) to clients, employers, funding sources, etc.- nothing more, nothing less.