EPPP Part 2 Implementation Pause

[VintageRed]

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Just saw this posted on Reddit. Looks like they’re pausing implementation of EPPP Part 2, but reconvening to imagine up a whole new test that just incorporates the aspects of Part 2.

 

[Fan_of_Meehl]

'...protect the public'

Which raises the obvious question: 'What is the exact nature (and extent) of the horrible peril that 'the public' has been subjected to during the past 100 years or so while all those doctoral-level psychologists who were only vetted by the traditional EPPP hurdle (after making it through 1000 other hurdles to even get there) were let loose on the poor vulnerable public that the 'new and improved' procedures are to vanquish, once and for all?'

'the horror...the horror...'

 

[AcronymAllergy]

'...protect the public'

Which raises the obvious question: 'What is the exact nature (and extent) of the horrible peril that 'the public' has been subjected to during the past 100 years or so while all those doctoral-level psychologists who were only vetted by the traditional EPPP hurdle (after making it through 1000 other hurdles to even get there) were let loose on the poor vulnerable public that the 'new and improved' procedures are to vanquish, once and for all?'

'the horror...the horror...'

I don't necessarily disagree, but I think everyone who's taken the EPPP (part 1) recognizes that it doesn't do a very good job of assessing what many of us would consider to be foundational knowledge for a psychologist. And we all probably also know numerous psychologists about whom we've wondered how they ever got licensed.

I'm all for increasing the utility of the licensing exam and providing a better minimum bar for psychologists. EPPP part 2 apparently wasn't it. At the end of the day, the licensing exam can still only do so much; the heft of the burden lies with graduate programs.

 

[WisNeuro]

I don't necessarily disagree, but I think everyone who's taken the EPPP (part 1) recognizes that it doesn't do a very good job of assessing what many of us would consider to be foundational knowledge for a psychologist. And we all probably also know numerous psychologists about whom we've wondered how they ever got licensed.

I'm all for increasing the utility of the licensing exam and providing a better minimum bar for psychologists. EPPP part 2 apparently wasn't it. At the end of the day, the licensing exam can still only do so much; the heft of the burden lies with graduate programs.

Unfortunately , we know full well that programs and "APA Accreditation" do little to nothing to keep incompetent and unethical people from practicing.

 

[PsyDuck90]

Out of curiosity, I went to the official ASPPB website, and I cannot find this letter anywhere. Also, the bottom of the letter says the website is .org but it’s actually .net, so I don’t think this is a real position statement from ASPPB.

 

[Fan_of_Meehl]

Unfortunately , we know full well that programs and "APA Accreditation" do little to nothing to keep incompetent and unethical people from practicing.

This is the central thrust of my point, dead on.

I am ALL FOR the *principle* of 'weeding out' the 'dangerous/incompetent' practitioners but I don't think that 'toughening up' the EPPP hurdle will actually accomplish that.

And what happens when that step fails?

Even MORE hurdles?

I detest what has happened to our field (and many others) over the past few decades where we have become SO over-regulated by 'protective' administrative bodies who say they are 'improving the quality' of psychological training/practice when all they appear to be doing is carving out an unassailable (and, ultimately unaccountable) niche of authority for themselves.

Those of you who have been in this field for 3+ decades...ask yourself if the 'quality' of post-graduate psychology education/training and practice has *actually* improved over the course of your career (along with the administrative bloat of 'accrediting' agencies and their increased oversight).

I know (first-hand) that the length of a required 'self-study' for an internship program that was about 12 pages in length had to balloon to 250+ pages just a couple of years later (and this was in the mid-2000's). God only knows what it is today. The eval form to rate interns was a crisp/efficient 1-pager and now it is something like a 12-page rating form.

I don't think ANY of this administrative bloat or generation of additional hurdles/steps has increased quality of education or training. It just exhausts people and distracts them from more crucial conversations regarding what--if anything--is actually broken in psychology education that may need to be addressed.

It is easy to just increase the length/complexity of our forms and processes and submit to the mouthbreathing instinct to believe that this concrete step of increasing the length/complexity of these things is somehow going to 'improve quality.'

It is the same pathology infecting the current suicide risk stratification/management process.

Complexity/forms and top-down/ organizational-bureaucratic and authoritarian oversight/auditing of the process has become extremely bloated and out of hand with no discernable (to my eyes) increase in 'quality' of the services and certainly no measurable improvement in outcomes.

It has become an endless recursive game of 'quis custodiet ipsos custodes.' Who will watch the watchers? Who will audit the auditors? Who will regulate the regulators?

At some point, we can't just keep adding additional layers/bureaucracies, committees, policies/procedures, etc.

What is the 'core problem?' If it's preventing the incompetent from practicing professional psychology then we should focus more efforts on upstream (i.e., undergrad) filters. Don't let people get to the very end of the process and then 'filter' them out. Do so up front.

In my spare time, I'm currently trying to learn linear algebra as a basis for understanding machine learning tech. It ain't exactly Stats for the Behavioral Sciences level of difficulty, lol. Hell, require completion of linear algebra coursework for undergrad psych majors (it was a pre-med requirement when I was an undergrad). Far better to weed people out early on in the process before they invest many years and dollars committing themselves to this profession. I mean, if that's (transparently) what we want to do ('weed out' people).

If significant numbers of people are graduating doctoral programs who need 'weeding out' at that point, then we need to focus our efforts far more 'upstream.' This presupposes (of course) that we as a field can come to some consensus on the filtering mechanism, its implementation, its reliability/validity as a filter of 'quality,' etc. ...oh...wait...

Aw Hell, that's too damn difficult and may not be politically popular. Let's just form a committee, increase the length/complexity of our forms/processes by orders of magnitude, add additional hurdles (and charge big $$$ for them) and call it 'quality improvement' that we MUST implement post-haste to address the 'imminent risk to public safety[TM].'

 

[WisNeuro]

Out of curiosity, I went to the official ASPPB website, and I cannot find this letter anywhere. Also, the bottom of the letter says the website is .org but it’s actually .net, so I don’t think this is a real position statement from ASPPB.

Yeah, It'd be surprising that they'd announce this prior to their annual meeting, which has not yet happened.

 

[jdawg2017]

Out of curiosity, I went to the official ASPPB website, and I cannot find this letter anywhere. Also, the bottom of the letter says the website is .org but it’s actually .net, so I don’t think this is a real position statement from ASPPB.

I also don’t see it on their website yet in my quick search, but the .org and .net both route to their website and even their contact page lists .org at the bottom of the page: https://www.asppb.net/page/ContactUs

I think this is welcome news. I would much rather see the sole test be updated to include more details about actual practice and less info on things that are functionally close to useless to practice as a *clinical psychologist*, like most parts on IO and social psych. The science base in these areas of psychology, in particular, is awful in terms of replication and I can firmly state that my knowledge of IO and social psych has benefitted me 0 times in a clinical situation in my near decade of training. I did feel like the sections on ethics, assessment, intervention, and biological bases of behavior were relevant and actually could be conceived of as a reasonable check to minimal knowledge needed in the field.

 

[Fan_of_Meehl]

I also don’t see it on their website yet in my quick search, but the .org and .net both route to their website and even their contact page lists .org at the bottom of the page: https://www.asppb.net/page/ContactUs

I think this is welcome news. I would much rather see the sole test be updated to include more details about actual practice and less info on things that are functionally close to useless to practice as a *clinical psychologist*, like most parts on IO and social psych. The science base in these areas of psychology, in particular, is awful in terms of replication and I can firmly state that my knowledge of IO and social psych has benefitted me 0 times in a clinical situation in my near decade of training. I did feel like the sections on ethics, assessment, intervention, and biological bases of behavior were relevant and actually could be conceived of as a reasonable check to minimal knowledge needed in the field.

The test content is definitely in need of an overhaul. When I was studying for it, I asked myself repeatedly, "I wonder...how would David FREAKING Barlow do on this test--if pulled out of his office *right now* and be required to take/pass it before being allowed to return to his consulting room and resume the 'safe/competent' treatment of patients?" I'd bet any sum of money he'd fail it (without serious study and preparation beforehand). He'd probably agree. So much for the validity of the test itself.

Which raises the question, 'what are we actually filtering for here with this required step?'

The ability to learn/memorize somewhat arbitrary psychology material and take a test? Didn't we do that in grad school? I mean, I'm good at that and passed on the first try but is THAT the point of the EPPP? The ability to pay the testing fee? Some sort of covert IQ 'filter' to shave off the lower end of the distribution? What, exactly?

And I'm not interested in the political/PR (non)answer in the form of a slogan such as 'protection of the public' or even some (begging the question) claim of 'ensuring competence.' I'm not interested in how the test is labeled/promoted. I'm interested in how it *actually functions* (or fails to) and what its *actual function* is as well as the nature of the logic and evidence that can be pointed to in order to argue for its validity and accuracy in implementing that specific function.

As a field we used to actually care about that stuff. We used to be appropriately critical of our own theories, our own tests and demand that they pass scrutiny. We debated controversies instead of reciting doctrines. We didn't just fall for the marketing or shrink from asking critical questions of those in authority. We used to point out the Naked Emperors...more and more it seems we want to emulate them nowadays. Psychology used to be cool. Now it's become just another sad and expensive example of marketing/PR gone awry masquerading as 'quality improvement.'

 

[smalltownpsych]

The test content is definitely in need of an overhaul. When I was studying for it, I asked myself repeatedly, "I wonder...how would David FREAKING Barlow do on this test--if pulled out of his office *right now* and be required to take/pass it before being allowed to return to his consulting room and resume the 'safe/competent' treatment of patients?" I'd bet any sum of money he'd fail it (without serious study and preparation beforehand). He'd probably agree. So much for the validity of the test itself.

Which raises the question, 'what are we actually filtering for here with this required step?'

The ability to learn/memorize somewhat arbitrary psychology material and take a test? Didn't we do that in grad school? I mean, I'm good at that and passed on the first try but is THAT the point of the EPPP? The ability to pay the testing fee? Some sort of covert IQ 'filter' to shave off the lower end of the distribution? What, exactly?

And I'm not interested in the political/PR (non)answer in the form of a slogan such as 'protection of the public' or even some (begging the question) claim of 'ensuring competence.' I'm not interested in how the test is labeled/promoted. I'm interested in how it *actually functions* (or fails to) and what its *actual function* is as well as the nature of the logic and evidence that can be pointed to in order to argue for its validity and accuracy in implementing that specific function.

As a field we used to actually care about that stuff. We used to be appropriately critical of our own theories, our own tests and demand that they pass scrutiny. We debated controversies instead of reciting doctrines. We didn't just fall for the marketing or shrink from asking critical questions of those in authority. We used to point out the Naked Emperors...more and more it seems we want to emulate them nowadays. Psychology used to be cool. Now it's become just another sad and expensive example of marketing/PR gone awry masquerading as 'quality improvement.'

You might have to get out of the federal system before you go over the edge. 😉
One of my patients, who happens to be a mathematical savant, and I will frequently discuss how systems work or don’t and existential questions related to purpose of life and progress. We are discussing this because they have recently made the step to go back into the educational system despite having been broken by it once. We both get frustrated with the inanity of it all as we explore this both from a mathematical stance and philosophical stance, yet have come to the conclusion that we can fight it naively and be crushed or participate fully in it with the talents we have to bear. As my patient likes to say it’s just math and it fits the model. If anyone has ever read Asimov’s Foundation novels, this patient is working on mathematical models to explain and predict human behavior on an individual and societal level, aka psychohistory. Fun stuff. 😊

 

[R. Matey]

It looks like Texas asked the FTC to investigate. I wonder if it's related to their decision to combine the exam.

https://cdn.ymaws.com/www.asppb.net/resource/resmgr/docs/call_for_public_comments/important_announcement_from_.pdf

 

[WisNeuro]

It looks like Texas asked the FTC to investigate. I wonder if it's related to their decision to combine the exam.

https://cdn.ymaws.com/www.asppb.net/resource/resmgr/docs/call_for_public_comments/important_announcement_from_.pdf

Probably partially that, and also the Texas Board wanting to let anyone with a pulse and the ability to minimally feed and dress themselves, practice psychology.

 

[Fan_of_Meehl]

It looks like Texas asked the FTC to investigate. I wonder if it's related to their decision to combine the exam.

https://cdn.ymaws.com/www.asppb.net/resource/resmgr/docs/call_for_public_comments/important_announcement_from_.pdf

From one of the documents I got to by clicking a link in the linked document (arguing for the validity of the test as well as lack of racial bias):

"...item writers are provided training to reduce unconscious bias..."

Oh boy.

 

[borne_before]

I'm gonna say it, consequences be damned. I don't think step 2 was about improving our field or protecting the public.

I generally assume that if you hold a doctoral degree, have gone through supervised experience (internship and postdoc), and passed the EPPP, you have every right to practice as a psychologist. I have extreme faith in 99% of universities, training programs, and licensing boards to protect the public. And I function from perspective that any licensed psychologist is my equal and colleague and is competent.

You simply cannot run life from the perspective that edge cases must control everything.

As someone with a background in test development and measurement, I honestly do not see how step 2 meaningfully contributes to increasing competencies.

From a test development perspective, I have a couple of questions:

• What is the goal of this test?
• What underlying variable are they trying tap into?
• Is there evidence that filtering people at this late stage leads to improvement of our field?

So why was this developed? Like who thought this was a good idea? To what extent did lobbying and money factor into this decision? I think the story is beginning to show that step 2 was not about improving out field. Rather, it appears to be about bureaucracy and corruption.

 

[R. Matey]

From one of the documents I got to by clicking a link in the linked document (arguing for the validity of the test as well as lack of racial bias):

"...item writers are provided training to reduce unconscious bias..."

Oh boy.

IAT pretest -> 15 hours of shaming -> IAT posttest

 

[Fan_of_Meehl]

IAT pretest -> 15 hours of shaming -> IAT posttest

Who is watching the watchers?

 

[WisNeuro]

I'm gonna say it, consequences be damned. I don't think step 2 was about improving our field or protecting the public.

I generally assume that if you hold a doctoral degree, have gone through supervised experience (internship and postdoc), and passed the EPPP, you have every right to practice as a psychologist. I have extreme faith in 99% of universities, training programs, and licensing boards to protect the public. And I function from perspective that any licensed psychologist is my equal and colleague and is competent.

You simply cannot run life from the perspective that edge cases must control everything.

As someone with a background in test development and measurement, I honestly do not see how step 2 meaningfully contributes to increasing competencies.

From a test development perspective, I have a couple of questions:

• What is the goal of this test?
• What underlying variable are they trying tap into?
• Is there evidence that filtering people at this late stage leads to improvement of our field?

So why was this developed? Like who thought this was a good idea? To what extent did lobbying and money factor into this decision? I think the story is beginning to show that step 2 was not about improving out field. Rather, it appears to be about bureaucracy and corruption.

Have you seen the work product people are putting out there? Those of us in forensic work get to see many years and many notes from a huge number of mental health providers in our field. I'd revise your number down to 50% realistically. The amount of either incompetent and in some cases iatrogenic clinical work is an epidemic. I can unequivocally say that many licensed psychologists in this field are not my equal. Many of these people are a net negative as it relates to the mental health of the public. These are not edge cases, they are everywhere and frequent in number.

 

[borne_before]

Have you seen the work product people are putting out there? Those of us in forensic work get to see many years and many notes from a huge number of mental health providers in our field. I'd revise your number down to 50% realistically. The amount of either incompetent and in some cases iatrogenic clinical work is an epidemic. I can unequivocally say that many licensed psychologists in this field are not my equal. Many of these people are a net negative as it relates to the mental health of the public. These are not edge cases, they are everywhere and frequent in number.

Like, I get the sentiment here, but you said it: you mostly do forensic work. That's a selection bias right there.

But i'm curious as to what would your solution be?

 

[WisNeuro]

Like, I get the sentiment here, but you said it: you mostly do forensic work. That's a selection bias right there.

But i'm curious as to what would your solution be?

I see records from notes from decades prior to the incident in question, across a wide variety of injuries. At this point, I've seen the work of nearly every boarded neuropych in the state, and most of the non-boarded ones, in addition to many dozens of psychologists and other MH workers. Can you explain how that would not provide a representative sample? Unless your assumption is that these providers somehow know that a person will file a claim for an accident that has not happened yet, several years down the line, and chose to treat that patient in an incompetent and/or iatrogenic way?

As for the solution, no great one, the horse is out of the barn, the things the make a psychologist a psychologist (e.g., in-depth knowledge and competency in therapy, assessment, research, etc) are continually de-emphasized, essentially making many people with a psychology license midlevels in expertise and knowledge base. Horse is out of the barn at this point, to the detriment of doctoral clinical reimbursements and patient care.

 

[jdawg2017]

FWIW - I have only trained in AMCs/VAs and seen atrocious assessment and intervention reports, such as a neuropsychologist diagnosing a 35 y.o. with early onset dementia with an entirely normal neuropsych report based on “the patient’s history.” Quacks and people who practice WAY outside their scope are rampant in the healthcare field which is why folks who do forensic work have a field day.

There definitely needs to be guardrails outside of presumed competence gained by completing a training program. MDs have the three-step test, for example, with Step 1 being grounded in early learning, and steps 2 and 3 relating to clinical practice. I don’t think we need three steps or even that EPPP2 is the solution, but rather EPPP1 should get rid of the totally irrelevant facts that don’t measure *competence.*

My recent learning that shocked me is that some states don’t have jurisprudence exams. I get it’s another hurdle (and often kind of a joke in some states), but not knowing state and federal laws can result in so many problems…

 

[WisNeuro]

FWIW - I have only trained in AMCs/VAs and seen atrocious assessment and intervention reports, such as a neuropsychologist diagnostic a 35 y.o. with early onset dementia with an entirely normal neuropsych report based on “the patient’s history.” Quacks and people who practice WAY outside their scope are rampant in the healthcare field which is why folks who do forensic work have a field day.

There definitely needs to be guardrails outside of presumed competence gained by completing a training program. MDs have the three-step test, for example, with Step 1 being grounded in early learning, and steps 2 and 3 relating to clinical practice. I don’t think we need three steps or even that EPPP2 the solution, but rather EPPP1 should get rid of the totally irrelevant facts that don’t measure *competence.*

My recent learning that shocked me is that some states don’t have jurisprudence exams. I get it’s another hurdle (and often kind of a joke in some states), but not knowing state and federal laws can result in so many problems…

We have a jurisprudence exam here, and in my time on the state assn and in conversations with colleagues, many are still quite ignorant of the actual psych statutes in our state.

 

[thebalmofhurtminds]

My current state's jurisprudence was fairly decent, but my future state's was riddled with errors and test questions that made little sense related to the actual material. So even the people creating the test can't figure it out.

 

[borne_before]

At this point, I've seen the work of nearly every boarded neuropych in the state, and most of the non-boarded ones, in addition to many dozens of psychologists and other MH workers. Can you explain how that would not provide a representative sample? Unless your assumption is that these providers somehow know that a person will file a claim for an accident that has not happened yet, several years down the line, and chose to treat that patient in an incompetent and/or iatrogenic way?

I have no doubt you have unparalleled and vast experience. I think it's possible that neuropsychological evaluations are relatively rare and typically conducted for specific reasons, such as complex cognitive or psychological concerns existing before legal procedures, thus there is something "special" about those patients who had undergone one before an injury. This can lead to a sampling bias because the patients who undergo these evaluations are not necessarily representative of the general population, may be providing the most beneficial information their case (e.g., incomplete discovery), etc. I'd also be weary conflating documentation with practice, as we all know it's impossible to summarize the complexities of patient issues fully in notes and reports.

As for the solution, no great one, the horse is out of the barn, the things the make a psychologist a psychologist (e.g., in-depth knowledge and competency in therapy, assessment, research, etc) are continually de-emphasized, essentially making many people with a psychology license midlevels in expertise and knowledge base. Horse is out of the barn at this point, to the detriment of doctoral clinical reimbursements and patient care.

It was not my experience at all that competency in therapy, assessment, and research were de-emphasized in training. However, I come from an atypical route for most psychologists. Are things really that messy in clinical training programs? That's not been my experience in child/school psychology. Even at the masters and specialist level, school psychology has a pretty heavy emphasis in doing good assessments for the limited area of practice - implementation is another concern given the realities of school and educational policy/political climate as resource access.

In the case of neuropsychology and psychologists, I'm curious about what the most common offenses you see are?

 

[quickpsych]

I'm all for increasing the utility of the licensing exam and providing a better minimum bar for psychologists. EPPP part 2 apparently wasn't it. At the end of the day, the licensing exam can still only do so much; the heft of the burden lies with graduate programs.

Well said. If only the APA that accredits programs would do a better job of ensuring graduate programs are improving their ability and focus on training and graduating competent psychologists. The EPPP never really made much sense because it's good at showing failings of a graduate program when their pass rate and licensure rate is low (but also punishes the student, who might have never been a good fit for graduate psychology, and who spent time and money pursuing an education they can't use without being licensed in most cases).

 

[Sanman]

The test content is definitely in need of an overhaul. When I was studying for it, I asked myself repeatedly, "I wonder...how would David FREAKING Barlow do on this test--if pulled out of his office *right now* and be required to take/pass it before being allowed to return to his consulting room and resume the 'safe/competent' treatment of patients?" I'd bet any sum of money he'd fail it (without serious study and preparation beforehand). He'd probably agree. So much for the validity of the test itself.

Which raises the question, 'what are we actually filtering for here with this required step?'

The ability to learn/memorize somewhat arbitrary psychology material and take a test? Didn't we do that in grad school? I mean, I'm good at that and passed on the first try but is THAT the point of the EPPP? The ability to pay the testing fee? Some sort of covert IQ 'filter' to shave off the lower end of the distribution? What, exactly?

And I'm not interested in the political/PR (non)answer in the form of a slogan such as 'protection of the public' or even some (begging the question) claim of 'ensuring competence.' I'm not interested in how the test is labeled/promoted. I'm interested in how it *actually functions* (or fails to) and what its *actual function* is as well as the nature of the logic and evidence that can be pointed to in order to argue for its validity and accuracy in implementing that specific function.

As a field we used to actually care about that stuff. We used to be appropriately critical of our own theories, our own tests and demand that they pass scrutiny. We debated controversies instead of reciting doctrines. We didn't just fall for the marketing or shrink from asking critical questions of those in authority. We used to point out the Naked Emperors...more and more it seems we want to emulate them nowadays. Psychology used to be cool. Now it's become just another sad and expensive example of marketing/PR gone awry masquerading as 'quality improvement.'

The changes you are talking about mark the shift from psychology being a more academic discipline to being something of a more regulated healthcare service profession. Every comment here about psychology could likely be leveled at healthcare in general.

Have you seen the work product people are putting out there? Those of us in forensic work get to see many years and many notes from a huge number of mental health providers in our field. I'd revise your number down to 50% realistically. The amount of either incompetent and in some cases iatrogenic clinical work is an epidemic. I can unequivocally say that many licensed psychologists in this field are not my equal. Many of these people are a net negative as it relates to the mental health of the public. These are not edge cases, they are everywhere and frequent in number.

Now, I have not seen what you have, but I will be the first to say that I wouldn't want a forensic psychologist sorting through my notes either and it is not because I am incompetent or don't know better. It is because incentives are misaligned. In the non-forensic world, quantity (of RVUs) is generally prized over quality and healthcare is an overly regulated space. When the RVU police are on your back and patients come in wanting XYZ, sometimes it is not worth the fight to deny it to them. Notes are also so overly regulated in some instances as to be pointless and a box to be checked.

 

[Shiori]

Has there been research on who is causing the most patient harm and when in their career it's occurring? It's great to get everyone up to a certain baseline at the beginning of their career, but I wonder if there is just some drift that happens over time. It makes me think of all the things we do to prepare everyone to drive a car.

 

[WisNeuro]

I have no doubt you have unparalleled and vast experience. I think it's possible that neuropsychological evaluations are relatively rare and typically conducted for specific reasons, such as complex cognitive or psychological concerns existing before legal procedures, thus there is something "special" about those patients who had undergone one before an injury. This can lead to a sampling bias because the patients who undergo these evaluations are not necessarily representative of the general population, may be providing the most beneficial information their case (e.g., incomplete discovery), etc. I'd also be weary conflating documentation with practice, as we all know it's impossible to summarize the complexities of patient issues fully in notes and reports.


It was not my experience at all that competency in therapy, assessment, and research were de-emphasized in training. However, I come from an atypical route for most psychologists. Are things really that messy in clinical training programs? That's not been my experience in child/school psychology. Even at the masters and specialist level, school psychology has a pretty heavy emphasis in doing good assessments for the limited area of practice - implementation is another concern given the realities of school and educational policy/political climate as resource access.

In the case of neuropsychology and psychologists, I'm curious about what the most common offenses you see are?

We review ALL of the medical records, not just neuropsych reports.

 

[WisNeuro]

The changes you are talking about mark the shift from psychology being a more academic discipline to being something of a more regulated healthcare service profession. Every comment here about psychology could likely be leveled at healthcare in general.




Now, I have not seen what you have, but I will be the first to say that I wouldn't want a forensic psychologist sorting through my notes either and it is not because I am incompetent or don't know better. It is because incentives are misaligned. In the non-forensic world, quantity (of RVUs) is generally prized over quality and healthcare is an overly regulated space. When the RVU police are on your back and patients come in wanting XYZ, sometimes it is not worth the fight to deny it to them. Notes are also so overly regulated in some instances as to be pointless and a box to be checked.

I am not referring to vague and unhelpful notes, I am talking about actively harmful treatment and/or harmful diagnoses made with no justification, among other things. Also, we have more than just their notes as some of these people later answer in depth interrogatories.

 

[Fan_of_Meehl]

The changes you are talking about mark the shift from psychology being a more academic discipline to being something of a more regulated healthcare service profession. Every comment here about psychology could likely be leveled at healthcare in general.




Now, I have not seen what you have, but I will be the first to say that I wouldn't want a forensic psychologist sorting through my notes either and it is not because I am incompetent or don't know better. It is because incentives are misaligned. In the non-forensic world, quantity (of RVUs) is generally prized over quality and healthcare is overly regulated space. When the RVU police are on your back and patients come in wanting XYZ, sometimes it is not worth the fight to deny it to them. Notes are also so overly regulated in some instances as to be pointless and a box to be checked.

Good points, and I largely agree. I agree that the pathology is endemic to health professions, generally, and is not unique to clinical psychology. I do, however, believe that our field is a particularly 'fuzzy/squishy' one and this makes for a highly 'nutritious' matrix within which the pathology can bloom.

I was trained in the 1990's and, by that time, clinical psychology had already been an established and regulated healthcare profession for many decades. I do believe that the emphasis on academic rigor has lessened since that time along with an increase in 'regulation' and 'direction/instruction' on how to 'do what it is we do' whether the authoritarian 'experts' hail from APPIC or APA (or Joint Commission).

 

[Sanman]

Good points, and I largely agree. I agree that the pathology is endemic to health professions, generally, and is not unique to clinical psychology. I do, however, believe that our field is a particularly 'fuzzy/squishy' one and this makes for a highly 'nutritious' matrix within which the pathology can bloom.

I was trained in the 1990's and, by that time, clinical psychology had already been an established and regulated healthcare profession for many decades. I do believe that the emphasis on academic rigor has lessened since that time along with an increase in 'regulation' and 'direction/instruction' on how to 'do what it is we do' whether the authoritarian 'experts' hail from APPIC or APA (or Joint Commission).

It is, but pointless targets and vanity have become a trend in healthcare. I say this as someone with family and friends in many different health professions. For example, there was a time when being overweight meant a chat with your doctor about diet and exercise. Now, it seems you can't escape a talk with a PA/NP (because good luck finding an MD as your PCP) about Wegovy or Ozempic if you are 10 lbs overweight. I wonder how iatrogenic that will be if side effects are found in the future? Same as the opioid issue. Healthcare by numbers...

 

[Sanman]

I am not referring to vague and unhelpful notes, I am talking about actively harmful treatment and/or harmful diagnoses made with no justification, among other things. Also, we have more than just their notes as some of these people later answer in depth interrogatories.

Not disagreeing, I am thinking more along the lines of group therapy for PTSD, therapy for recent grief/loss, EMDR for xyz. Things that are common in the field right now that we know are not the best, but solve a fiscal problem.

 

[Fan_of_Meehl]

It is, but pointless targets and vanity have become a trend in healthcare. I say this as someone with family and friends in many different health professions. For example, there was a time when being overweight meant a chat with your doctor about diet and exercise. Now, it seems you can't escape a talk with a PA/NP (because good luck finding an MD as your PCP) about Wegovy or Ozempic if you are 10 lbs overweight. I wonder how iatrogenic that will be if side effects are found in the future? Same as the opioid issue. Healthcare by numbers...

I actually originally fell in love with psychology as an undergraduate while taking a social psych course that described many of the 'classic' research studies on conformity/groupthink, obedience to authority, diffusion of responsibility (bystander intervention effect), etc.

Maybe I'm wrong but I get the sense that we went from being predominantly the people who identify and call out these things to being the people who systematically implement them ourselves. At some point over the last few decades it feels to me like the color of the 'team jersey' slowly morphed into that of the opposing team. For me it probably flipped about the same time the APA made it clear that they were officially okay with torture...as long as it was associated with some weird sense of increased prestige as the CIA / ninja class to whom the ordinary rules didn't apply.

 

[Sanman]

I actually originally fell in love with psychology as an undergraduate while taking a social psych course that described many of the 'classic' research studies on conformity/groupthink, obedience to authority, diffusion of responsibility (bystander intervention effect), etc.

Maybe I'm wrong but I get the sense that we went from being predominantly the people who identify and call out these things to being the people who systematically implement them ourselves. At some point over the last few decades it feels to me like the color of the 'team jersey' slowly morphed into that of the opposing team. For me it probably flipped about the same time the APA made it clear that they were officially okay with torture...as long as it was associated with some weird sense of increased prestige as the CIA / ninja class to whom the ordinary rules didn't apply.

We also morphed into a field that was PhDs who were often professors with a side practice to one where there are fewer academics (cranking out sometimes pointless research to justify their existence to a tenure committee) and many PsyDs with large student loan balances in need of a job. One of my first neuropsych mentors was a professor, had a large research lab, worked in the hospital clinic, and a had a forensic assessment practice going with the local prison. Good luck pulling all that off in this day and age.

 

[cara susanna]

I'm going to say what I've said all along here: the appropriate place for the bottleneck is BEFORE the person begins their doctoral program. Once you've already obtained the damn degree, including an APA accredited internship, it shouldn't be a huge hurdle to pass a licensure exam.

 

[Sanman]

I'm going to say what I've said all along here: the appropriate place for the bottleneck is BEFORE the person begins their doctoral program. Once you've already obtained the damn degree, including an APA accredited internship, it shouldn't be a huge hurdle to pass a licensure exam.

Yeah, but there is less money that way. You are clearly anti-capitalism, lol.

 

[WisNeuro]

I'm going to say what I've said all along here: the appropriate place for the bottleneck is BEFORE the person begins their doctoral program. Once you've already obtained the damn degree, including an APA accredited internship, it shouldn't be a huge hurdle to pass a licensure exam.

Agreed, and for the vast majority of legitimate programs, pass rates are exceptionally high. Most of those programs hover near 100% for long-term pass rates.

 

[Fan_of_Meehl]

Yeah, but there is less money that way. You are clearly anti-capitalism, lol.

If there's a procedure/hurdle in place, then there has to be some non-insignificant failure rate in order to (appear to) justify its existence in the first place. That failure rate also probably rises in direct proportion to the potential for the gatekeepers to profit from the conflict of interest.

As PsyDr observed elsewhere, "Welcome to the layer cake, son."

 

[cara susanna]

Right, I know we need quality control but I don't think the EPPP is the place to do it. It's not fair to make the people who worked their butts off to get into solid programs to have to jump through EVEN more hoops than they already do.

 

[WisNeuro]

Right, I know we need quality control but I don't think the EPPP is the place to do it. It's not fair to make the people who worked their butts off to get into solid programs to have to jump through EVEN more hoops than they already do.

Are you saying that psychologists should be the only doctoral level healthcare profession without a license exam of some sort? This would not be a fun question to answer on cross exam.

 

[smalltownpsych]

I'm going to say what I've said all along here: the appropriate place for the bottleneck is BEFORE the person begins their doctoral program. Once you've already obtained the damn degree, including an APA accredited internship, it shouldn't be a huge hurdle to pass a licensure exam.

I agree with this sentiment 100%, but isn’t the educational part of our field getting away from this in the name of more inclusive admission practices? I actually went to a program that was intentionally trying to recruit non-traditional or diverse candidates, including myself, and is one reason that my school has lower EPPP pass rates than most of the funded PhD programs. Our school was trying not to be a diploma mill and was trying to give good candidates a chance that they might not have otherwise, but it points to pros and cons of where and how you place the gates.

 

[smalltownpsych]

I actually think that the test already does a pretty good job of doing what is intended to do which is screen out psychologists who lack foundational knowledge of our field. The stats seem to bear this out with the diploma mill students having a tough time passing. I have actually worked with numerous non-accredited PhDs in psychology from places like Cal Southern, Walden, and Capella and most of them could pass the EPPP and even the one that I know did had to get licensed as a counselor, not a psychologist. In working with these individuals as opposed to other psychologists the knowledge gap is very apparent. In my mind, we don’t seem to speak the same language and they are clearly more like the average midlevel in that regard. Part of my unique perspective is that I have been in clinical leadership positions overseeing many clinicians and in settings that skew toward less traditional paths. In other words, the VA or other more academic and structured settings aren’t going to hire the people that I have been working with.

 

[Sanman]

I agree with this sentiment 100%, but isn’t the educational part of our field getting away from this in the name of more inclusive admission practices? I actually went to a program that was intentionally trying to recruit non-traditional or diverse candidates, including myself, and is one reason that my school has lower EPPP pass rates than most of the funded PhD programs. Our school was trying not to be a diploma mill and was trying to give good candidates a chance that they might not have otherwise, but it points to pros and cons of where and how you place the gates.

This is the argument for the American way. In England and other countries, your A-levels at the end of high school determine admissions to higher education and course of study. Here you take you loans and gamble on your chances. Pick your poison.

 

[jdawg2017]

I actually think that the test already does a pretty good job of doing what is intended to do which is screen out psychologists who lack foundational knowledge of our field. The stats seem to bear this out with the diploma mill students having a tough time passing. I have actually worked with numerous non-accredited PhDs in psychology from places like Cal Southern, Walden, and Capella and most of them could pass the EPPP and even the one that I know did had to get licensed as a counselor, not a psychologist. In working with these individuals as opposed to other psychologists the knowledge gap is very apparent. In my mind, we don’t seem to speak the same language and they are clearly more like the average midlevel in that regard. Part of my unique perspective is that I have been in clinical leadership positions overseeing many clinicians and in settings that skew toward less traditional paths. In other words, the VA or other more academic and structured settings aren’t going to hire the people that I have been working with.

Well, I guess one can argue about what constitutes “foundational knowledge,” but sure. Some parts of the exam are key, IMO, but the exam itself is full of a lot of junk items that I feel would correspond poorly with whether or not someone is a competent psychologist.

I’d be curious to see stats from EPPP fails to see where these folks struggle. Is it across the board, including the basically clinically useless IO/social psych parts, or do they also struggle on ethics, assement, intervention, and biological bases of behavior?

 

[Shiori]

I'll be interested to see if there are changes in measures of harm in states with the EPPP part 2 versus just part 1 versus a revised part 1.

I think working in the VA has made me less excited for implementing things for "improvement" without evidence that it'll actually make substantial changes for the level of effort and expense. I spent 4 hours of my day practicing how to get away from veterans trying to physically attack me. It probably didn't improve the likelihood that I'll default to what I was trained to do. It does feel like it shifts a little of the blame onto me if I injure the veteran or the veteran injures me. Do I think it's critically important? Definitely. Do I think the training was effective? Probably not. Is it better than nothing? Who knows?

I am fine with checks on competence. I don't love the idea of checks with no mechanism to fix them if they add no real benefit. If a revised part one or adding part two doesn't do anything to protect the public, why add another hurdle to a very hurdle-y system to give the illusion that it's improving safety?

 

[cara susanna]

Are you saying that psychologists should be the only doctoral level healthcare profession without a license exam of some sort? This would not be a fun question to answer on cross exam.

No, but they shouldn't make the licensure exam needlessly hard and complicated (with multiple steps) just for the sake of gatekeeping people who should never have gotten PhDs/PsyDs in the first place

 

[Fan_of_Meehl]

No, but they shouldn't make the licensure exam needlessly hard and complicated (with multiple steps) just for the sake of gatekeeping people who should never have gotten PhDs/PsyDs in the first place

Maybe I'm nuts but I would think that any exam that the likes of David Barlow, Marsha Linehan, Edna Foa, Steven C. Hayes would likely 'fail' if randomly required to take it (without being provided the opportunity to review/study that specific material) would be, per se, invalid as a litmus test of professional 'competence' or ability to safely practice psychology.

I agree that there should be some 'floor' of mastery of knowledge that should be enforced at the licensure level. And I don't think it would be ridiculous to expect the makers of the EPPP to perform a 'test' (of the test) by randomly sending it out to, say, 100 eminent/accomplished psychologists in order to at least estimate the mean score and standard deviation of performance among this cadre after providing them specific instructions to take the test 'cold' (without studying, as it were). This would even allow for an item-level analysis of which items tended to be successfully answered by most eminent psychologists as well as which items performed more poorly.

Hell, they could even 'spring' it on them at some international conference event (like ABCT) and get them all to gather and take the test. I'd LOVE to see the average score among this cohort as well as an item-specific breakdown of results.

 

[Sanman]

I'll be interested to see if there are changes in measures of harm in states with the EPPP part 2 versus just part 1 versus a revised part 1.

I think working in the VA has made me less excited for implementing things for "improvement" without evidence that it'll actually make substantial changes for the level of effort and expense. I spent 4 hours of my day practicing how to get away from veterans trying to physically attack me. It probably didn't improve the likelihood that I'll default to what I was trained to do. It does feel like it shifts a little of the blame onto me if I injure the veteran or the veteran injures me. Do I think it's critically important? Definitely. Do I think the training was effective? Probably not. Is it better than nothing? Who knows?

I am fine with checks on competence. I don't love the idea of checks with no mechanism to fix them if they add no real benefit. If a revised part one or adding part two doesn't do anything to protect the public, why add another hurdle to a very hurdle-y system to give the illusion that it's improving safety?

And the same people spent 10 weeks teaching them how to attack you. Don't you feel safer after 4 hours of training?

 

[WisNeuro]

Well, I guess one can argue about what constitutes “foundational knowledge,” but sure. Some parts of the exam are key, IMO, but the exam itself is full of a lot of junk items that I feel would correspond poorly with whether or not someone is a competent psychologist.

I’d be curious to see stats from EPPP fails to see where these folks struggle. Is it across the board, including the basically clinically useless IO/social psych parts, or do they also struggle on ethics, assement, intervention, and biological bases of behavior?

A panel of psychologists who volunteer/are chosen are who determine what "foundational knowledge" is, not ASPBB. Or at least that's how it had been run, unsure if they made a big change recently or not. As for where these folks struggle, ASPPB lists averages by content area, the diploma mills struggle with stats, and in many cases ethics, which is downright scary, as those are the most straightforward sections.

No, but they shouldn't make the licensure exam needlessly hard and complicated (with multiple steps) just for the sake of gatekeeping people who should never have gotten PhDs/PsyDs in the first place

It's really only hard for those from diploma mills, otherwise the pass rate is incredibly high, probably one of the easiest bars to clear for doctoral level practice there is.

 

[cara susanna]

A panel of psychologists who volunteer/are chosen are who determine what "foundational knowledge" is, not ASPBB. Or at least that's how it had been run, unsure if they made a big change recently or not. As for where these folks struggle, ASPPB lists averages by content area, the diploma mills struggle with stats, and in many cases ethics, which is downright scary, as those are the most straightforward sections.



It's really only hard for those from diploma mills, otherwise the pass rate is incredibly high, probably one of the easiest bars to clear for doctoral level practice there is.

Right, so EPPP step 1 is fine, but I'm referring to this idea that we need a step 2.

 

[psycho1391]

What do folks think of something like combining step 1 with a portion similar to ASPPB boarding?