Decline of the Field & APA's Role?

[foreverbull]

I didn't want to derail the other thread about pursuing a psychology doctorate, but I found this letter from a state psych association member to be interesting. It's long, but if you have some time, it's worth a read. Feel free to share your thoughts on whether you agree with him or not about APA failing to act in psychologists' best interests (as he outlines below).

"The last decade has been a tough one for professional psychology. The profession has been divided by the Hoffman Report, and disputes over resource allocation within APA, whose enrollment continues to sputter. Medicare has imposed onerous documentation requirements, and is now routinely discouraging utilization through the “Targeted Probe and Education” (“TPE”) process, while Medicare reimbursement is currently only 5% greater than it was in 1985 (worth about a third as much), and is increasingly subject to labyrinthine value-based reimbursement formulae. Private health insurance rates have not been much better. With growing frequency, articles appear in professional journals and trade publications questioning the viability of the profession.

Many explanations have been offered for psychology’s diminishing status. These include questioning psychotherapy’s efficacy, or whether experienced clinicians achieve better outcomes than amateurs; the profession’s failure to “keep up with the times;” and possibly, the inability of the economy to support outpatient psychotherapy. It is notable that all of these explanations come from professional psychology, which blames itself for its loss of status and potentially dark future.

There is, however, another possible explanation for psychology’s sinking status and potential demise. It is that the profession’s leadership continues to make a series of decisions that have become self-fulfilling prophecies of doom. Here are some examples:

1. Rather than advocating for adequate reimbursement and manageable documentation requirements for independent practitioner psychologists (IPPs) with the Center for Medicare and Medicaid Services (CMS) and private insurers, psychology’s professional associations -- the profession’s nominal advocacy groups and leaders -- have largely side-stepped third-party reimbursement and documentation issues. Instead, they have encouraged IPPs to “familiarize yourself with MIPS/PQRS/EHRs” (CMS documentation requirements), and APA has partnered with Healthmonix, a for-profit company that sells such services to psychologists. For the IPP, it is difficult not to feel that APA is working for the other side: CMS and private insurers. In any event, the lack of advocacy has only led to lower reimbursement rates and increased documentation requirements, making third-party payment less attractive and thus reducing the range of practice options for the profession. Consequently, it has also made it all but impossible to find a psychologist who accepts new Medicare referrals.

2. For decades, APA and state associations have encouraged IPPs to “develop alternative income streams,” or “develop a cash only practice.” In other words, to give up on billing insurance and/or independent practice, with the possible exception of boutique practices catering to the very wealthy.

3. More recently, APA and state associations have encouraged IPPs to pursue careers in Integrated Primary Health Care (“IPHC”) settings. For the last three years, APA has aggressively promoted work in IPHC settings, sponsoring an online IPHC training program funded by a 2016 $2 million grant from none other than…CMS. Why CMS is so invested in pushing IPPs and ECPs into IPHC is simple: in IPHC settings, mental health care is capitated, triage-based (read: extremely time-limited), and thus, of minimal cost to CMS. Why our own professional associations see this as a priority – over the promotion of independent practice – is unclear, and contributes both to the impression that our leadership has taken sides with CMS, and to the self-fulfilling prophecy of an end to independent practice.

4. Speaking of the IPHC model, the Viewpoint section of the last issue of the National Psychologist (March/April 2019, Volume 28, No.2) features an article by Morgan Sammons, Ph.D., Executive Director of the National Register of Health Service Psychologists (another prominent national organization nominally committed to promoting professional psychology). The article is entitled “Integrated care is future for psychology.” The article promotes APA’s agenda to place more psychologists in primary medical health settings as members of a treatment team, and bemoans current doctoral psychology training programs that “mainly imbue our graduate students with a skill set aimed at independent or specialty mental health practice.”

The data, however, indicate quite the opposite. Doctoral psychology programs have historically failed to prepare students for independent practice, offering not a single course in small business management, business economics, or even contract law.

Rather, doctoral psychology programs have notoriously emphasized skills in research and teaching, requiring coursework in advanced statistics, research design and methodology, and of course, the preparation of a research dissertation. These requirements have little to do with the practice of psychotherapy or running a small business, explicitly preparing students for academic careers, and rather transparently demonstrating the bias of the career academicians who constitute the faculties and administrators of doctoral psychology programs. It can be argued that doctoral psychology students are being programmed to fail in a business environment, which collectively means programming independent practice for failure.

In fact, the IPHC model has serious limitations. First and foremost, the number of employment opportunities for licensed psychologists in IPHC settings is extremely limited. APA has been tight-lipped about the number (much less the percentage) of psychologists employed in IPHC settings. The reality is that the vast majority of licensed psychologists continue to work as IPPs.

Second, despite APA’s flowery rhetoric, licensed psychologists in IPHC settings are de facto in roles subordinate (if not subservient) to physicians, and do not practice to the full extent of their licensure. Their roles as “team members” are limited to assessment and referral of patients flagged as potential “mental health patients” by physicians or screening staff.

Third, the IPHC model begs the question of to whom referral will then be made – ostensibly, an IPP. But the spin from APA and the National Register suggests that there is no future as an IPP. So to whom will the licensed psychologist working in an IPHC setting refer patients for outpatient mental health treatment? This hole in the model represents a logical tautology that should be obvious and is frankly an embarrassment.

Fourth, I can speak from experience as a licensed psychologist who has worked as a team member in hospital settings for over 35 years, as an employee in a psychiatric unit, as a member of the medical staff in psychiatric departments, as the chair of a psychiatric department, and as an IPP consultant. For decades, I’ve provided on-call emergency room (ER) coverage, and ER and inpatient consultation on an ongoing basis – not incidentally, exactly the assessment and referral work purportedly only available to psychologists who are employed in the IPHC setting.

My experience has been that as a hospital employee member of the treatment team, I was absolutely subordinate to physician staff (as is everyone employed in a hospital setting). It is only as an IPP medical staff member that I have been permitted to practice the full extent of my licensure and training, and accorded collegial respect in hospital and clinic settings by physicians.

5. The lead story on the cover of the same issue of the National Psychologist was entitled “APA council moves master’s accreditation closer to reality.” According to the article, 87 of the 174 American Psychological Association council members voted in favor of accepting a task force report that establishes how APA could establish that accreditation. Although 87 is exactly 50% of 174, APA CEO Arthur C. Evans, Ph.D., is quoted in the article as saying “It really was a mandate.” How 50% represents a mandate is a mystery to me, but perhaps that is why I am not a high-ranking official in a national professional psychology advocacy organization. As a naif in that realm, my mind rather goes to terms like “hyperbolae.”

What is not a mystery, or shouldn’t be, is the direction that master’s accreditation will take professional psychology. What it means is de facto elevation of the status of the master’s degree. Anointing the master’s degree with the APA blessing opens the door for stronger arguments against the necessity of a doctoral degree for the independent practice of professional psychology. For decades, this has been the argument employed by state and national Marriage and Family Therapist (MFT) associations, which have been successful in gradually encroaching into territory once held only by licensed psychologists (psychological testing, diagnosing, third-party reimbursement).

Not coincidentally, MFT graduate programs emphasize business coursework, engendering a mentality in newly-minted MFTs that not only makes them more business-minded and thus more successful independent practitioners, but also a more organized and cohesive professional group, with much larger memberships and much more powerful lobbies than those commanded by professional psychology -- whose state and national professional associations continue to lose members, and are torn by internal conflicts.

6. In combination with promotion of the IPHC setting as “psychology’s future,” elevated status for the master’s degree in psychology leads to the inevitable conclusion that MA level “psychologists,” or perhaps in today’s parlance, the more cautious term “psychological technicians,” will be preferred by IPHC employers over licensed psychologists. After all, MA level people are perfectly capable of brief assessment and referral, MFT professional organizations have already won MA level therapists the legal right to use most psychological assessment instruments, and frankly MA people will accept lower rates of reimbursement than that expected by people with earned doctoral degrees. In short: accreditation of MA level psychotherapists and promotion of the IPHC model is a formula for the extinction of doctoral level psychologists.

7. APA’s corporate Executive Director receives an annual salary approximating ¾ of one million dollars, while Medicare’s reimbursement rates to practicing psychologists hover within 5% of 1985 figures. There is no current incentive for APA’s corporate administrators to protect or increase reimbursement to practicing psychologists. APA is essentially paying a sales representatives a base salary that exceeds that of the company’s owners, with no link between performance and reimbursement. Lacking incentive to protect psychologist reimbursement, APA’s executives continue to make decisions that are bad for practicing psychologists, but have no negative consequences for APA administrators. This is a corporate formula for disaster. "

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[PsyDr]

Wanna hear a sick fact? Psychologists used to be allowed to bill e/m codes. We just gave it up. Which means we could sue to restore them. Apa instead lobbies.

 

[WisNeuro]

Kind of a rambling read. Some fair points, many are a little off the mark. I hear many people voice some dissatisfaction about the APA. Almost all of these people tend to be people who have never run for office in a psych association, and have not been APAP members for some time, and d not contribute to the APAPO. They expect the APA to work miracles with little direct input, and little money with which to lobby with. It's like telling a school to increase student test sores, cut their funding every year, and then yell at them when the test scores continue to fall. As a field we have lacked any serious participation and financial follow through. It's on us as a field. Some missteps are made, as in any large org, but it's mostly our collective apathy and unwillingness to give a damn.

The pattern with APA is mirrored at the state level. Memberships are almost universally declining in state psych associations. And, as a result, fewer people and fewer resources to lobby and advocate for state level legislation, which can in turn influence federal level legislation. We're killing ourselves here. Even great leaders can't overcome the level of complacency and passivity in the field right now.

 

[Sanman]

Kind of a rambling read. Some fair points, many are a little off the mark. I hear many people voice some dissatisfaction about the APA. Almost all of these people tend to be people who have never run for office in a psych association, and have not been APAP members for some time, and d not contribute to the APAPO. They expect the APA to work miracles with little direct input, and little money with which to lobby with. It's like telling a school to increase student test sores, cut their funding every year, and then yell at them when the test scores continue to fall. As a field we have lacked any serious participation and financial follow through. It's on us as a field. Some missteps are made, as in any large org, but it's mostly our collective apathy and unwillingness to give a damn.

The pattern with APA is mirrored at the state level. Memberships are almost universally declining in state psych associations. And, as a result, fewer people and fewer resources to lobby and advocate for state level legislation, which can in turn influence federal level legislation. We're killing ourselves here. Even great leaders can't overcome the level of complacency and passivity in the field right now.

It is a bit chicken or the egg. I don't think it is complacency. Between student loan debt and decreasing reimbursement, contributing money to the APA, state psych orgs, specialty orgs, etc can be a stretch. I know that I was not consistent with memberships until achieving a position with greater time and reimbursement than my previous jobs. APA and my state org fees are not cheap. My specialty org is cheap and was recently made cheaper.

There are some good points in the article and some that have been missed entirely. I will jump in with more thoughts later.

 

[Justanothergrad]

Agreed with WisNeuro. There are a lot of good points in there and a few that miss the mark. A lot of the points about billing advocacy and approaches to ensuring parity in access to codes/representation in medical settings/etc are valid. There are alternative views, of course, and some might argue we need to prove our utility first (c.f., why some suggest that why neuro is more esteemed compared to other HSP specialties/proficiencies/etc). That's a debate for elsewhere though. APA hasn't done a good job of advocating for psych billing, and neither have psychologists as a whole.

The dismissing of research training is something that strikes me a big odd given the ability to provide a number of decisive advantages in the age of evidence-based evaluation/assessment. Likewise, the promotion of mid-level providers within a psych training model is beyond needed - that only 50% voted to approve speaks not to it being not wanted, but how out of touch the APA is. How we define MA level training is important here, as the author points out, but to pretend like we can stop a field in which we are a minority is ignorant at best. If we had done this first and established competency benchmarks for areas we wanted to preserve (e.g., assessment), then maybe we could have hedged this process a bit more. Anyone who thinks that MA level clinicians are trained in assessment and competent should present some data to me to show that - the evidence doesn't suggest sufficient training at a doctoral level. I can't imagine that it looks BETTER with less training. Ugh. My frustration with the field's handling of assessment really sparks me up.... I guess I'll write more on these competency papers now that I've finished this post.

 

[WisNeuro]

It is a bit chicken or the egg. I don't think it is complacency. Between student loan debt and decreasing reimbursement, contributing money to the APA, state psych orgs, specialty orgs, etc can be a stretch. I know that I was not consistent with memberships until achieving a position with greater time and reimbursement than my previous jobs. APA and my state org fees are not cheap. My specialty org is cheap and was recently made cheaper.

There are some good points in the article and some that have been missed entirely. I will jump in with more thoughts later.

I think a very significant amount is complacency. For example, many healthcare organizations will pay for x number of professional affiliations. I get two automatically. This is aside from them already covering all of my license and board cert fees. This is true for all psychologists in the organization. In talking to more than a handful of other psychologists in the system I am the only one who is a member of the state psych association, and I only talked with one other person who is a member of APA. This is despite our system being willing to pay for some of these costs. Even if you have one specialty org membership, that still leaves one paid membership for state or APA. After that, professionals should easily be able to afford one membership. Heck, just pay for the cheapest one out of pocket. We can't even get people to join up when someone else is footing the bill! I put this problem at 80% psychologists in general, and 20% in leadership.

 

[Sanman]

I think a very significant amount is complacency. For example, many healthcare organizations will pay for x number of professional affiliations. I get two automatically. This is aside from them already covering all of my license and board cert fees. This is true for all psychologists in the organization. In talking to more than a handful of other psychologists in the system I am the only one who is a member of the state psych association, and I only talked with one other person who is a member of APA. This is despite our system being willing to pay for some of these costs. Even if you have one specialty org membership, that still leaves one paid membership for state or APA. After that, professionals should easily be able to afford one membership. Heck, just pay for the cheapest one out of pocket. We can't even get people to join up when someone else is footing the bill! I put this problem at 80% psychologists in general, and 20% in leadership.

Never had any organization offer to pay for those things for me. I wonder how common that is.

 

[WisNeuro]

Never had any organization offer to pay for those things for me. I wonder how common that is.

The 3 largest non-VA healthcare systems in my state offer these benefits as far as I know. Don't know much about the smaller, rural based systems.

 

[singasongofjoy]

Wanna hear a sick fact? Psychologists used to be allowed to bill e/m codes. We just gave it up. Which means we could sue to restore them. Apa instead lobbies.

Did not know that. When did that change?

 

[PsyDr]

Did not know that. When did that change?

IIRC, sometime after the 4th edition of the CPT codebook.

 

[Peacemaker36]

I didn't want to derail the other thread about pursuing a psychology doctorate, but I found this letter from a state psych association member to be interesting. It's long, but if you have some time, it's worth a read. Feel free to share your thoughts on whether you agree with him or not about APA failing to act in psychologists' best interests (as he outlines below).

"The last decade has been a tough one for professional psychology. The profession has been divided by the Hoffman Report, and disputes over resource allocation within APA, whose enrollment continues to sputter. Medicare has imposed onerous documentation requirements, and is now routinely discouraging utilization through the “Targeted Probe and Education” (“TPE”) process, while Medicare reimbursement is currently only 5% greater than it was in 1985 (worth about a third as much), and is increasingly subject to labyrinthine value-based reimbursement formulae. Private health insurance rates have not been much better. With growing frequency, articles appear in professional journals and trade publications questioning the viability of the profession.

Many explanations have been offered for psychology’s diminishing status. These include questioning psychotherapy’s efficacy, or whether experienced clinicians achieve better outcomes than amateurs; the profession’s failure to “keep up with the times;” and possibly, the inability of the economy to support outpatient psychotherapy. It is notable that all of these explanations come from professional psychology, which blames itself for its loss of status and potentially dark future.

There is, however, another possible explanation for psychology’s sinking status and potential demise. It is that the profession’s leadership continues to make a series of decisions that have become self-fulfilling prophecies of doom. Here are some examples:

1. Rather than advocating for adequate reimbursement and manageable documentation requirements for independent practitioner psychologists (IPPs) with the Center for Medicare and Medicaid Services (CMS) and private insurers, psychology’s professional associations -- the profession’s nominal advocacy groups and leaders -- have largely side-stepped third-party reimbursement and documentation issues. Instead, they have encouraged IPPs to “familiarize yourself with MIPS/PQRS/EHRs” (CMS documentation requirements), and APA has partnered with Healthmonix, a for-profit company that sells such services to psychologists. For the IPP, it is difficult not to feel that APA is working for the other side: CMS and private insurers. In any event, the lack of advocacy has only led to lower reimbursement rates and increased documentation requirements, making third-party payment less attractive and thus reducing the range of practice options for the profession. Consequently, it has also made it all but impossible to find a psychologist who accepts new Medicare referrals.

2. For decades, APA and state associations have encouraged IPPs to “develop alternative income streams,” or “develop a cash only practice.” In other words, to give up on billing insurance and/or independent practice, with the possible exception of boutique practices catering to the very wealthy.

3. More recently, APA and state associations have encouraged IPPs to pursue careers in Integrated Primary Health Care (“IPHC”) settings. For the last three years, APA has aggressively promoted work in IPHC settings, sponsoring an online IPHC training program funded by a 2016 $2 million grant from none other than…CMS. Why CMS is so invested in pushing IPPs and ECPs into IPHC is simple: in IPHC settings, mental health care is capitated, triage-based (read: extremely time-limited), and thus, of minimal cost to CMS. Why our own professional associations see this as a priority – over the promotion of independent practice – is unclear, and contributes both to the impression that our leadership has taken sides with CMS, and to the self-fulfilling prophecy of an end to independent practice.

4. Speaking of the IPHC model, the Viewpoint section of the last issue of the National Psychologist (March/April 2019, Volume 28, No.2) features an article by Morgan Sammons, Ph.D., Executive Director of the National Register of Health Service Psychologists (another prominent national organization nominally committed to promoting professional psychology). The article is entitled “Integrated care is future for psychology.” The article promotes APA’s agenda to place more psychologists in primary medical health settings as members of a treatment team, and bemoans current doctoral psychology training programs that “mainly imbue our graduate students with a skill set aimed at independent or specialty mental health practice.”

The data, however, indicate quite the opposite. Doctoral psychology programs have historically failed to prepare students for independent practice, offering not a single course in small business management, business economics, or even contract law.

Rather, doctoral psychology programs have notoriously emphasized skills in research and teaching, requiring coursework in advanced statistics, research design and methodology, and of course, the preparation of a research dissertation. These requirements have little to do with the practice of psychotherapy or running a small business, explicitly preparing students for academic careers, and rather transparently demonstrating the bias of the career academicians who constitute the faculties and administrators of doctoral psychology programs. It can be argued that doctoral psychology students are being programmed to fail in a business environment, which collectively means programming independent practice for failure.

In fact, the IPHC model has serious limitations. First and foremost, the number of employment opportunities for licensed psychologists in IPHC settings is extremely limited. APA has been tight-lipped about the number (much less the percentage) of psychologists employed in IPHC settings. The reality is that the vast majority of licensed psychologists continue to work as IPPs.

Second, despite APA’s flowery rhetoric, licensed psychologists in IPHC settings are de facto in roles subordinate (if not subservient) to physicians, and do not practice to the full extent of their licensure. Their roles as “team members” are limited to assessment and referral of patients flagged as potential “mental health patients” by physicians or screening staff.

Third, the IPHC model begs the question of to whom referral will then be made – ostensibly, an IPP. But the spin from APA and the National Register suggests that there is no future as an IPP. So to whom will the licensed psychologist working in an IPHC setting refer patients for outpatient mental health treatment? This hole in the model represents a logical tautology that should be obvious and is frankly an embarrassment.

Fourth, I can speak from experience as a licensed psychologist who has worked as a team member in hospital settings for over 35 years, as an employee in a psychiatric unit, as a member of the medical staff in psychiatric departments, as the chair of a psychiatric department, and as an IPP consultant. For decades, I’ve provided on-call emergency room (ER) coverage, and ER and inpatient consultation on an ongoing basis – not incidentally, exactly the assessment and referral work purportedly only available to psychologists who are employed in the IPHC setting.

My experience has been that as a hospital employee member of the treatment team, I was absolutely subordinate to physician staff (as is everyone employed in a hospital setting). It is only as an IPP medical staff member that I have been permitted to practice the full extent of my licensure and training, and accorded collegial respect in hospital and clinic settings by physicians.

5. The lead story on the cover of the same issue of the National Psychologist was entitled “APA council moves master’s accreditation closer to reality.” According to the article, 87 of the 174 American Psychological Association council members voted in favor of accepting a task force report that establishes how APA could establish that accreditation. Although 87 is exactly 50% of 174, APA CEO Arthur C. Evans, Ph.D., is quoted in the article as saying “It really was a mandate.” How 50% represents a mandate is a mystery to me, but perhaps that is why I am not a high-ranking official in a national professional psychology advocacy organization. As a naif in that realm, my mind rather goes to terms like “hyperbolae.”

What is not a mystery, or shouldn’t be, is the direction that master’s accreditation will take professional psychology. What it means is de facto elevation of the status of the master’s degree. Anointing the master’s degree with the APA blessing opens the door for stronger arguments against the necessity of a doctoral degree for the independent practice of professional psychology. For decades, this has been the argument employed by state and national Marriage and Family Therapist (MFT) associations, which have been successful in gradually encroaching into territory once held only by licensed psychologists (psychological testing, diagnosing, third-party reimbursement).

Not coincidentally, MFT graduate programs emphasize business coursework, engendering a mentality in newly-minted MFTs that not only makes them more business-minded and thus more successful independent practitioners, but also a more organized and cohesive professional group, with much larger memberships and much more powerful lobbies than those commanded by professional psychology -- whose state and national professional associations continue to lose members, and are torn by internal conflicts.

6. In combination with promotion of the IPHC setting as “psychology’s future,” elevated status for the master’s degree in psychology leads to the inevitable conclusion that MA level “psychologists,” or perhaps in today’s parlance, the more cautious term “psychological technicians,” will be preferred by IPHC employers over licensed psychologists. After all, MA level people are perfectly capable of brief assessment and referral, MFT professional organizations have already won MA level therapists the legal right to use most psychological assessment instruments, and frankly MA people will accept lower rates of reimbursement than that expected by people with earned doctoral degrees. In short: accreditation of MA level psychotherapists and promotion of the IPHC model is a formula for the extinction of doctoral level psychologists.

7. APA’s corporate Executive Director receives an annual salary approximating ¾ of one million dollars, while Medicare’s reimbursement rates to practicing psychologists hover within 5% of 1985 figures. There is no current incentive for APA’s corporate administrators to protect or increase reimbursement to practicing psychologists. APA is essentially paying a sales representatives a base salary that exceeds that of the company’s owners, with no link between performance and reimbursement. Lacking incentive to protect psychologist reimbursement, APA’s executives continue to make decisions that are bad for practicing psychologists, but have no negative consequences for APA administrators. This is a corporate formula for disaster. "

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For psychologists in private practice (in other words for the majority of psychologists), this post articulates a lot of serious issues very accurately.
Join your member associations! Pay your dues!

 

[Sanman]

Agreed with WisNeuro. There are a lot of good points in there and a few that miss the mark. A lot of the points about billing advocacy and approaches to ensuring parity in access to codes/representation in medical settings/etc are valid. There are alternative views, of course, and some might argue we need to prove our utility first (c.f., why some suggest that why neuro is more esteemed compared to other HSP specialties/proficiencies/etc). That's a debate for elsewhere though. APA hasn't done a good job of advocating for psych billing, and neither have psychologists as a whole.

The dismissing of research training is something that strikes me a big odd given the ability to provide a number of decisive advantages in the age of evidence-based evaluation/assessment. Likewise, the promotion of mid-level providers within a psych training model is beyond needed - that only 50% voted to approve speaks not to it being not wanted, but how out of touch the APA is. How we define MA level training is important here, as the author points out, but to pretend like we can stop a field in which we are a minority is ignorant at best. If we had done this first and established competency benchmarks for areas we wanted to preserve (e.g., assessment), then maybe we could have hedged this process a bit more. Anyone who thinks that MA level clinicians are trained in assessment and competent should present some data to me to show that - the evidence doesn't suggest sufficient training at a doctoral level. I can't imagine that it looks BETTER with less training. Ugh. My frustration with the field's handling of assessment really sparks me up.... I guess I'll write more on these competency papers now that I've finished this post.

I don't think the original article is dismissing research training as much as it is highlighting the lack of other training (such as business skills) that are not emphasized in graduate school. Basic training is good, but I would rather a business class than publishing my 5th article given that I am a clinician and not an academic (and so are most people entering the field). There is something to be said the lack of change in graduate curriculum and training despite the change in job demographics.

Likewise, mid-levels are needed and encroachment has already occurred. However, the question is how well will psychology delineate tasks and provide discrete job tasks for doctoral level clinicians. Will it be like physicians and PAs where oversight is required or will it take positions away from more expensive doctoral practitioners with no oversight needed.

Something that has not been brought up is the larger context. Psychology has spent years hitching it's hopes and dreams on the medical model that does not currently reimburse "thinking" professions well. Add to that, psychology has done a poor job of defining a concrete task that it can define for the system. Therapy encompasses a lot of things and idea is muddled in many minds for that reason. The hope is that value-based care will improve the position of psychologists by showing their role in reducing costs and improving adherence, but without defining our role clearly. Colleagues in healthcare often define what I do as "magic" for some of our patients. Unfortunately, I can't bill for magic and billing codes are poorly setup for many of the newer positions in integrated care. Health and behavior codes often reimburse less than psychotherapy codes for equivalent time. So, other than neuropsych testing, what is the concrete well-reimbursed task that psychology is protecting?

 

[foreverbull]

There is something to be said the lack of change in graduate curriculum and training despite the change in job demographics.

Likewise, mid-levels are needed and encroachment has already occured. However, the question is how well will psychology delineate tasks and provide discreet job tasks for doctoral level clinicians. Will it be like physicians and PAs where oversight is required or will it take positions away from more expensive doctoral practitioners with no oversight needed.

Something that has not been brought up is the larger context. Psychology has spent years hitching it's hopes and dreams on the medical model that does not currently reimburse "thinking" professions well. Add to that, psychology has done a poor job of defining a concrete task that it can define for the system. Therapy is encompasses a lot of things and idea is muddled in many minds for that reason. The hope is that value-based care will improve the position of psychologists by showing their role in reducing costs and improving adherence, but without defining our role clearly. Colleagues in healthcare often define what I do as "magic" for some of our patients. Unfortunately, I can't bill for magic and billing codes are poorly setup for many of the newer positions in integrated care. Health and behavior codes often reimburse less than psychotherapy codes for equivalent time. So, other than neuropsych testing, what is the concrete well-reimbursed task that psychology is protecting?

I think this is a huge problem. Out in the job market, psychologists are seen as a more expensive version of master's level therapist, just with more years of training. Instead of being trained across all doctoral programs in a particular skill that goes beyond what master's level folks are able to practice, we are indistinguishable other than assessment, which is spotty training, not standard (my program had 2-3 required classes with assessment components, but we had to seek out our own assessment practica experiences outside of that because it wasn't emphasized in practice nor were assessment practica standard. My program definitely trained more for academia, and most faculty were not competent in assesment). Further, our research background certainly doesn't matter to the rest of the world, only within psychology. People who don't know research well are naive to what they are actually missing without that training.

I find it sad that most people in the public who come to therapy (and my private practice) don't know the difference between doctoral training and master's level training (a few sought me out because of my doctorate, but some don't even know I have a doctorate). If the public doesn't pay attention to the difference, how can we expect to survive in a market in which we charge more for our services when the differences aren't even clear? I don't even charge more than what master's level therapists charge in my area because my rate is standard for ECPs in my area and master's level practitioners simply match that rate.

I agree with the author on some points about private practice being the far more common outcome for doctoral-level practitioners and our complete lack of graduate training in that area, which leaves us poorly-prepared for the job market. If psychology moves more in the health psychology direction (I'm pretty sure my program added a Health Psychology course as part of the standard coursework after I left), how many grad students can reasonably expect to be employed in medical settings if they're just part of a team doing triage/assessment for a large number of patients? I would imagine it wouldn't open up a lot of jobs for psychologists, with the majority still seeking jobs elsewhere (as is true for academia). What of the majority of psychologists? What are we training them to do in the job market?

I'm wondering if we really missed the boat as a profession to distinguish ourselves, and if so, is there a way to fix this through our state/local organizations pressuring insurance companies, etc. Or as @PSYDR mentioned, suing to get billing privileges in the medical system and/or suing for underpayment. Folks in here have mentioned how powerful the MFT and SW organizations have been at organizing/lobbying for their autonomy and share in the job market. What about our own organizations? Why haven't they been successful at the same endeavor?

EDIT: Is the only way for psychologists to distinguish themselves through neuropsych training? I'm wondering if programs need to revamp their courses/practica to provide this as an integral part of the training curriculum and practice in the future if we are to distinguish ourselves. Neuropsych seems to be the only area that master's level therapists haven't been able to encroach upon.

 

[AcronymAllergy]

A couple random thoughts:

Psychology seems to have trouble defining (for others AND ourselves) who we are and what we actually do, particularly outside academia. What are our universal (or near-universal) areas of expertise? Compounding this has been a hesitancy to stand up for ourselves professionally and politically, and to spend more time nit-picking and tearing ourselves down internally than building ourselves up to others. Answering the question of who we are/what we do might go a long way toward focusing our professional identity and advocacy efforts, the latter of which, by necessity as a result of the ambiguity of the former, are pretty hodgepodge.

Money. Like folks above have mentioned, lobbying takes money, and politicians do a lot to dictate practice in healthcare (in addition to plenty of other industries; see: tariffs). Psych associations just don't seem to have as much money as in other professions, and psychologists seem more hesitant to support practice organizations as a whole. Without money, nothing gets done.

 

[PsyDr]

EDIT: Is the only way for psychologists to distinguish themselves through neuropsych training? I'm wondering if programs need to revamp their courses/practica to provide this as an integral part of the training curriculum and practice in the future if we are to distinguish ourselves. Neuropsych seems to be the only area that master's level therapists haven't been able to encroach upon.

There's a bunch of ways, but it gets ignored.

1) Psychologists can admit in some states. This is profitable as hell.
2) Psychologists can be paid for the behavioral component of fMRI testing. Few actually do this.
3) IIRC JCAHO requires a psychologist to be on staff at every psychiatric hospital.
4) RxP.

 

[Sanman]

There's a bunch of ways, but it gets ignored.

1) Psychologists can admit in some states. This is profitable as hell.
2) Psychologists can be paid for the behavioral component of fMRI testing. Few actually do this.
3) IIRC JCAHO requires a psychologist to be on staff at every psychiatric hospital.
4) RxP.

A bigger one than those, only psychologists, psychiatrists, and Psych NPs/PA have the ability to bill medicaid/medicare for services in a skilled nursing facility. A big reason I moved towards geriatrics work.

 

[Sanman]

Hmm. We have a lot of dead weight in the field. APA, for years, had Argosy as a sponsor. I'm not paying money into an organization that does that. They can be idiots on their time and dime.

A bigger issue with money is the identity crisis in the field. Just because I am paying dues, it doesn't mean APA is going to be advocating for my needs. They may advocate against it. If they fight for increased reimbursement of behavioral interventions great for me (maybe not so great for others). If they begin limiting certain assessments to neuropsychologists, great for them and not great for me if I am doing capacity evaluations and am not boarded in neuro. More Argosy students was good for incoming students and the school, not for the rest of the field. So, who should be contributing and who shouldn't?

 

[erg923]

Two sides to every story. With regards to the professional association issue (I addressed some of the other professional practice issues and concerns via PMs to various posters) I don't know what the answer is. It seems somewhat similar to the policital voting debate in this country, right? The rationale is seen here:



You participate, you are to blame. You don't participate, you are ALSO to blame??? **** that noise! I blame the people who do **** before I blame the people who say, didn't do ****. "It's the mess you created, which I had nothing to do with..."is what keeps me comfortable, I guess you could say?

And I'm not one of those who is doing the torture protest thing to APA, just to be clear. I'm just saying, until I see otherwise, we are fighting an uphill battle that threw the majority of our training and science and value/expertise overboard long ago. Dare I say some of it may have been overvalued and/or overestimated to begin with????
I mean, does anyone actually think the MMPI, as developed and touted in the 1940s, holds much value to psychiatry/psychiatric practice today? Or could be viably funded and developed today? Most don't care about this kind of stuff anymore. And that fact is well outside our control as a profession, frankly. There are about a half dozen players in this.

 

[WisNeuro]

A bigger issue with money is the identity crisis in the field. Just because I am paying dues, it doesn't mean APA is going to be advocating for my needs. They may advocate against it. If they fight for increased reimbursement of behavioral interventions great for me (maybe not so great for others). If they begin limiting certain assessments to neuropsychologists, great for them and not great for me if I am doing capacity evaluations and am not boarded in neuro. More Argosy students was good for incoming students and the school, not for the rest of the field. So, who should be contributing and who shouldn't?

I am definitely against some of the moves (i.e., Argosy). But, every large organization with a very heterogeneous member base has to pick and choose their advocacy efforts. It's impossible to make everyone 100% happy 100% of the time. Orgs need to hear from people about what's important. It's similar to your elected legislators at the state and federal level. I've met in person with mine several times, as a general citizen and as a member of my state psych governing council, it's amazing how little they hear from most of their constituent groups. People like to bitch about things, but they rarely want to lift a finger to actually do anything about it. Heck, most of us in the field can't even be bothered to write an e-mail or call a senator or congressperson on key issues. There's an easy way to advocate for what you want, get involved in some way.

 

[Sanman]

Well, You can't argue with Carlin, he is the best. I really miss seeing him live.

 

[Therapist4Chnge]

EDIT: Is the only way for psychologists to distinguish themselves through neuropsych training? I'm wondering if programs need to revamp their courses/practica to provide this as an integral part of the training curriculum and practice in the future if we are to distinguish ourselves. Neuropsych seems to be the only area that master's level therapists haven't been able to encroach upon.

Neuropsych has to deal with midlevels in Texas and likely other places that are wildly overstepping to muddy the training standards. There are some highly questionable efforts by mid-levels (MA/MS/School Psych) to do neuropsych in schools after taking online/wkend classes. The training is a complete joke, but they are chipping away at divide between competently trained neuropsychologists and the completely made-up and wholly insufficient “school neuropsychologists”. There were a couple/few threads on here about it.

 

[Therapist4Chnge]

I mean, does anyone actually think the MMPI, as developed and touted in the 1940s, holds much value to psychiatry/psychiatric practice today? Or could be viably funded and developed today? Most don't care about this kind of stuff anymore. And that fact is well outside our control as a profession, frankly. There are about a half dozen players in this.

Maybe not the original assessment, but I use the 2RF regularly in my assessments for chronic pain + psych, sometimes for TBI + psych, and I also use it in forensic/medicolegal cases that have a strong psych overlay.

 

[erg923]

Maybe not the original assessment, but I use the 2RF regularly in my assessments for chronic pain + psych, sometimes for TBI + psych, and I also use it in forensic/medicolegal cases that have a strong psych overlay.

Not arguing against the utility of the MMPIs scales/subscales in the context of modern practice as it relates to that area/niche. Or even psychiatric differentials in certain cases. More big picture, I suppose?

Does anyone care about accurate diagnosis (or using the MMPI as evidence of such ) during an inpatient psychiatric stay/hold nowdays? This was how it was originally designed to work/function via Hathaway and Stark's vision (and how it was normed), no? I think alot of its original vision and global utility is now passed? We don't use Scale 9 (or the Harris-Lingoes or various other subscales) to help diagnose Bipolar Disorder do we? Or maybe we do, but I don't see it...or I don't see the utility/ROI of it in addition to a proper psychiatric evaluation? I mean, if history suggests that (or if it's is on the fence), I can only see this muddying the waters, ultimately? I very rarely see the MMPI being an influencer/determinate of the actual psychiatric treatment/treatment plan now days.

That said, I will surrender to @Justanothergrad to better articulate current utilization and ROI of the MMPI and other personality profiles within our current mental health system. Aside from university/graduate student clinics, I'm not sure what this data looks like, and how (or if) it translated positively into practice/treatment outcomes as a whole.

 

[Justanothergrad]

EDIT: Is the only way for psychologists to distinguish themselves through neuropsych training? I'm wondering if programs need to revamp their courses/practica to provide this as an integral part of the training curriculum and practice in the future if we are to distinguish ourselves. Neuropsych seems to be the only area that master's level therapists haven't been able to encroach upon.

I'm not sure we need to focus exclusively on one type of assessment (neuro or otherwise) as the bastion within the field. I think the better approach is to raise the standard in training, interpretation, etc across the board in assessment (broadly defined). Neuro has done a great job providing a framework for doing so - I don't understand why personality/diagnostic testing hasn't followed suit in a lot of the critical issues (e.g., standardized reporting of scaled scores versus some crappy, vague interpretive paragraph about 'is likely to'... which means nothing). Step (1) demonstrate relationship between statistical and assessment training in making competent diagnoses based on test results, step (2) advance scale utility to treatment, step (3) promote testing standards consistent with training/outcomes in steps 1/2

Not arguing against the utility of the instruments parts/scales/subscales in the context of modern practice as it relates to that area/niche. Or even certain psychiatric case differentials? More big picture, I suppose?

Does anyone care about accurate diagnosis (or using this evidence of such ) during an inpatient psychiatric stay/hold nowdays? This was how it was originally designed to work/function via Hathaway and Stark's vision (and how it was normed), no? I think alot of its original vision and global utility is now passed? Don't you? We don't use scale 9 or (Harris-lingoes or various subscales) to diagnose Bipolar Disorder do we? Or maybe we do, but I don't see it..or don't see the utility? I mean, if history suggests that (or is on the fence), I can only see this muddying the waters, ultimately? I very rarely see this being a influencer of the actual treatment/treatment plan now days.

Oh! an MMPI discussion! I'm not gonna miss this! I sit around coffee houses just waiting to hear people talk about personality assessment.

I don't know of anyone who trains for differential diagnosis on certain scales - the original practice was super flawed anyway because of the underlying scale development problems as there were a ton of resulting issues stemming from scale heterogeneity (see RC revisions; Tellegen, 2003). So, that's probably part of the reason no one does it now. I would love to see more work returning to scales defining clear content clusters/content of disorders (e.g., Criteria B,C,D,E in PTSD are prime examples and I suspect the same would hold true of patterns of emotional, somatic, interpersonal, and cognitive problems in depressive disorders, etc.). That would improve treatment utility substantially I suspect, especially if we used modern testing theories to take a look at how we might scale/score them. Bad news is that we don't take this approach in any type of assessment (go look at the PTSD treatment literature, they use PCL total scores to track change in EBP outcomes almost exclusively). Honestly, part of the problem in my eyes is that that assessment inventories have tried to maintain their historic formats without improving their utility for treatment - which seems odd given the expanded focus on EBA. I mean, the PAI is one of the primary trained instruments and it was published under DSM-3 criteria conceptualizations of disorders and its unlikely to have a revision anytime soon (heck, it still has the first-factor problem the RF helped try and resolve about 15 years ago). They also generally lack treatment-focused scales despite a few studies that show 'random scale a'

Side note. If anyone every wants to do some MMPI papers - message me

 

[erg923]

I don't know of anyone who trains for differential diagnosis on certain scales -

Ok. But, the vast majority of requests for administration of this instrument to a third-party payer (insurance) seem to be predicated on this assumption
("differential diagnosis") and this rationale is often explicitly written and stated within the insurance record.

No one is doing this for their health. What do you propose the requesting psychologist is doing in seeking the administration of this test? By far, my understanding is that psychologists want to administer an MMPI for purely diagnostics purposes...however minimally or negligibly it may effect their treatment plan/planning.

I have NEVER had psychologist say or document that they want to administer an MMPI so they can learn how to more effective treat their psychotherapy patient.

 

[Justanothergrad]

The vast majority of requests for administration of this instrument to a third-party payer (insurance) seem to be predicated on this assumption (this is often explicate written and stated within the insurance record). Please explain?

No one is doing this for their health. What do you propose the requesting psychologist is doing in seeking the administration of this test? By far, my understanding is that psychologists want to administer an MMPI for purely diagnostics purposes...however that may minimally or negligibly effect their treatment plan/planning.

I have NEVER had psychologist say or document that they want to administer an MMPI so they can learn how to more effective treat their psychotherapy patient.

None of the scales are designed, explicitly, to create a diagnosis in any modern sense. Maybe Welsh's codes back in the day was the last time I'd see someone push that seriously. Scales can aid diagnostic utility and assess symptoms as discrete occurences (hopefully, if homogeneity isn't an issue and if the scales are good), but I'd be shocked if anyone would argue that 'elevation on scale X indicates diagnosis Y' because the scales simply aren't constructed in a manner consistent with any specific diagnosis. Take CS2/RC2, the scale content assesses some areas but there isn't a ton of sensitivity/specificity work on scale/scale combinations to suggest that an elevation or set of elevations. RC9 is about as linked to making a clear case for BP as I am to owning a Ferarri. I'm not yet to see a request for testing in which 'make Test A diagnosis person B', instead they ask for a diagnosis based on the incremental utility of the test to aid conceptualization beyond hokey pokey of clinical judgement.

If you are diagnosing something, the idea is to provide a subsequent treatment recommendation associated with the outcome category you place someone in. Treatment recommendation equates to therapy/service needs, regardless of if people say it like that or not. So if instruments aren't providing clear/direct evidence for what treatment is appropriate, then its not doing a good job linking itself to a diagnostic presentation to start with - which I'd argue they're not for the most part. The more the scales focus on defining clinical constructs and linking those constructs with clear treatment outcomes to make recommendations that much more evidence-based, the stronger the case for assessment utility / this specialty.

If a diagnosis isn't impacting treatment planning, there is a broader issue at play.

 

[Ollie123]

Interesting discussion, albeit a few different threads to follow.

- I agree that some business training would be helpful, but its not like other healthcare fields provide this either. Ask an MD or an MSW how many accounting courses they took. This doesn't justify the lack of training in such areas, but it does suggest its a poor excuse for us losing ground to other fields. Personally, I think more intensive training in medical coding, billing, etc. would be better than some of the general topics discussed above. I don't know what a single graduate course in contract law would do for anyone.
- The notion that we need to be fighting MIPS/MACRA/etc. is absurd and that APA is in the pocket of the insurers if not is equally so. Moving away from fee-for-service in healthcare is very much a good thing, it was comically stupid idea from the start. I think it has the potential to be amazingly good for us as a field. Even if not, I think it will be good for our patients and certainly good for our society. I'm a human first and I care about more than my bottom line.
- Fully agree RE: failure to carve out appropriate niches and defend turf.
- Fully disagree RE: the seemingly bizarre notion that we can distance ourselves from the rest of healthcare? At least that was what I understood they were suggesting. Several levels beyond stupid. Possibly small short-term gains with massive long-term costs. Again - despite their background this person seems truly out of touch with the healthcare system? Its not just psychology...independent medical practice is growing more difficult too. Look around any major urban area...there is a reason independent practices are being bought up left and right by <insert major hospital system here>. I have mixed feelings about it, but I'd rather be ahead of the curve than pouting in the corner.


Assessment could be a whole other thread. Suffice it to say, I think if we are planning our future around administering 500-item personality measures to people that don't clearly inform diagnosis or treatment planning....we're in big, big trouble. There are certain exceptions (forensics, neuro), but I don't think I am alone in failing to see much utility for the prototypical assessment instruments beyond what I'd get from a symptom inventory and a diagnostic interview. I developed a battery of symptom inventories to use across studies in my lab that covers everything I typically see in practice (depression, gad, AUD, SUD, insomnia, pain, stress, etc.) that is < 100 items and (despite the fact that it was designed for research) would offer far more clinical utility in my daily practice than an MMPI would.

Part of this is that our diagnostic system is already a mess. For all its pitfalls, I think RDoC was a step in the right direction though we're still at least a decade out from seeing direct clinical benefits emerge. Its tough to assess something you only half understand and that probably isn't even a "thing." If it doesn't aid decision-making and treatment planning in a robust way (emphasis on robust), its not something I would want to hang my hat on moving forward.

 

[WisNeuro]

Just gonna say, I agree with Ollie for most of his response, Well said.

 

[cara susanna]

I feel so validated right now, guys! I've been thinking for a while now that the MMPI-2 doesn't really tell me anything when I use it for assessments (which in our clinic are generally for psychodiganostic purposes). The PAI is slightly more useful depending on the referral question, but even that has limitations. I pretty much only use the MMPI-2-RF for C&P exams, now, and there I'm really most concerned with the validity scales.

 

[AcronymAllergy]

Ollie, if you ever publish that symptom inventory, let me know.

 

[Ollie123]

I'm happy to send it to you if you like, feel free to PM. It isn't "mine" - its just a battery of well-established, brief symptom inventories I glued together. No magic to it, I just went through the literature and picked out my favorite measures from broad domains with an eye towards brevity. Did this right when I was first setting up my lab to have a fixed battery I could use across all my projects...wanted to be able to amass data on different issues so I would have pilot data on a variety of topics and could pivot as needed if specialized funding opportunities arose. Plus, I'm hoping to move into more of a primary care setting for my clinical effort long-term and this seemed potentially useful down the road.

It was actually fun for me. I may have a problem.

 

[cara susanna]

Ollie, can you send to me please?

Thanks!

 

[Sanman]

I am definitely against some of the moves (i.e., Argosy). But, every large organization with a very heterogeneous member base has to pick and choose their advocacy efforts. It's impossible to make everyone 100% happy 100% of the time. Orgs need to hear from people about what's important. It's similar to your elected legislators at the state and federal level. I've met in person with mine several times, as a general citizen and as a member of my state psych governing council, it's amazing how little they hear from most of their constituent groups. People like to bitch about things, but they rarely want to lift a finger to actually do anything about it. Heck, most of us in the field can't even be bothered to write an e-mail or call a senator or congressperson on key issues. There's an easy way to advocate for what you want, get involved in some way.

Agreed. However, part of the heterogeneity of the group is due to a lack of standards and long-term identity confusion. While medicine has some of the same heterogeneity, they can all agree that they prescribe meds and complete surgical procedures. It is clear who does each of those things and the credential needed to be able to do so. In not creating and enforcing clear pathways that are protected, the APA has also shot itself in the foot and cost itself money.

It is funny you mention local government, I'm currently involve in trying to stop the expansion of a landfill/recycling plant close to my residential area. While many people are in agreement that it is upsetting, it is the classic case of a small group (the company) with a lot to gain going to the trouble of fighting for approval vs a large group who are all a little dissatisfied, but less invested. We show up to meetings and zoning board votes and argue against it, but no one is stepping up to run the show and invest the time in truly getting a lawyer and putting resources to it. Most of us don't have that kind of time. In the end, you need good leadership and clear vision to get everyone to come together in a united way or things fail. I vote for APA board members and send emails to congress, but I have to work. We need better leadership if we are going to unite and I am concerned it just is not there. The internship crisis, CAPIC, and Argosy are an example of poor leadership. Creating more than one standard for programs and internships divided the field and will continue to do so. Whatever we decide going forward will hurt a percentage of the voting APA members. Same with post-docs and board certification. You need a single articulate vision to gather not 100%, but a majority to advocate for a single cause.

 

[BuckeyeLove]

Legit (almost solely) use the RF only for SV purposes. But even then im better using my time to just do an M-FAST (which everyone that truly malingers tends to score in the 100% PPP range) and behavioral obs/history. Side note: anyone using the SIRS-II, do yourself a favor and stop. Like...right now.

 

[cara susanna]

Legit (almost solely) use the RF only for SV purposes. But even then im better using my time to just do an M-FAST (which everyone that truly malingers tends to score in the 100% PPP range) and behavioral obs/history. Side note: anyone using the SIRS-II, do yourself a favor and stop. Like...right now.

Can you elaborate on the SIRS-II? I used it once and it seemed pretty solid.

 

[Therapist4Chnge]

Ollie, if you ever publish that symptom inventory, let me know.

Same.

For the last 5-6 years i’ve been kicking around the idea of doing some assessment development, but I haven’t had a ton of time to dig into the nitty gritty of it.

 

[BuckeyeLove]

Last I checked/heard, Rogers has still refused to release all of his data, citing it as "proprietary." Push comes to shove (i.e., a defendant with legit means) it likely wouldn't pass a Daubert hearing.

 

[Justanothergrad]

Same.

For the last 5-6 years i’ve been kicking around the idea of doing some assessment development, but I haven’t had a ton of time to dig into the nitty gritty of it.

I wanted to create the Multi-Axil Malingering Instrument, pronounced the [ma-mi]. Then make a longer version called the big mami. Lots of opportunity for this I think......

 

[Ollie123]

Already gotten a whole boatload of PMs about the battery. I will get back to you all, but its actually my clinic day (first post made during a cancellation) so it will likely be next week since I want to get it into a format that will be useful for you all (i.e. with citations for each measure, etc.). Don't think I forgot or am being dodgy about sharing!

Happy to do so as its really nothing beyond what I imagine anyone could get from 2-3 days of lit searching (and obviously somewhat specific to the populations I treat - for example I don't cover EDs at all). That said, would be happy to collaborate if people have research ideas - perhaps we can start the SDN collaborative given I'm already up to 7 requests and counting

 

[Justanothergrad]

That said, would be happy to collaborate if people have research ideas - perhaps we can start the SDN collaborative given I'm already up to 7 requests and counting

Sign me up so long as we can include SDN as an acknowledgement lol

 

[PsyDr]

I see a lot of problems:

1) The decade of the brain was about the stupidest thing a professional organization that specializes in behavior could have done.
2) The focus upon social ills is just about the second dumbest thing our profession does. We're not trained as diplomats, policy makers, etc. The world has politicians, lobbyists, and attorneys for that. Ignoring that we have next to no training in the subject and attempting to practice in that arena is beyond narcissistic. And the APA goes along with it. The Monitor shows students taking f'ing field trips to other countries. Notice medicine or law trying that? Me neither.
3) The entire "fight the power" nonsense makes the profession look immature. Most professions keep private problems private.
4) Feels over reals is terrible. If you have a doctorate, you should be able to quote stats and research just like MDs or JDs.
5) People complaining about professional dues, while also complaining about the APA getting revenue elsewhere.

 

[Spydra]

Hopefully this question isn't deemed off topic and you'll all pardon my naivety since I'm still in my PhD program. Some of the responses in this thread highlight the poor assessment training offered by doctoral programs and I'm experiencing that in my program. I'm also learning from students currently on internship at a variety of sites that assessment training isn't provided there either. Yet I've routinely observed in threads on this forum that many of you that are licensed and in the field are routinely doing assessments, but its unclear to me how you learned to do them well. So where does assessment training come from?

 

[BuckeyeLove]

So where does assessment training come from?

practicum training; internship; fellowship

 

[WisNeuro]

Hopefully this question isn't deemed off topic and you'll all pardon my naivety since I'm still in my PhD program. Some of the responses in this thread highlight the poor assessment training offered by doctoral programs and I'm experiencing that in my program. I'm also learning from students currently on internship at a variety of sites that assessment training isn't provided there either. Yet I've routinely observed in threads on this forum that many of you that are licensed and in the field are routinely doing assessments, but its unclear to me how you learned to do them well. So where does assessment training come from?

2 years of practicum in grad school, 2 years working for an Alzheimer's Institute in grad school doing testing, internship with neuro focus, 2 years postdoc. Also, many classes in grad school in assessment, neurobiology, and neuroanatomy.

 

[Sanman]

Hopefully this question isn't deemed off topic and you'll all pardon my naivety since I'm still in my PhD program. Some of the responses in this thread highlight the poor assessment training offered by doctoral programs and I'm experiencing that in my program. I'm also learning from students currently on internship at a variety of sites that assessment training isn't provided there either. Yet I've routinely observed in threads on this forum that many of you that are licensed and in the field are routinely doing assessments, but its unclear to me how you learned to do them well. So where does assessment training come from?

It is very much on topic and is one of the things I think the field needs to address, a lack of standardization in training.

My program provided didactic training in assessment and required the 3 semesters of interview and assessment focused practica. For me, that was a rehab hospital, a school system rotation, and a VA hospital. Required classes in neuroanatomy and physiology. I also completed a one-year elective sub-internship in neuropsych (6 mths peds; 6 mths adult; 3 days per week) that included testing cases and didactic classes. I had a partial rotation in neuropsych during my internship year a well (all interns did). I did less in my post-doc year due to most testing being referred to neuropsych. I have continued to do brief assessments throughout my career in geriatrics since then to keep up (Mostly, RBANS, brief mood measures, lots of MOCA, MMSE previously, SLUMS, etc).

What kind of training are you getting?

 

[WisNeuro]

It is very much on topic and is one of the things I think the field needs to address, a lack of standardization in training.

My program provided didactic training in assessment and required the 3 semesters of interview and assessment focused practica. For me, that was a rehab hospital, a school system rotation, and a VA hospital. Required classes in neuroanatomy and physiology. I also completed a one-year elective sub-internship in neuropsych (6 mths peds; 6 mths adult; 3 days per week) that included testing cases and didactic classes. I had a partial rotation in neuropsych during my internship years a well (all interns did). I did less in my post-doc year due to most testing being referred to neuropsych. I have continued to do brief assessments throughout my career in geriatrics since then to keep up (Mostly, RBANS, brief mood measures, lots of MOCA, MMSE previously, SLUMS, etc).

I'm split, I think all students need to have an appreciation for neuropsych assessment, but they don't all need a lot of training and background. The problem with some of them giving "just enough" neuro, encourages the weekend warrior types. Those that think they can do neuropsych assessments because of a one semester prac at one point. but in reality know less than 5% of adequately trained neuropsychs and just throw out junk assessments. Nothing wrong with specializing if you know what you want to do. I do think that every doctoral level practitioner should be able to do a high quality psych assessment though.

 

[PsyDr]

@Spydra

Not trying to make you feel bad, but it’s strange that someone from an apa program wouldn’t have assessment experience.

1-2 years assessment practica in grad school depending on how you define it, contiguous 3 years in a neuro lab in a med school during grad school (where I first got on sdn), testing focused internship with some peripheral therapy experience, 2 year fellowship in neuro testing after graduation.

I am branching out from testing these days.

 

[Sanman]

I'm split, I think all students need to have an appreciation for neuropsych assessment, but they don't all need a lot of training and background. The problem with some of them giving "just enough" neuro, encourages the weekend warrior types. Those that think they can do neuropsych assessments because of a one semester prac at one point. but in reality know less than 5% of adequately trained neuropsychs and just throw out junk assessments. Nothing wrong with specializing if you know what you want to do. I do think that every doctoral level practitioner should be able to do a high quality psych assessment though.

IMO, you need everyone needs a strong basis in psych testing and therapy in the first few years, allow elective specializations later in grad school and limit neuropsych assessment to people with post-docs. Even though not everyone is doing, they should know how to use it to inform treatment and be able to understand patterns in the data, test construction, etc.

Truth, I could probably get away with doing neuropsych and psycho-ed evals given I have written dozens of reports have hundreds of hours of testing under my belt. However, I also know what I don't know (or at least what I need to know more about). I know at least one colleague that now advertises neuropsych evals on her practice website after spending her training years only studying psychodynamic therapy and 1 rotation during her internship in neuropsych (which she complained about being completely unnecessary for her career goals at the time). As it turns out money talks and hypocrites abound.

 

[Spydra]

I appreciate the responses from everyone, but am still bewildered. I'm not sure if its that training standards across programs have gotten worse in recent years or if those of you posting regularly just went to better programs in general.

Yes I am in an APA accredited PhD program and there is very little assessment training. We're required to take two assessment courses, one of which is theory focused but only discusses academic achievement tests. The other provides hands on training on one academic achievement test and one cognitive test, but we're only taught how to sit down and administer the test and then how to input the data in the computer for the score report. Assessment interviewing, score interpretation, how to select appropriate tests for each client, and report writing aren't covered. The program has no established assessment practicums either. We have a required therapy practicum and sometimes those clients request an ADHD evaluation or high school students will come for AP testing, but that's about it. We don't have access to personality, neuro, or forensic measures that we're aware internship sites ask about and like to see some exposure to. There's a huge struggle to get integrated reports as well because of the lack of options and the department routinely tells us that administering interpersonal measures like the BDI or BAI combined with a WAIS is sufficient for an integrated report. Per APPIC guidelines that isn't true, but the department isn't listening.

Complaints to the department have gone nowhere and they've said what is offered is sufficient. We're told if we want more assessment experience then to seek out professionals in the community that are willing to offer us one, but many students in the program have found that nearly impossible because who has time to train a PhD student from scratch that should have some basic knowledge? I got very lucky and found a professional that agreed to create a practicum for me and they remind me every week how unprepared I am and how they're going above and beyond to teach me basic concepts. I'm learning so I'll be sticking it out as long as I can, but it really seems like the program has a responsibility to offer more training.

 

[AcronymAllergy]

I've heard mention of a trend of recent graduate students getting less and less training in assessment. The causes are probably multifocal, including having fewer faculty in training programs who are themselves comfortable with assessment. More and more folks are leaving graduate school with single-digit numbers of integrated reports, if they have any at all. It's disheartening.