I find the honesty in your comments about what the VA is interested in refreshing - but sadly rare. Good people cannot do a full and complete job when serving the masters of numerical economics. While many excellent people with outstanding skills work for the VA - the system impedes the lion's share of their productivity and quality. The magic beans you mentioned are very important to powerful people in leadership positions at the VA. As we know, the scope of mental health needs and services are not driven by the VA policies or much influenced by it. The VA is a closed system to many people and many communities and quite frankly, they don't think much about it. It is not they don't care, they just don't think about it because it is not a part of their life. The mental health profession has changed massively in terms of providers and networks over the past 25 years an it is getting more diverse each year through the process of sanctioned licensing of various types and that is driving additional degrees and credentials into the marketplace. Who ever thought Licensed Professional Counselors would be a force existing mental health providers would need to recon with 20 years ago. When I entered healthcare those people were not licensed to do anything, now they are licensed in about every state. Need data? Look at the Psychology Today website for "therapists". Look at the training of those listed. It is very revealing. Most of those people who would not have been employable (i.e. reimbursable) 25 years ago because their sanctioned licenses did not exist and their practice boundaries were much narrower. Now through years of new "regulations", the differences in mental health providers has largely disappeared in the minds of the public. Simply put,there is excellent training (and some crap training), throughout the professional preparation system, but innovation should not be something any of us should fear. The model of new forms of professional development may have been launched or illustrated by the introduction of the Psy.D degree, but considering its rise in popularity and influence, I do not feel such degree development will be the last. The Psy.D degree fills a need in something or somebody and my opinion what that is is not very powerful or relevant. The marketplace makes those calculations. The last chapter is not written on the functionality or utility of the DBH degree or its holders, that largely rests with THEM. People seeking those degrees are adults and I for one am not in a position to be their guardian or worse, their guidance counselor. They have an opportunity to prove themselves and that is okay for me. They spend their money at their own peril - just like the rest of the world in almost every aspect of employment and its intersection with economics. They (DBH'ers) are licensed mental health providers anyway and the additional training in integrated care is yet to be fully realized in the primary care system. They (the DBH holders) have their work cut out for them without my criticism or comment. Whatever happens will be a change in how the system works - noting I am not the systems guardian either. Change is sometimes difficult to understand, even resented or feared. That fear and resentment is a reflection of the shadow of change all of us see in the mirror - as it places doubt in our own minds about our own decisions. I am not sure that is all bad. The DBH is not the boogie man no matter how much anyone want it to be.If you want to get empirical and examine the effectiveness of the 'Choice' program in satisfying veteran's healthcare needs then I invite you to survey (ask) a few veterans about what their experience has been with it.
One of the biggest issues with the VA and its public image is that the negatives are always published and covered in detail in the media but the positives go largely unappreciated. The folks we provide good mental health treatment to (for example, a recent veteran with PTSD who just completed cognitive processing therapy with me and who was able to see how his symptom scores were reduced to about 20-30% of their original severity since starting treatment, his expanded social network (that he attributes to the therapy) going from zero friends/buddies to about 4-5 buddies that he socializes regularly with, and the improvement in the trajectory that his marital relationship (things are going much better now)...these never make it to the media because the folks who are truly suffering from PTSD just want to get help, get better, and be left alone to live their lives (they're not the ones, generally, who are going to be front and center in the media).
I apologize for the negative tone of my rant in a prior post...I actually love the central mission of my job (applying psychological science (with a good dose of human fallibility and sincere desire to connect with others who are suffering) to address psychological problems). I am grateful for the VA for providing me an opportunity to do this on a regular basis and job security so I can focus on my central mission as a provider. Of course I (and other providers) get frustrated at times when we reflect on how much better a job we could do (and how the job could be even better) if, basically, the administrators/bureaucrats would just get out of the way and let us do what we do. Alternatively, if they are truly interested in my work ethic with respect to my caseload, then they can interview me on the spot at any time and I will gladly share my case formulation, diagnostics, rationale for current interventions, etc. But they aren't interested in that, they want to count magic beans.
). Somewhere in the first few weeks of that course, we would've been exposed to Festinger's work, as well as that of those who followed him (most of us actually probably were exposed to cognitive dissonance theory and research as undergraduates). As a a result, we know that the answers we would get as a result of "asking the graduates" how they feel would likely be biased, and thus more objective data is necessary to support the costs of a DBH degree.
Us graduates of traditional, APA approved clinical training programs were required to take a course in social psychology (I know- pretty myopic and "non-integrated" right
Sorry. I'll get back to calculating ANOVAS by hand and treating the symptoms but not the person, just like I was trained.Hey doofus, training in basic psychological science is not needed in order to effectively diagnose and treat behavioral or psychological disturbances in primary care because it such a unique setting where none of the other rules apply do the vastly shifting healthcare system , didn't you get the memo?
