Contact Congress to Vote NO on Master's Therapist Bill

[edieb]

Here is the address to locate your representatives:

www.house.gov/writerep

Here is the bill (so you can reference the number):

20. S.AMDT.988 to S.1 To provide for the coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program, and for other purposes.
Sponsor: Sen Thomas, Craig [WY] (introduced 6/23/2003) Cosponsors (1)
Latest Major Action: 6/26/2003 Senate amendment agreed to. Status: Amendment SA 988 agreed to in Senate by Voice Vote.

---

Members don't see this ad.

 

[50960]

I understand this bill may creat more competition with Medicare for psychologists and LCSW's, but is it really fair to be against it based solely on that?? After being in a medical union for 5 years I am a bit tired of people telling me how to vote just because I belong to a group, and of people deciding national issues based on how it may affect them!

 

[JatPenn]

agreed. voting against this bill seems like a purely selfish move. let's just accept the fact that there are other areas where doctorate-level psychologists are needed.

 

[Logic Prevails]

"Disagree. We need to protect the field."

Do you mean you need to protect yourself? As the previos individual has stated, there are other areas where PhD psychologists are needed. To say that ALL Masters level psyhcologists are incompetent at providing family counseling or handling 'simpler' therapy cases would be a bit much I think.

"Every time something like this happens, it makes things more difficult for us."

Depending on what you want to do I suppose. Realistically, I think there will be more Masters psychologists in the future doing therapy. I think there will be less and less people going for the PhD for the purpose of doing clinical work as the restrictions let up as to who should be doing what type of therapy. That being said, there are areas where Masters psychologists should not be practicing, and those should be the areas of focus for psychologists who are currently practicing therapy. I would suspect the more specialized areas to pay more in the long run as there are fewer and fewer individuals who are competent in providing services in these areas.

"A masters degree is not the standard of training in psychology, just as a masters degree is not the standard of training in medicine."

I don't think this is a fair comparison at all. It's scary what powers an individual has as a 'doctor' with only 4 years of training. Learning about the WHOLE BODY - and then they are labeled an expert in the eyes of most laypeople with any kind of problem they might have. In medicine you can also specialize (i.e. in ortho etc.). The way I see it is that PhD programs offer the 'specialization' component whether we want it or not. Do we really need the stats, methods, and research work under our belts to be able to practice all types of therapy. Yes, this makes it easier to keep up to date in and understand the literature relevant to our areas blah blah blah, but I don't think it is a necessity for doing certain types of intervention (i.e. family counseling or CBT provided the individual has the training). The more complicated stuff (i.e. psychodynamically oriented therapies) should be left to the PhD psychologists.

"IT is not selfish to insist on meeting that level in order to practice psychology."

No, it's not selfish if your intent is to protect the welfare of potential clients, but it may be selfish if your motive is to protect your bank account. It's a tough issue and can be debated for sure.

 

[PublicHealth]

Specialize! Psychologists are exceptionally well trained in psychological assessment. Neuropsychologists are trained even better. Master's level folks are unlikely to threaten this aspect of clinical practice. Sure, a Master's-level person can administer psychological and neuropsychological tests, but they do not have the training to interpret these findings in the broader context of neurodevelopment, functional neuroanatomy, cognitive neuroscience, and medical/psychiatric history. Clinical neuropsychology has a promising future.

 

[Logic Prevails]

"It is to the advantage of managed healthcare and the government, at least in a direct fiscal sense, to lower the standard of care."

Little biased much? The argument that I am making is that in at least SOME areas of practice I believe Masters level psychologists just as competent as those with a PhD in terms of their CLINICALLY RELEVANT skills. This would not mean "lowering the standard of care" as you put it.

"This is a common misconception among people with masters level education (i.e., it's only another two years and that's mostly stats and research)."

I'm a tad offended that you assume my misconceptions (as you see it) are related to my level of psychology relevant education. Don't let your superego get carried away. I have no misconceptions; I interact and speak with students at varying levels of PhD training about topics such as this often. Those students who don't want to become an academic wish the program was more clinically focused (my opinions are assuredly informed).

"Medicine is not 4 years of training, just as clinical psychology is not 4 years if training. It is 4 years of school, an internship, and four years or so of residency, plus a fellowship (maybe). Clinical psychology also has internship and fellowship requirements of varying lengths depending on specialty."

Right - so it goes the other way around as well. 'Masters psychologists won't have 2 years of training. They will have practica in assessment and intervention, and will likely have years of supervision before they are permitted to practice solo.' I'm arguing that this IS sufficient training for providing certain types of services as a psychologist.

"That depends on the context, patient population, and purpose that CBT is being applied to. CBT is a general category of therapy that has alot of research specific to certain disorders/symptoms."

Agreed, and that's why anyone using this technique should be trained appropriately and be familiar with the research and theory underlying its use (whether they have a PhD or Masters degree)

"Psychodynamic therapies are not more complicated and have less research support. Given that, your hierarchy should be reversed."

I disagree. Given the research and RELATIVE cookbook type fashion in which CBT can be applied, I would argue that it is much easier to learn, understand , and apply in practice. Psychodynamically oriented therapies are much harder for students to grasp in terms of how they work, and require much more therapist skill to apply. Yes, they have less research support, but I believe that is because they require a good 'mitfull' of skill for them to be effective. They certainly have their place; I think short term PDT in particular is an excellent approach if used by the right therapist.

"The more lines that are dissolved between masters and doctorate level, the more doctorate level is pushed out."

Not pushed out, but perhaps less people going that route. Not necessarily a bad thing.

"We are talking about protecting the presence of the profession in certain disciplines that are traditionally within its scope of practice."

Sometimes even tradition needs to be re-evaluated

"I see no reason to weaken the field of psychology and I don't see how doing so helps potential patients or mental health in general."

I wouldn't want to see psychology "weakened" either, but I don't see how that is related to this discussion.

 

[alexPDX]

Disagree. We need to protect the field. Every time something like this happens, it makes things more difficult for us. A masters degree is not the standard of training in psychology, just as a masters degree is not the standard of training in medicine. IT is not selfish to insist on meeting that level in order to practice psychology.

You lost that standard when LCSW were included in the medicare program. Besides, marriage and fammily therapists are already licensed and trained for this kind of intervention and are activelly doing therapy. They are included on private insurance panels, but not competent enough to see medicare patients? That is like saying that a physician is comptent enough to see Blue Cross Blue Shield patients, but not medicare patients. If this is not a clear back stabbing/guarding my turf alfa psychologist reaction, I don't know what is.

 

[edieb]

LPCs and LMFTs, who I believe do not even have 2 years of training, are also included on this bill. The scary thing about this is that the line of demarcation b/t PhDs and Masters or less is being further and further eroded.

 

[LM02]

I disagree. Given the research and RELATIVE cookbook type fashion in which CBT can be applied, I would argue that it is much easier to learn, understand , and apply in practice. Psychodynamically oriented therapies are much harder for students to grasp in terms of how they work, and require much more therapist skill to apply.

Not to get completely off topic here, but the use of "relative" doesn't cut it. If people actually believe that CBT or any other manualized treatment is conducted in a cookbook fashion, you're completely missing the point. And, in fact, you're making an argument for why advanced training is necessary.

If you apply the techniques without understanding the research supporting the underlying rationale, you might feel like you're treating someone in a cookbook way.

However, effective and competent CBT (or any other manualized Tx) relies on several things:

1. The therapist's understanding of the proposed mechanisms of change, which are grounded in research.

2. A recognition that the manual outlines techniques, skills, exercises that can be used to target those mechanisms of change. Often, these techniques have been subject to empirical scrutiny as well (e.g., research on homework adherence in CBT).

3. The clinician's skill in choosing what techniques/skills/exercises to apply at what point in the treatment. The manual provides guidance, but it is the therapist, in collaboration with the patient, who determines "what" and "when."

Altogether, this requires a firm knowledge of the "how" and the "why." If you don't know why you're doing something, it may not feel "right" to you as a therapist. My fear with master's level therapists is that they haven't spent enough time in training to fully cover both of these areas. You don't have to do research to fully understand and appreciate research. Unfortunately, I've encountered too many master's level clinicians who don't get this point.

Finally, regarding this notion that psychodynamic therapy is more "difficult" and requires "more skill" I disagree. Using CBT as an example, coming up with creative and effective behavioral experiments is harder than it sounds. Similarly, most of us are not accustomed to using Socratic methods of questioning in our daily lives. Sure, anyone can read the manual and go through an Automatic Thought Record with a patient. But there's a difference between "just doing it" and "doing it well."

Personally, it has taken me many years to feel skilled in both of these very basic CBT foundational skills.

 

[MeghanHF]

Whatever the modality, I think it’s more about the person and their expertise than their degree. Letters after a person’s name don’t always reflect the extent of their training or capacity to apply certain interventions. Sometimes it even seems to me one of the biggest distinctions is that it’s those who can afford the extra tuition, academic lifestyle, and additional interning who make it to the PhD level. In that case, maybe MA’s should get bonus points for fiscal smarts and we should vote the bill down to ensure we can pay back our student loans!

 

[Logic Prevails]

"Not to get completely off topic here, but the use of "relative" doesn't cut it. If people actually believe that CBT or any other manualized treatment is conducted in a cookbook fashion, you're completely missing the point. And, in fact, you're making an argument for why advanced training is necessary."

You're absolutely right, my glib remark was simply made to make a point, and in doing so I didn't give enough credit. By no means am I saying that any type of therapy is a true cookbook application.

"If you apply the techniques without understanding the research supporting the underlying rationale, you might feel like you're treating someone in a cookbook way."

Point taken. I agree wholeheartedly. You might feel like that and you'd probably be doing just that.

"Altogether, this requires a firm knowledge of the "how" and the "why." If you don't know why you're doing something, it may not feel "right" to you as a therapist."

Very true and well put.

"My fear with master's level therapists is that they haven't spent enough time in training to fully cover both of these areas."

A fear that should be relieved by the fact that these individuals would be required to write the same written and oral exams and have to prove their competence to a board.

"You don't have to do research to fully understand and appreciate research."

That is a very good point and relevant to the debate.

"Finally, regarding this notion that psychodynamic therapy is more "difficult" and requires "more skill" I disagree."

If you consider yourself competent in psychodynamic approaches to therapy and find that they are relatively easier to understand in theory or implement in practice compared to CBT approaches then I would love to hear your rationale. If you're just trying to say that there is more to CBT than my glib comment gave credit to... well then you're absolutely right.

 

[Logic Prevails]

"I'm not all that impressed with psychodynamic approaches. There is a rare nugget of substance within a theoretical structure that takes the long way around to stating the obvious."

From what I gather, it can be a very powerful approach (particularly short term PDT) if you're skilled enough to use it. Many people (particularly those who are extremely intelligent or habitually 'over-intillectualize' in thier lives) are great candidates for this type of therapy as many don't respond well to CBT.

"Psychodynamic theory borders on the metaphysical in some forms and, as such, doesn't really belong in the repertoire of a doctoral level practitioner (M.D., Ph.D., or otherwise)."

The generalization may almost it its mark, but again, competence is a big issue here. The theory is a bit sketchy at times, but it can be very effective in the right hands.

HEY - I thought you don't practice therapy!

Great debate Snow - just so you know, I'm not intentionally trying to get under your skin or anything - I just like getting multiple perspectives on these sorts of issues (helps to reinforce or change a fella's own views)

 

[MeghanHF]

LOL. Most Ph.D. programs pay their students to attend. I don't have any student loans.

I should've known not to chose the school with the ocean view!

...however, I wouldn't want there to be a mechanism by which said PA/nurse could get equal footing with a physician with regards to expected expertise.

Agreed. I was stretching a bit to make the point. I wouldn't want a nurse/PA performing open heart surgery on me no matter what their personality. However, if PhD's do have greater expertise than MA's in several areas, maybe it's up to us as psychologists to get clear on and educate the public about what those areas are. That way the choice is dictated by the patients seeking help instead of Medicare. Just a thought.

 

[edieb]

I think one way to begin educating the public is to vote down this bill.
I wish the APA were as active as the state psychological association here in Louisiana where no LCSW, M.A., LPC, etc. can interpret tests, diagnose, etc.

I should've known not to chose the school with the ocean view!



Agreed. I was stretching a bit to make the point. I wouldn't want a nurse/PA performing open heart surgery on me no matter what their personality. However, if PhD's do have greater expertise than MA's in several areas, maybe it's up to us as psychologists to get clear on and educate the public about what those areas are. That way the choice is dictated by the patients seeking help instead of Medicare. Just a thought.

 

[Logic Prevails]

I can't believe this thread and some of these views. Get off yer high horses would ya (just for a minute). Most of the arguments against such a bill sound like "... but that's the kind of stuff that I do!" Try some logical or unbiased arguements for a minute - please.

Since everyone likes the nurse/doctor analogy: Remember there was a time where nurses could not give needles etc. - should we petition to revoke their ability to do so because a doctor has more training and therefore (by the logic of some individuals on this board), should be able to give better injections?

Solution: have a damn licensing board determine what an individual can or can't do based on their education and experience (not the almighty PhD title).

God, you've got LCSW giving such services (probably with less intervention coursework under their belts), what the bleepin bleep is everyones issue (would you like a tissue?)

 

[LM02]

If you consider yourself competent in psychodynamic approaches to therapy and find that they are relatively easier to understand in theory or implement in practice compared to CBT approaches then I would love to hear your rationale. If you're just trying to say that there is more to CBT than my glib comment gave credit to... well then you're absolutely right.

Actually, I wasn't clear. I wasn't trying to argue that CBT was more difficult - just that the training in the two modalities is challenging in different ways.

After having taught a 2 hour class, losing my keys, and waiting in the pouring rain for my husband to rescue me, I haven't had time to read the rest of the posts. Will catch up soon.

However, I did want to make one point. Nowhere in my post did I say that I am outright against master's-level clinicians providing treatment. I just wanted to respond to your comment and throw out some concerns related to this movement.

 

[psych101]

I think it's too late to shut the barn door on this one...master's level folks can already see Medicaid clients and be reimbursed by private insurance. Sure, the rate of reimbursement is a little less, but it's more the norm to employ master's level folks than PhD-level folks. In fact, testing reimbursement rates are so ridculously low with Medicaid deciding exactly what they think it's worth (e.g., $62 an hour) that it pays MORE to do a clinical interview or therapy (services that take far less training to be qualified to do). The whole thing is insane.

 

[Sanman]

Frankly I believe that this bill is a bad idea. And I find the LCSW's can do it so I can too argument to have the same merit as the no, it will hurt my income argument. Just because it was done before does not mean that it should be done again. Like it or not, medicare allowing this sends the message that masters level professionals are competent to have unrestricted therapy licenses. I feel that it hurts everyone involved. If doctorates are forced to stop providing therapy and leave it to master's level practiitoners, it will reduce salaries across the board and patient care will suffer.
1. The idea that all psychologists acn do ther things is absurd, the fact is that most psychologists provide therapy and if everyone shifts to testing, there won't be enough patients and psychoogists will end up competing in a fierce marketplace, that is aside from the fact that you are essentially suggesting a government backed bait and switch if things continue this way.
2. Brad3117, if read you're posts correctly, what you are suggesting is not good for clients. If masters level practitioners are are only competent at certain types of therapies, then it is a disservice to the patient. In my opinion, part of being a competent psychologist is adapting you style to what works for the patient. You can't do that because you are not versed in a diverse backgrouns and you can't refer because how would know decide if something they don't know is beneficial. More later...

 

[PublicHealth]

I think one way to begin educating the public is to vote down this bill.
I wish the APA were as active as the state psychological association here in Louisiana where no LCSW, M.A., LPC, etc. can interpret tests, diagnose, etc.

How has RxP changed the practice of psychology in Louisiana?

 

[banana k]

sorry for poking my nose in--i usually don't even lurk in this forum, but this thread caught my eye on the main menu.

i won't cast my hat in either camp because i'm a grad student in a different field. BUT, i can tell you my experience: in australia, you're eligible to practice with a B.Sc. (Hons), which is roughly the level of a master's degree though it takes a slightly shorter amount of time. i have a couple acquaintances from undergrad who did their Hons theses and went on to practice... and seem to me to be pretty bloody competent. (though who am i to say, really.) and overall, the system works even though it's obviously not the same as the US.

like i said--no opinion, because i'm not informed in the least, so make of that what you will... i guess my only opinion is, well, it can be done!

 

[Logic Prevails]

Sanman:
"Brad3117, if read you're posts correctly, what you are suggesting is not good for clients. If masters level practitioners are are only competent at certain types of therapies, then it is a disservice to the patient. In my opinion, part of being a competent psychologist is adapting you style to what works for the patient. You can't do that because you are not versed in a diverse backgrouns and you can't refer because how would know decide if something they don't know is beneficial."

I see what you're getting at, and you make a good point. However, we could say the same for many new PhD practitioners as well. I am currently in a program where the MSc/PhD program is somewhat mixed. I know what coursework and practica experiences the individuals further along in the program will have. Many people are going off to do internships with little more than a working knowledge and application of CBT. I asked our clinical co ordinator when we would learn some of the other approaches to therapy (both in theory and practice). Her reply was that we would have to learn much of this stuff on our own (in theory) and apply them as we see fit and with the guidance of appropriate supervision. Additionally (I am told), we can learn from workshops and conferences. This is no different from how a Master's level practitioner would learn these techniques.

By no means am I saying that the degrees are equivalent in what cliniclal skills they provide. What I'm saying, is that even at the PhD level, there are lots of practitioners with few intervention approaches available to them in their toolbox. If I understand what you are saying correctly, you would suggest that we prevent current psychologists (the ones with their PhD's) from practicing therapy if they are only knowledgable in relatively few types of approaches to therapy.

I do hear part of what you're saying, and it has some merit, but you haven't sold me on it. In Canada (where there are Masters level psychologists), some clinics are set up so that there is a lead psychologist (with a PhD) that screens cases and gives cases to the Masters level practitioners as they feel they are capable of handling.

It seems by your logic, none of the individuals graduating from my acredited program should be practicing therapy. I think the issue is that we need to be aware of our level of knowledge and expertise. Any practitioner (masters or Phd) will likely see the value in learning more (outside of thier program & through workshops & supervision) in the interest of being a better provider of services.

 

[Logic Prevails]

Oh yeah... one more thing. I think people assume to much in terms of what a PhD gives you in clinical skills. There is so much variability among schools and where the emphasis is.

 

[RobinA]

I can't believe this thread and some of these views. Get off yer high horses would ya (just for a minute). Most of the arguments against such a bill sound like "... but that's the kind of stuff that I do!" Try some logical or unbiased arguements for a minute - please.

Since everyone likes the nurse/doctor analogy: Remember there was a time where nurses could not give needles etc. - should we petition to revoke their ability to do so because a doctor has more training and therefore (by the logic of some individuals on this board), should be able to give better injections?

Solution: have a damn licensing board determine what an individual can or can't do based on their education and experience (not the almighty PhD title).

God, you've got LCSW giving such services (probably with less intervention coursework under their belts), what the bleepin bleep is everyones issue (would you like a tissue?)

New to the board, eh? This attitude is rampant. It's the Bloods and the Crypts and the Badboys and the Jade Warriors all waving their respective degrees instead of guns. I just figure most of them will grow up eventually. Most of the Bloods and the Crypts do.

 

[alexPDX]

Like it or not, medicare allowing this sends the message that masters level professionals are competent to have unrestricted therapy licenses. I feel that it hurts everyone involved.

Those who would benefit from this bill already are already licensed for unrestricted therapy, so I don't really see your point here. This doesn't have anything to do with professional standards or quality of patient care, as these professionals would continue to see the same clients, and perform the same type of intervention they are already doing. Right now, they are able to see Mr. A, CEO of a big company, because he has private health insurance that reimburses a licensed professional counsellor or licensed marriage and familly therapist. But they cannot see grandma Betty in the nursing home, because she is on medicare? Where is the logic in this?

 

[Logic Prevails]

"Nah, it's more like people are really quick to be insulted and tend to interpret things as insulting that are not. Brad has done so a few times already."

I'm offended by that remark!
(seriously, I'm sensing some heavy countertransference here)

"This isn't about the haughty phd/psyd stomping on the just as knowledgable ms."

If it isn't, then why are some people on this board arguing this issue from the idea that regardless of their knowledge, Masters level practitioners provide subpar services? As if the glistening parchment itself gives some kind of super powers in assessment and intervention. Yeah, well I wear superman underwear - thats gotta count for something!

I feel like I'm arguing in circles. Break down those defenses man!

"People love this story:
Young, uneducated phenom knows more than his professors (Good Will Hunting) or hard-working nurse knows more than the aloof physician."

I loved that story too. I also cried at the end of braveheart (FREEEEEDDDOOOOOOOOOOOM!)

"The real world doesn't often operate that way."

No, it doesn't. But read my bit on the PhD / MSc comparison in terms of clinical coursework and training. The real world also fails to provide many PhD programs with the types of experiences that many people just assume they get. An ethical practitioner (PhD or no) will get the experiences they need to become a better provider of services.

"Allowing a lower standard of care necessarily lowers the standard to the least common denominator. We should oppose that."

AAAAARRRRRRRRHHHHHHHHHGGGGGGGG - CHARLIE BROWN!

Who's saying anything about "lowering the standard of care!" Please refer to my 'Physician giving better injections than Nurses' example. I'm NOT arguing for equivalence - I'm saying people can provide certain types of services with a Masters.