Can I be a clinical psychologist given my history with PTSD?

[PsychRobK]

I was accepted to a great PsyD program and have everything fully funded. I am excited for my new career path, but would like to ask now if/what road blocks exist (either by the APA, employers, etc.) for those who have a history of mental illness?

I was in the military and have PTSD from combat. I was placed in an intensive inpatient program/trauma center for 30 days, and now am doing better but still being seen by the VA and take medication. I do not consider myself a risk to any future patients I have, nor do I get triggered by words or anything that could come up in a session I am leading.

I am fully adjusted, hard working, and crush any interviews I have faced, so I am not worried about self-imposed barriers with regards to future licensing/employment. This thread is not meant to dive into whether or not I feel my issues would effect my ability to be an effective clinical psychologist. I purely want to discuss roadblocks/filters the APA/clinics/school programs have in place. Will I be asked/denied at some point because I was (voluntarily) admitted to an intensive inpatient program for my PTSD? I don't want to waste years of my life attaining my PsyD only to get rejected later down the road.

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[WisNeuro]

Your history would not be a barrier to any of the gatekeepers you mentioned in my state. Criminal history can be flagged for psychologists in my state, but MH history would not bar anyone from practicing as long as it is adequately managed.

 

[PsyDr]

You will be asked if you have any psychiatric diagnosis that impairs your ability to work effectively on:

1) every license application
2) every license renewal
3) every hospital credentialing procedure every year
4) every malpractice insurance application
5) every malpractice insurance renewal

Likewise, if you have been diagnosed with a substance use disorder this will apply again.

These issues will almost certainly come up during any board complaint and malpractice lawsuit ever.

 

[futureapppsy2]

You will be asked if you have any psychiatric diagnosis that impairs your ability to work effectively on:

1) every license application
2) every license renewal
3) every hospital credentialing procedure every year
4) every malpractice insurance application
5) every malpractice insurance renewal

Likewise, if you have been diagnosed with a substance use disorder this will apply again.

These issues will almost certainly come up during any board complaint and malpractice lawsuit ever.

I think you are being a bit doom and gloomy. There are plenty, plenty of successful, licensed psychologists with histories of mental illness. I knew someone who is licensed in a state that required an oral interview component for licensure. They had to disclose both physical and mental health issues on their licensure application and were sure that they would have to address it in the interview. It never came up.

 

[Jxz]

You will be asked if you have any psychiatric diagnosis that impairs your ability to work effectively on:

1) every license application
2) every license renewal
3) every hospital credentialing procedure every year
4) every malpractice insurance application
5) every malpractice insurance renewal

Likewise, if you have been diagnosed with a substance use disorder this will apply again.

These issues will almost certainly come up during any board complaint and malpractice lawsuit ever.

Citation
Boyd, J. E., Graunke, B., Frese, F. J., Jones, J. T. R., Adkins, J. W., & Bassman, R. (2016). State psychology licensure questions about mental illness and compliance with the Americans with Disabilities Act. American Journal of Orthopsychiatry, 86(6), 620–631. https://doi.org/10.1037/ort0000177

Abstract
State licensing boards have obligations to protect the public from impaired professionals and to protect the rights of professionals applying for licensure. Competently functioning professionals who have or have had a mental health diagnosis or are being treated for a mental health condition should not be screened out, according to the Americans with Disabilities Act (ADA). A review of case law shows applicable precedents from discrimination among physicians and lawyers but not, to date, among psychologists. An examination of psychology licensure application materials from all 50 states and the District of Columbia revealed that some states, particularly Alaska, Arkansas, Colorado, Florida, Georgia, Kentucky, Missouri, Montana, and New Hampshire, include language that might screen out professionals with lived experience who are currently functioning competently. For comparison, we review a sample of licensure applications for physicians and lawyers and find a similar pattern. Five of the present authors offer ourselves and other published authors as examples of competent licensed psychologists who have lived with mental illnesses. We conclude with recommendations for more inclusive language and protection of confidentiality. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

 

[PsyDr]

Citation
Boyd, J. E., Graunke, B., Frese, F. J., Jones, J. T. R., Adkins, J. W., & Bassman, R. (2016). State psychology licensure questions about mental illness and compliance with the Americans with Disabilities Act. American Journal of Orthopsychiatry, 86(6), 620–631. https://doi.org/10.1037/ort0000177

Abstract
State licensing boards have obligations to protect the public from impaired professionals and to protect the rights of professionals applying for licensure. Competently functioning professionals who have or have had a mental health diagnosis or are being treated for a mental health condition should not be screened out, according to the Americans with Disabilities Act (ADA). A review of case law shows applicable precedents from discrimination among physicians and lawyers but not, to date, among psychologists. An examination of psychology licensure application materials from all 50 states and the District of Columbia revealed that some states, particularly Alaska, Arkansas, Colorado, Florida, Georgia, Kentucky, Missouri, Montana, and New Hampshire, include language that might screen out professionals with lived experience who are currently functioning competently. For comparison, we review a sample of licensure applications for physicians and lawyers and find a similar pattern. Five of the present authors offer ourselves and other published authors as examples of competent licensed psychologists who have lived with mental illnesses. We conclude with recommendations for more inclusive language and protection of confidentiality. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

So... there are some states that do exactly what I said. And the Trust has exactly what I said.

@futureapppsy2 boards do not care IF you have a diagnosis. They care if you have a diagnosis that IMPAIRS your work.

And of course I’m doom and gloom.

 

[futureapppsy2]

So... there are some states that do exactly what I said. And the Trust has exactly what I said.

@futureapppsy2 boards do not care IF you have a diagnosis. They care if you have a diagnosis that IMPAIRS your work.

And of course I’m doom and gloom.

In theory, yes. In practice, as noted above, some states and boards can be really vague and subjective in how they phrase it and interpret it ("have you ever been diagnosed with a physical or mental illness that COULD potentially impair...") and lying on your licensure application isn't a great idea.

Your post came across as "this will be a huge barrier your entire career", which isn't necessarily (or even likely) true. Heck, if it was, neither Hayes nor Linehan would be currently licensed, just to note some extremely famous examples. There are, again, no small number of licensed psychologists with mental illnesses, and trainees are more likely to experience barriers in training--with ableist/biased supervisors, for example--than in licensure (although some of this may be people with disabilities experiencing so much discrimination in earlier stages of training that they just leave the field entirely and never make it to the point of applying for licensure).

 

[cranberrysavage]

If you will be seeking out therapy to support and maintain your progress made in treatment (which I recommend, honestly I recommend all who go through grad school at least consider therapy or counseling) depending on where you are living and the prominence of your school in the area, it may be significantly difficult, bordering on impossible, to get services somewhere that truly feels "private." I attend a program in a rural area and in the actual sense of the word, literally every mental health agency and professional is affiliated with our training program in some way, such as supervising students individually or on placements.

I still think it is manageable, though a significant hurdle depending on training program, and maybe something worth finding a way to ask about on interviews (asking grad students, not professors). My best advice for avoiding this problem would be to be trained in a more populated area without a dearth of therapists. If it's unavoidable, I'd be happy to give more detailed advice in a PM.

 

[futureapppsy2]

If you will be seeking out therapy to support and maintain your progress made in treatment (which I recommend, honestly I recommend all who go through grad school at least consider therapy or counseling) depending on where you are living and the prominence of your school in the area, it may be significantly difficult, bordering on impossible, to get services somewhere that truly feels "private." I attend a program in a rural area and in the actual sense of the word, literally every mental health agency and professional is affiliated with our training program in some way, such as supervising students individually or on placements.

I still think it is manageable, though a significant hurdle depending on training program, and maybe something worth finding a way to ask about on interviews (asking grad students, not professors). My best advice for avoiding this problem would be to be trained in a more populated area without a dearth of therapists. If it's unavoidable, I'd be happy to give more detailed advice in a PM.

This may be easier if the OP continues to receive treatment at the VA. It would likely preclude them from doing a practicum at that VA—but might not if the VA is large and divided enough—but would likely have minimal interference with non-VA placements.

 

[AbnormalPsych]

Your history would not be a barrier to any of the gatekeepers you mentioned in my state. Criminal history can be flagged for psychologists in my state, but MH history would not bar anyone from practicing as long as it is adequately managed.

Same.

 

[WisNeuro]

I will add the caveat that while it won't be a barrier to get through all of our gatekeeper functions, @PsyDr is correct in his first post of this thread. The burden is on you to keep things well-managed. And, if you are ever brought up in a board complaint, it will likely be brought up as an issue. Also, as a piece of advice, I would never get involved with forensic/IME/medicolegal work that involved a diagnosis that I shared. As soon as its brought up once and a lawyer gets your work removed, EVERY lawyer you work against will use the tactic to question your objectivity. It's not fair, but the legal world isn't fair, and opposing counsel will use any and every tactic to discredit you that they can. They don't care, they just want their cut of the settlement.

 

[PsyDr]

In theory, yes. In practice, as noted above, some states and boards can be really vague and subjective in how they phrase it and interpret it ("have you ever been diagnosed with a physical or mental illness that COULD potentially impair...") and lying on your licensure application isn't a great idea.

Your post came across as "this will be a huge barrier your entire career", which isn't necessarily (or even likely) true. Heck, if it was, neither Hayes nor Linehan would be currently licensed, just to note some extremely famous examples. There are, again, no small number of licensed psychologists with mental illnesses, and trainees are more likely to experience barriers in training--with ableist/biased supervisors, for example--than in licensure (although some of this may be people with disabilities experiencing so much discrimination in earlier stages of training that they just leave the field entirely and never make it to the point of applying for licensure).

I can see how some would make such inferences, but that is not what I wrote. OP asked for a discussion on barriers he/she will encounter. I started a list. I did not provide value based statements about the list. He/she can come up with solutions for such barriers though preparation and/or consultation, if provided with forewarning.

 

[BuckeyeLove]

As soon as its brought up once and a lawyer gets your work removed, EVERY lawyer you work against will use the tactic to question your objectivity.

Just wondering/curious: what would this have to look like for their work to be discredited/not stipulated to/not allowed as an expert? If someone has an historical diagnosis of PTSD, and let's say they are doing an evaluation where that diagnosis is on the table and substantive to the overall opinions, how would their historical diagnosis have any baring on their proffered opinions? (if of course...it isn't impacting their functioning in any way shape or form?)

"Doctor, have you ever been diagnosed with a mental health condition? Oh you have! Which one? Oh the exact one at the heart of your analysis on my client? Do you think in any way shape or form that could have biased or shaped your overall analysis?" My answer: "Maybe...who knows. But I do know that the opinion I came to was informed not on one data point, but rather, based on the totality of the available evidence, and blah blah blah." Then it gets cleaned up on redirect. I would think it would be a bit of an illogical fallacy road for an attorney to go down in this example, especially if the evaluator is savy and knows how to testify with the best of them. I'm probably not thinking of other examples where this could get bad though, so what would that look like?

 

[WisNeuro]

Just wondering/curious: what would this have to look like for their work to be discredited/not stipulated to/not allowed as an expert? If someone has an historical diagnosis of PTSD, and let's say they are doing an evaluation where that diagnosis is on the table and substantive to the overall opinions, how would their historical diagnosis have any baring on their proffered opinions? (if of course...it isn't impacting their functioning in any way shape or form?)

"Doctor, have you ever been diagnosed with a mental health condition? Oh you have! Which one? Oh the exact one at the heart of your analysis on my client? Do you think in any way shape or form that could have biased or shaped your overall analyses?" My answer: "Maybe...who knows. But I do know that the opinion I came to was informed not on one data point, but rather, based on the totality of the available evidence, and blah blah blah." Then it gets cleaned up on redirect. I would think it would be a bit of an illogical fallacy road for an attorney to go down in this example, especially if the evaluator is savy and knows how to testify with the best of them. I'm probably not thinking of other examples where this could get bad though, so what would that look like?

A lot of the time, they don't care if it gets cleaned up on redirect, the damage is done, and the well is poisoned. They simply want the trier of fact to think that you may be biased. Additionally, they may engage in that line of questioning to get a reaction out of you. They don't care of it's necessarily relevant or not, as soon as you lose your cool, that was the intent, it discredits you in the eyes of the trier of fact.

I think too many people think that the legal world is fair-ish and rules based. It's not, especially in the assessment world. Ask people who do ME work some of the questions they have been asked by opposing counsel in depo or cross. Some of it is humorous, some of it is shocking. I'm sure plenty of people with MH histories do this work in an area they have personal experience in, just something I'd avoid, personally. Plenty of work to be had in other areas without every attorney using it to try and discredit your testimony.

 

[BuckeyeLove]

A lot of the time, they don't care if it gets cleaned up on redirect, the damage is done, and the well is poisoned. They simply want the trier of fact to think that you may be biased. Additionally, they may engage in that line of questioning to get a reaction out of you. They don't care of it's necessarily relevant or not, as soon as you lose your cool, that was the intent, it discredits you in the eyes of the trier of fact.

I guess I can see this being an issue in some jurisdictions, or maybe more in civil work where more (sadly) is on the line because $ and the attorneys may take the gloves off more? Anecdotes, but I know many evaluators who would be salivating at the chance for something like this to be brought up on the stand, solely because a. they know exactly how to respond, b. they legit get off on keeping their cool in these moments and making the attorney look foolish for even bringing it up. Most of the work I do is criminal though. The people I know that do civil work aren't usually even forensically trained, and often have no idea how to testify at all, usually getting into it because of the dollar signs.

 

[WisNeuro]

I guess I can see this being an issue in some jurisdictions, or maybe more in civil work where more (sadly) is on the line because $ and the attorneys may take the gloves off more? Anecdotes, but I know many evaluators who would be salivating at the chance for something like this to be brought up on the stand, solely because a. they know exactly how to respond, b. they legit get off on keeping their cool in these moments and making the attorney look foolish for even bringing it up. Most of the work I do is criminal though. The people I know that do civil work aren't usually even forensically trained, and often have no idea how to testify at all, usually getting into it because of the dollar signs.

Definitely more of an issue with civil work. The collegiality is definitely anything but civil in many of these that reach the depo/testimony level.

 

[BuckeyeLove]

 

[WisNeuro]

They're more passive aggressive than that these days, from a colleague of mine

Opposing counsel: So, you have your PhD.
Neuropsych: That is correct.
OC: So, that means that you are not a real doctor, then?

And that's some of the tamer attempts at attacking credibility.

 

[BuckeyeLove]

I had one who kept calling me "Mr." last week, for an hour. First time in a while actually where I could tell they were trying to get me going.

 

[PsyDr]

Just wondering/curious: what would this have to look like for their work to be discredited/not stipulated to/not allowed as an expert? If someone has an historical diagnosis of PTSD, and let's say they are doing an evaluation where that diagnosis is on the table and substantive to the overall opinions, how would their historical diagnosis have any baring on their proffered opinions? (if of course...it isn't impacting their functioning in any way shape or form?)

...

I'm not saying it's nice, or even ethical, but this is common stuff.

Dr. X, have you ever been diagnosed with a psychiatric disorder?
What is that disorder?
Are you currently diagnosed with this disorder?
Are you currently receiving any treatment for this disorder?
When was the last time you received treatment?
(In the case of military) Are you receiving disability money for this diagnosis?
Isn't it true that the distress or impairment is required for the diagnosis of PTSD?
So are you impaired or are you lying?

 

[Mama Bear]

They're more passive aggressive than that these days, from a colleague of mine

Opposing counsel: So, you have your PhD.
Neuropsych: That is correct.
OC: So, that means that you are not a real doctor, then?

And that's some of the tamer attempts at attacking credibility.

I enjoy thinking of all the petty responses I could give in these situations.

 

[WisNeuro]

I enjoy thinking of all the petty responses I could give in these situations.

The petty response is the last thing you want to respond with if you want to work with the attorney/company that hired you ever again. It shows that you got rattled, and that OC can needle you at will.

 

[Mama Bear]

The petty response is the last thing you want to respond with if you want to work with the attorney/company that hired you ever again. It shows that you got rattled, and that OC can needle you at will.

A mama bear can dream, though.

 

[deleted343839]

I was accepted to a great PsyD program and have everything fully funded. I am excited for my new career path, but would like to ask now if/what road blocks exist (either by the APA, employers, etc.) for those who have a history of mental illness?

I was in the military and have PTSD from combat. I was placed in an intensive inpatient program/trauma center for 30 days, and now am doing better but still being seen by the VA and take medication. I do not consider myself a risk to any future patients I have, nor do I get triggered by words or anything that could come up in a session I am leading.

I am fully adjusted, hard working, and crush any interviews I have faced, so I am not worried about self-imposed barriers with regards to future licensing/employment. This thread is not meant to dive into whether or not I feel my issues would effect my ability to be an effective clinical psychologist. I purely want to discuss roadblocks/filters the APA/clinics/school programs have in place. Will I be asked/denied at some point because I was (voluntarily) admitted to an intensive inpatient program for my PTSD? I don't want to waste years of my life attaining my PsyD only to get rejected later down the road.

Congratulations! I don't foresee this being a barrier. It is not uncommon for psychologists or any other health professionals to have a history of one or more mental disorders. You don't need to be an open book, but where it counts, err on the side of disclosure and candor.

Graduate school can be stressful and you may experience reactions to the work that surprise you, in which case the best course of action is to acknowledge it and seek help. If you are training in a reputable program you will receive documented feedback at regular intervals, and if you ever have a question about your performance then your supervisors should be willing to discuss this with you candidly. Evidence of impaired performance is far more likely to harm your career than evidence of a psychiatric diagnoses per se, and the best you can do is show evidence of consistent or improving evaluations over time.

I sought mental health services in graduate school with my training director's full knowledge and support. PM me if you want to discuss further.

 

[PsychRobK]

Thanks for the responses. This makes me feel a little better. It sounds like as long as I avoid the court room(s) I should avoid having my history/diagnosis dug into.

 

[R. Matey]

I had one who kept calling me "Mr." last week, for an hour. First time in a while actually where I could tell they were trying to get me going.

It’s spite. They're saying that because they have "doctorates" and aren't called “doctor.”

 

[student til 30]

History of diagnosis and treatment is a common issue covered in the ethics code. A diagnosis is only career limiting to the extent it interferes with competence or isn't managed appropriately and ethically. If you demonstrate sound judgment by seeking appropriate treatment, consultation, and maybe referring some cases out, I wouldn't worry about gatekeepers.

2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

 

[Sanman]

There no standard institutional roadblocks to stop you from getting a PsyD or practicing. Your program or your licensing board can prevent you from graduating or holdin a clinical license if your MH disorder affects your professional work. As others have said, I would stay away from forensics. Beyond that, it is up to each individual to decide if they want to take on the risk involved (time and money) to pursue a graduate education and a career in psychology. I will caution you that in this field, perception carries a lot of power. A graduate program does not need to meet some strict burden of proof to dismiss you. I know people dismissed because they simply did not get along with faculty or an adviser. If the funding is taken care of, you are only risking time and maybe a little bit of money.