Here come the Master's-level therapists!

[PublicHealth]

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[psych101]

Interesting. This is already happening in my state and I can attest to the fact that it has made it increasingly difficult to find a decent job. Why hire a doctoral-level psychologist when a master's level psychologist can be licensed -- to test independently and do therapy--- especially since you can hire them and pay them less?? And, in many cases, licensed social workers are selected for positions traditionally held by psychologists since they can work completely independently. Managed care and agency work certainly doesn't value the doctoral-level education or quality of care provided overall. It's all about money -- billing the most for clinical work using the most poorly-paid clinicians.

 

[Logic Prevails]

I can see this being an issue of distain for those already holding a PhD, I think it's going to happen in time regardless. Masters level psychologists have been practicing in Canada for some time now. When you register, you are required to state your area of competence and not work outside of this area. Most provinces also require a minimum of 5 years supervision post graduation. Although I'd agree that most people with a degree in SW should not practice therapy (b/c I've never heard of their programs providing much therapy/intervention coursework or supervision), I don't think that this should include MSc psychologists (although I'm biased b/c that's the route I'm taking).

There have been several studies showing that degree (PhD vs. Masters) does not predict the quality of treatment clients receive in outpatient settings. There is also so much variation by university training. Keep in mind that while a Masters degree (on the way to receiving a PhD) might not be sufficient, while there are other programs (as those in Canada) specifically designed to train MSc psychologists. I think many of you will admit that most PhD programs prepare individuals for academic careers. In my own opinion, I think I could have done without the thesis, publicaitions, research methods and stats courses in terms of what they would offer someone training to be a clinician.

- My biased opinion (off with my head! )

 

[Logic Prevails]

"Partly, but that is not the complete story. The Ph.D. programs are still applied (e.g., clinical or counseling psychology)."

A program labeled 'clinical' may simply mean that it teaches clinical skills above and beyond an academically focused degree. I am in such a program, the 'clinical' focus is minimal. Students are more concerned about getting publications and theses completed than getting the most out of clinical coursework and supervision.

"Maybe, but I think that such work promotes greater depth of understanding of the field, how things interrelate, and general clinical issues. Lowering the bar continually is doing more than just allowing people that don't have research training associated with doctoral programs to conduct therapy and assessments."

This is just the same slippery slope argument that has been around forever for not allowing masters level psychologists to practice. Let us not lower that bar! Honestly, are publications, theses, statistics and methods courses going to significantly add to an individuals clinical ability? Realize that MSc programs still have stats courses, offer assessment & intervention coursework and require practica; just not to the same degree.

"The qualifications and training exposures are completely different in terminal masters programs. I think a masters level therapist should be able to do things like supportive therapy and behavioral analysis (provided they attended the proper program). Beyond that, I'm very skeptical."

I'll slightly agree with you here. There are things that a MSc psychologist should not do. Limiting practice to supportive therapy and behavioral analysis
is a bit superficial though. A an individual should be limited on a case by case basis dependent on what they knowledge and skills they have acquired in a particular program. Just as you (assuming you are registered) are required to limit your own practice to those areas that you are deemed competent in. A regulatory board should make these decisions.

 

[PublicHealth]

PhD/PsyD students need to start lobbying for prescriptive authority in their respective states! Expansion of practice scope is the key to success in today's healthcare market for nonphysician providers!

 

[Logic Prevails]

"That may be, but they still have internship and fellowship requirements if they wish to be licensed"

Yes; and Masters psychologists will have the practica and supervision requirements that should be more than enough to permit them to practice within certain areas in which they are competent.

"and practice psychology and school should be about theory and research."

Why? Because they always have been.. so they must continue to be? Masters programs still require 1 or 2 graduate stats courses and a thesis. Is it really essential to therapy that they get a publication, learn how to use canonical correlations etc. in their research, and do a dissertation?

"Psychology is not a trade, it is a purported science."

Depending on how you use it. We can also argue that in therapy it is an art. Yes, it is important to understand (as much as needed) the underlying science of the dicipline, but we don't need therapists to get the knowledge one might have in order to teach the subject.

"I think the argument is quite valid and certainly not a slippery slope."

Okay...

"See, now there's a slippery slope. We (psychology) need to push for stronger boards (specialty and general). It's difficult enough for folks to agree on doctoral level boards. I don't see how adding the complexity of masters level boards is going to do anything but further blur the lines between what is and is not acceptable."

Okay, so you don't get the slippery slope idea. There's nothing slippery about my argument at all. I'm saying "Yes, put up a block on what individuals can do as a psychologist!" But you're basing this decision on your 'fancy-pants' degree, while I'm basing it on (perhaps more fairly) as a restriction on what the individual is competent at. Don't tell me that we should not have Masters boards because it makes more work for those on the board or that they will disagree from time to time. Are you suggsting that they should 'wave' the board entirely for individuals such as yourself, assuming you have your golden PhD degree?

It seems you like to use the 'slippery elevator' in your arguing, so let us continue on that path and see where it leads... What if we say that no.. a PhD as it sits right now is not sufficient to be the 'best psychologist' that we can be. Let us say that these individuals should also have at least minor in Philosophy so that they might learn to reason rationally (add another 2 years)... and it would be also good to learn several other languages... and on and on.

I'll end it with this: Who is it to decide what we need in terms of education? We can always be better or learn more. The questoin is whether we will have what is required to provide therapy that is benefiting the client and that is ethical and within our level of competence - is it not?



"We already have enough *****s doing thought-field therapy."

Don't assume that only Master's level psychologists would do such things. There's plenty of "*****" PhD individuals out there as well.

 

[50960]

Snow, I am going to smack you.... There is nothing in this legislation that would creat a MA level psychologist. It is only to allow already licensed MFT and LPC's to get medicare reimbursement, and we should have no problem with that. LCSW's have been doing it for years, and have not replaced us. Really man you are a walking Rorschach!!!

cheers

 

[Logic Prevails]

Damn, I think some of you would loose your minds if you were to practice in Canada where we have Masters level "Psychologists" (yes, I said psychologist and not "therapist") practicing in most provinces (with some supervision of course).

"What! they're practicing psychology with a WHAT!!??? My god the incompetence must be overflowing at the borders of every province."

I'm sure this disease of professional practice will eventually make it south of the boarder at some point.

 

[Heath82371]

Who really cares? Do PhD trained psychologist really want to work with the dredges of society doing home visits or working with indigent people? My guess is no. I doubt any sane PhD trained licensed psychologist would work for the 32k that my last job paid me. I should point out that I am a LMHC (Licensed Mental Health Counselor) and I have a masters degree in clinicial psychology. My last job was in the state hospital and my title was Clinician III. Interestingly enough I wanted to get my PhD at one point. Luckily I have left the field.

Just thought I would clarify a few things that were incorrectly stated on this website (though not necessarily this thread). Individuals with Masters degrees in certain fields may obtain licensure as therapists by the state they reside in (I live in Florida). These individuals must have a masters in psychology, counseling, or mental health and after 2 years of supervised experience and passing boards they will be licensed as LMHC (Licensed Mental Health Counselor). If they did graduate work in the field social work they will be a LCSW (Licensed Clinical Social Worker), or if they studied marriage and family therapy, they will be licensed as a LMFT (Licensed Marriage and Family Therapist).

I am in nursing school and though, I personally will not do this, I could become a ARNP (Advanced Registered Nurse Practitioner) and I could effective prescribe meds to the oh-so-fun mental health clients I have left behind. I know there is a big push for pscyhologists to have Rx rights. Guess I could do this (prescribe Rxs), and do therapy and still never do a doctorate in psych or complete post doc in psychopharm. Am I more or less qualified than a PhD....who cares? Actually, I am actually leaning towards nurse anesthesia or FNP at this point. If you entering the field of psychology for the money...RUN....or change your specialization ASAP. Listening to people complain is not all that it is cracked up to be. Jobs are few and far between and the burn out rate is high for a reason.

I am sorry if it upsets some that once we (LMHCs) complete our supervision and pass boards we are independently licensed, can accept third party reimbursement, and can "hang a shingle." It's just a part life and it happens in all aspect of healthcare.

 

[deuist]

Maybe, but I think that such work promotes greater depth of understanding of the field, how things interrelate, and general clinical issues.

If that were true, all medical students would be required to do research and write a thesis in order to become better physicians. While some schools (e.g., Duke et al.) have these requirements, the vast majority of other universities have done just fine in graduating high quality doctors without ever forcing them to take stats or making them do original research.

 

[psych101]

Who really cares? Do PhD trained psychologist really want to work with the dredges of society doing home visits or working with indigent people? My guess is no. I doubt any sane PhD trained licensed psychologist would work for the 32k that my last job paid me. I should point out that I am a LMHC (Licensed Mental Health Counselor) and I have a masters degree in clinicial psychology. My last job was in the state hospital and my title was Clinician III. Interestingly enough I wanted to get my PhD at one point. Luckily I have left the field.

No, and that's exactly the problem. I do work in a state where master's level psychologists can be licensed. They're called Psychological Associates, and although they must be supervised by doctoral-level psychologists, they can pretty much independently test, do therapy, etc. However, as fas as most agencies go, this has only contributed to the phenomenon of equating psychologists with master's level counselors & social workers. Unfortunately, agencies don't really see the benefit of differentiating between doctoral-level clinicians and master's level clinicians...why pay a (slightly, if the clinician is lucky) higher salary for a doctoral-level person when you can pay a master's level person less to do the exact same job (in their minds). My last job (and I have a PhD) included home visits and working with nothing but indigent people who never even bothered to show up for their appts most of the time. My current job also serves this population. In fact, the entire field of mental health (at least public mental health) is moving toward home visits rather than inpatient, residential, day treatment, etc. - but I suppose that's an entirely different issue. As far as doctoral-level psychologist go, agencies and reimbursement entities don't see the benefit of assessment, which is something we do really well...too bad it hardly pays anything and is viewed as a waste of time when you could really be seeing therapy clients for a higher fee. And nobody (i.e., APA) is doing anything to protect our turf. Gotta love watching this field self-destruct.

 

[sasevan]

Gotta love watching this field self-destruct.

I'm interested in knowing others' perspective on the above post.

My own views tend toward seeing the field continuing to diversify with a minority of clinical psychologists in teaching and research, another minority in assessment (neuro, forensic, educational) and the majority in treatment.

I believe that those in teaching, research, and assessment are going to be fine but those in treatment may not be unless they sub-specialize.

My hope is that clinical psychologists exclusively or primarily involved in providing therapy will become more interested in health psychology (primary care) and medical psychology (psychopharm).

I guess the bottom line for me is that if psychology becomes more like medicine (e.g., doctoral level practitioners, sub-specialization, prescriptive authority) the future of the field is a bright one. However, I agree with the sentiment that if it remains in large part in competition for therapy patients with LCSW, LMHC, and LMFT it may in fact risk that aforementioned future.

Peace.

 

[psych101]

I agree with sasevan and jon snow – both analyses seem accurate. I guess I just get frustrated because the job of a psychologist is so often dictated by bigger entities like reimbursement sources and business people who run agencies but don’t understand clinical work. I get frustrated because, in many cases, we have to get creative and specialize and find a new way to change ourselves in response to external forces in the mental health field. Why is it that we have to constantly change instead of doing a better job at protecting our turf and advocating for ourselves? In addition to outside entities controlling the type of work we do (or are reimbursed for doing and at what rate), we are also contributing to our own self-destruction by overpopulating the field with psychologists. I wish I knew how to solve these problems.

Yes, the population I was initially referring to regarding assessments is the low-income population – Medicaid. In my state, a fully licensed doctoral level psychologist is reimbursed for services by Medicaid at the following rates: $141 for an intake, $92 per hour for individual therapy, $108 per hour for family therapy, $30 per event for group therapy, and $88 per hour for testing (defined as “psychological testing, neurobehavioral exam, or neuropsychological testing” – so pretty much any kind of testing). I find the testing reimbursement rate to be RIDICULOUS considering the level of training required to do a competent evaluation and the valuable recommendations that can be provided based on the evaluation. It’s also ridiculous when you think of the non-billable time it takes to score, interpret, and write a report summarizing test results. Agencies begin to think it is, overall, a waste of time for a psychologist to do that type of work when they could be billing more for therapy or intakes. Even psychologists start to avoid much testing because it doesn’t pay well for all the time and energy that goes into it. Incidentally, in my state, the master’s level (i.e., LCSW, LPC, master’s level psychologist) reimbursement rate is as follows: $106 for an intake, $68 per hour for individual therapy, $81 for family therapy, $23 per event for group therapy, and $66 per hour for testing (defined as “psychological testing, neurobehavioral exam, or neuropsychological testing”).

I do find myself thinking of other alternatives such as private practice or specialization. I find myself hoping I can “stick it out” with the low-income population, even if only to obtain licensure hours. But what a shame that so many of us end up framing such work in these terms while the low-income population remains so underserved. I don’t have the answers, I just hope that we can find a better way of advocating for ourselves and the people who could benefit from what we do.

 

[sasevan]

I guess I just get frustrated because the job of a psychologist is so often dictated by bigger entities like reimbursement sources and business people who run agencies but don’t understand clinical work. I get frustrated because, in many cases, we have to get creative and specialize and find a new way to change ourselves in response to external forces in the mental health field. Why is it that we have to constantly change instead of doing a better job at protecting our turf and advocating for ourselves?

Hi psych101,
I think I know what you mean.
I was recently offered a forensic psych job at a state hosp for 55k (it is a 40+ hrs, 50 cases job involving competency assessments, restoration treatment, expert testimony, and supervision of interns/externs).
When I was completing my psychology residency I was looking at jobs that were offering even less. My colleagues completing their psychiatry residency were being recruited for 80-100k for 20 hrs. I have a friend who graduated from a med school in the Caribbean and who did his psych resiency here in Florida who took two of those 100k jobs and is now making well over 200k as he has plenty of time to do private practice on the side.
And its not just salary.
A friend of mine, currently completing an informal post-doc fellowship (getting paid 35K), has for her immediate supervisor an unlicensed mid-level provider who routinely introduces her at community outreach programs by her first name.
So I think I can relate to your frustration.
In fact, when I realized the constant and permanent challenges that I was going to have to face in psychology (e.g., salary, status, scope issues) I decided to pursue psychiatry.
Having said that, I also know that there are many doctors in our field who are doing fine.
My two mentors (clinical and forensic) both make about 120k (combining teaching, supervising, assessing, and treating services). They've both been in the field for about 15 years and work more than 40 hrs but they are content.
I also have another friend, completing a pre-doc internship, who is very confident that after residency he'll get a job as a researcher at a pharmaceutical company probably making 70-80k.
I guess my bottom line is that while our field has a lot of challenges (low salaries, limited scope) it also has a lot of opportunities for those willing to adapt to the ever-changing environment.
I believe that once someone is licensed (if s/he is willing to move) s/he will be able to get a job that pays ok and will be able to eventually establish a practice that is fulfilling.
Best of luck to you; keep the faith.
P.S. Alternatively, you could join me in psychiatry; just a thought.

 

[sasevan]

Regarding your friend who is being supervised by an unlicensed midlevel (social worker?) on an informal postdoc. . . I am under the impression that won't count for postdoctoral hours? The rule is generally that supervision by a licensed clinical psychologist is required.

Hi Jon Snow,

I've asked my friend about this and she's informed that while her immediate supervisor (i.e., her boss at the branch) is an unlicensed social worker she also has another supervisor (i.e., a colleague at headquarters) who is a licensed psychologist with whom she meets with for 2-3 hrs/weekly for individual/group supervision. She assures me that this arrangement is acceptable to the Board of Psychology.

Peace.

P.S. I've enjoyed your posts in the various threads here and in the psychiatry forum; especially the point that psycheval and you (as well as others) have made about all clinical psychologists needing to be better trained in neuroanatomy, pathophysiology, pharmacology, etc. in order to be able to provide efficient diagnostic et al. services. I couldn't agree more. I also liked the point that you made regarding the posibility that medical psychologists who have to collaborate with physicians (by law) may appear to be mid-level providers. I don't agree but I liked the point nonetheless; something to at least think about, perhaps resulting in a different RxP model. I am, however, really curious as to why you believe that psychologists shouldn't prescribe medications. What if med psych were trained in a more rigorous manner than currently proposed psychopharm programs (something akin to the DoD project)? What about increasing patient access to pharmacotherapy? What about expanding scope for psychology in order to improve status/salary?
I grew in tremendous appreciation of the biological dimension of mental illness during my psychology residency and as a result of that became interested in pharmacotherapy and have since begun to pursue psychiatry but given the success of the med psychs from the DoD project (and now NM and LA) I don't see why cl psychs shouldn't prescribe and I believe that this will be a benefit both for patients as well as for psychology. Your thoughts will be very appreciated. Thanks in advance.

 

[PsychEval]

Hi psych101,
I think I know what you mean.
I was recently offered a forensic psych job at a state hosp for 55k (it is a 40+ hrs, 50 cases job involving competency assessments, restoration treatment, expert testimony, and supervision of interns/externs).
When I was completing my psychology residency I was looking at jobs that were offering even less. My colleagues completing their psychiatry residency were being recruited for 80-100k for 20 hrs. I have a friend who graduated from a med school in the Caribbean and who did his psych resiency here in Florida who took two of those 100k jobs and is now making well over 200k as he has plenty of time to do private practice on the side.
And its not just salary.
A friend of mine, currently completing an informal post-doc fellowship (getting paid 35K), has for her immediate supervisor an unlicensed mid-level provider who routinely introduces her at community outreach programs by her first name.
So I think I can relate to your frustration.
In fact, when I realized the constant and permanent challenges that I was going to have to face in psychology (e.g., salary, status, scope issues) I decided to pursue psychiatry.
Having said that, I also know that there are many doctors in our field who are doing fine.
My two mentors (clinical and forensic) both make about 120k (combining teaching, supervising, assessing, and treating services). They've both been in the field for about 15 years and work more than 40 hrs but they are content.
I also have another friend, completing a pre-doc internship, who is very confident that after residency he'll get a job as a researcher at a pharmaceutical company probably making 70-80k.
I guess my bottom line is that while our field has a lot of challenges (low salaries, limited scope) it also has a lot of opportunities for those willing to adapt to the ever-changing environment.
I believe that once someone is licensed (if s/he is willing to move) s/he will be able to get a job that pays ok and will be able to eventually establish a practice that is fulfilling.
Best of luck to you; keep the faith.
P.S. Alternatively, you could join me in psychiatry; just a thought. [/QUOTE]

If your going the med school route, why not do neuroradiology? $400,000 / year sounds much better than $150,000 / year.

 

[sasevan]

If your going the med school route, why not do neuroradiology? $400,000 / year sounds much better than $150,000 / year.

Hi PsychEval,
I really liked your posts in the psychiatry forum; like you I support all clinical psychologists being trained in the biological dimension of mental illness in order to increase diagnostic skills (e.g., differentials, triage) as well as a sub-specialty of medical psychologists having RxP.
I considered a post-doc MS in psychopharm or going the route of a psych NP but in the end decided to become a psych MD/DO.
My passion is really clinical work, especially intervention strategies. I don't know much about neuroradiology but it sounds to me to be a branch of diagnostic radiology; if so I don't think I'd be interested. I see myself in the future as a psych PsyD-MD or PsyD-DO providing direct service to both outpatient and inpatient populations.
Peace.

 

[sasevan]

Hi Jon Snow,
Thanks for the response. Again you make some very good points. Allow me to suggest some counter-points.

I am concerned about how it would change the field. The midlevel point I've alread made, but it goes beyond that. Money is one issue. Will prescribing psychologists make materially more than non-prescribing psychologists? If so, what will that do to the numbers of prescribing psychologists? Will most psychologists pursue prescription rights? Will training programs adjust and make prescription training part of graduate school? If that becomes the case, what will be replaced?

Don't neuropsychs and forensic psychs already make on avg much more than cl psychs? Are most cl psychs sub-specializing in neuro or forensic? I may be wrong but my impression is that the answer is "no."
What about making med psych a concentration in psych school (just like neuro, forensic, health, pedi) with a 3 yr residency (just like neuro)-1 yr internship and 2 yr fellowship?

Also, how will malpractice insurance rates for the field be affected? Right now, they're low. If psychology adds prescription priv, how much will they increase? Will it affect psychologists who choose not to pursue prescription rights? Further, expertise issues come into play.

Have NP/CNS insurance rates skyrocketed after these providers acquired RxP? Again, my impression is "no."

At the moment, clinical psychology is very good at assessment (neuropsych, psychosocial, health, behavior analyses, developmental - asperger's, autism, adhd, etc. . .) and non-pharm treatment. Will clinical psychology shift to mirror psychiatry if it gets prescription priv? How much of a blitz will drug companies put on psychology? There are alot more clinical psychologists than psychiatrists. I would think the blitz would be strong. Would the field shift in terms of research?

APA has suggested that med psych would have a different model for prescribing than psychiatry, e.g., psychopharmacotherapy in the context of psychological treatment (psychodynamic psychotherapy, CBT, behavioral therapy) not exclusively med mgm (especially the often reported 15-20 min psychiatric evals and 10 min med checks) and close consultation with the PCP.

I have some problems with the medical model as practiced by psychiatrists. My perception is that they throw pills at nearly every problem that walks through their office. This is not a strategy supported by research in my opinion. There are many conditions that responsd just as well or better with specific types of psychotherapy.

I totally agree. I think that that is why the APA is advocating for a psychological model for med psych as opposed to the med model of psychiatry. I think that the implementation of this model would offer patients a viable alternative and maybe even inspire psychiatry to reconsider its current approach to pharmacotherapy.

I think there is a potential for psychology to lose its identity and become psychiatry-lite if prescription priv become wide spread. I don't think that's good for patients. I don't think it's good for our understanding of the human condition (something that I think psychology has a better handle on than psychiatry both from research and clinical vantage points).

I agree that there is this potential but perhaps it can be guarded against by faithful implementation of APA's proposed psychological model of RxP (pre-doc training as currently established with med psych reserved for post-doc training).

At the moment, psychology is distinct from psychiatry. It does alot of things that psychiatry does not do and it does them well. It does things that neurology does not do and it does them well. I think what we have is a bunch of clinical psychologists who want to be psychotherapists and from their vantage-point, adding prescription priv sounds like a good idea.

Again, I totally agree. I believe, though, that most cl psychs won't specialize in med psych and RxP will be limited to a sub-set that will not usurp psychology's identity but only add to its diversity and continued development from an exclusively academic discipline to a mental heath profession and now more and more to a healthcare one.

Peace.

 

[PublicHealth]

I went into grad school with the intent to specialize in neuroscience/neuropsychology and I did that from the start. Everything I've done from my research to my clinical work has focused on physiology, pathophysiology, and brain-behavior relationships.

If you don't mind my asking, where did you complete your PhD/PsyD? Did your clinical training REALLY focus on physiology, pathophysiology, and brain-behavior relationships? I find this hard to believe, given the emphasis on cognitive-behavioral models of treatment that seem to be in vogue at most clinical psychology programs.

 

[sasevan]

New link to RxP issues:
http://www.nationalregister.org/TRR_online_fall2005.htm

 

[PublicHealth]

Hi PsychEval,
I really liked your posts in the psychiatry forum; like you I support all clinical psychologists being trained in the biological dimension of mental illness in order to increase diagnostic skills (e.g., differentials, triage) as well as a sub-specialty of medical psychologists having RxP.
I considered a post-doc MS in psychopharm or going the route of a psych NP but in the end decided to become a psych MD/DO.
My passion is really clinical work, especially intervention strategies. I don't know much about neuroradiology but it sounds to me to be a branch of diagnostic radiology; if so I don't think I'd be interested. I see myself in the future as a psych PsyD-MD or PsyD-DO providing direct service to both outpatient and inpatient populations.
Peace.

Hi, sasevan.

I applaud your effort to pursue MD/DO and psychiatry. There's a long road ahead. MS1 is rough and MS2 is comparably difficult. I have several friends in clinical psych PhD programs who seem to be having a MUCH better time than me -- more free time, interesting research, no debt, etc. Nevertheless, I'm committed to sticking it out in favor of comprehensive medical training and a ticket to a good psychiatric residency.

That said, it seems like psychologist RxP efforts have really picked up in several states. Have you considered moving to Louisiana to pursue certification as a "medical psychologist?" Given that you currently live in Florida -- two states away from Louisiana -- this seems like a highly time efficient and cost effective option. I'm not sure what it's like to live in Louisiana, though! Last I heard, RxP efforts in Florida have been stalled. A number of southern states -- Tennessee, Georgia, Alabama, Mississippi -- look like they may pass psychologist RxP legislation over the next few years, as they have been lobbying hard lately. I sincerely believe that it's only a matter of time before this happens in most US states.

As a medical student with an interest in psychology and psychiatry, I embrace wholeheartedly the "biopsychosocial model" of pharmacotherapy, with integrate pharmacotherapy and psychotherapy. Psychiatry has pretty much abandoned this integrative practice in favor of primary pharmacotherapy a number of years ago, and is now moving toward a tighter integration in medicine -- psychosomatics. This has been a longstanding interest of Dr. Michelle Riba, current President of the American Psychiatric Association. It's also a good way to convince policymakers that psychologists are not physicians and do not understand the intricacies of clinical medicine and its interaction with psychiatry.

We should try to carry on a dialogue in this forum. I'm curious to hear everyone's responses.

 

[PublicHealth]

New link to RxP issues:
http://www.nationalregister.org/TRR_online_fall2005.htm

Like I said, sas, it's time for psychologist RxP!

 

[sasevan]

Hi, sasevan.

I applaud your effort to pursue MD/DO and psychiatry. There's a long road ahead. MS1 is rough and MS2 is comparably difficult. I have several friends in clinical psych PhD programs who seem to be having a MUCH better time than me -- more free time, interesting research, no debt, etc. Nevertheless, I'm committed to sticking it out in favor of comprehensive medical training and a ticket to a good psychiatric residency.

That said, it seems like psychologist RxP efforts have really picked up in several states. Have you considered moving to Louisiana to pursue certification as a "medical psychologist?" Given that you currently live in Florida -- two states away from Louisiana -- this seems like a highly time efficient and cost effective option. I'm not sure what it's like to live in Louisiana, though! Last I heard, RxP efforts in Florida have been stalled. A number of southern states -- Tennessee, Georgia, Alabama, Mississippi -- look like they may pass psychologist RxP legislation over the next few years, as they have been lobbying hard lately. I sincerely believe that it's only a matter of time before this happens in most US states.

As a medical student with an interest in psychology and psychiatry, I embrace wholeheartedly the "biopsychosocial model" of pharmacotherapy, with integrate pharmacotherapy and psychotherapy. Psychiatry has pretty much abandoned this integrative practice in favor of primary pharmacotherapy a number of years ago, and is now moving toward a tighter integration in medicine -- psychosomatics. This has been a longstanding interest of Dr. Michelle Riba, current President of the American Psychiatric Association. It's also a good way to convince policymakers that psychologists are not physicians and do not understand the intricacies of clinical medicine and its interaction with psychiatry.

We should try to carry on a dialogue in this forum. I'm curious to hear everyone's responses.

Hi PublicHealth,

Thanks and congrats on being an MS2; that is really awesome.
I considered for about a year all possible options (including moving to NM or LA) and finally decided on going the psychiatry route when I concluded that RxP will come to FL (where I want to live and practice) only at the very end (FMA and FPS are very influential in FL to the point that this State is one of only six that does not permit psych NP-eventhough they need to have a collaborative agreement with a psych MD/DO-to Rx controlled substances like benzos and stimulants).
Besides I believe that getting legislative approval for RxP is only half the battle as insurance coverage for med psych also has to be garnered and efforts at this are now just starting in NM.
So, while I support this development in cl psych I believe it will be a long-time coming (at least on a national scale).
I also believe that while medical psychology will provide a very neccessary service to patients (especially increasing access to integrated psych treatment for the outpatient population) I continue to believe that psychiatry will still be the gold standard in pharmacotherapy. I envision that medical psychologists will be the primary mental health providers of the future (as opposed to PCPs) but that they will refer to psychiatrists the harder to treat cases (e.g., treatment resistant, polypharmacy, inpatient).
I'm also very interested in psychosomatics.
Bottom line, I'm very much in support of this development in psychology but its current status and what I foresee as its ultimate unfolding do not fully respond to my professional aspirations.
Peace.
P.S. Can't wait to be in med school. Congrats again. BTW,
NYCOM is still one of my top choices; especially because of its clerkships in The City and awesome residency matches.

 

[PublicHealth]

Cognitive-behavioral and social learning theory were definitely present. But, like many clinical programs, mine allowed individual tracking beyond core courses. Within the core, bio-specific courses were available (e.g., bio bases of behavior and neuropsychology). Outside of that, electives could be anywhere. Example elective courses might include psychophysiology, frontal lobe developmental, advanced topics: cognitive neuroscience - attention, advanced topics: cognitive neuroscience - imaging and EEG, behavioral genetics, neuro-ethology, and neuroanatomy, etc. . . Outside of classes, directed individual study was allowed (topic to be determined by student, I did, neuro-vasculature and vascular diseases), research projects were required, of course (e.g., masters and dissertation). Most people do projects beyond that, as did I . For me, all of these were psychophysiology/cognitive neuroscience research projects. Teaching can also be a learning method in graduate school (e.g., teach nervous systems and behavior, or physiological psychology, or sensation and perception).

Practicums:
Many programs offer neuropsychology practicums yearly. Externships are required. There are formal externship programs for neuropsychology at places like the University of North Carolina, Duke, VAs, and so on. . .

In addition:

at the internship level, if you go to a division 40 certified program at an academic medical center you might experience:

wada testing as part of epilepsy surgery
neuropathology - brain cuttings - (many programs require interns to attend this weekly throughout the year).
psychiatry grand rounds
neurology grand rounds

some programs require/offer interns to do neurological exams under the supervision of a neurologist as a rotation

Then, there is post-doc.. . .

If you don't mind my asking, where did you train?

 

[PsychEval]

Hi PsychEval,
I really liked your posts in the psychiatry forum; like you I support all clinical psychologists being trained in the biological dimension of mental illness in order to increase diagnostic skills (e.g., differentials, triage) as well as a sub-specialty of medical psychologists having RxP.
I considered a post-doc MS in psychopharm or going the route of a psych NP but in the end decided to become a psych MD/DO.
My passion is really clinical work, especially intervention strategies. I don't know much about neuroradiology but it sounds to me to be a branch of diagnostic radiology; if so I don't think I'd be interested. I see myself in the future as a psych PsyD-MD or PsyD-DO providing direct service to both outpatient and inpatient populations.
Peace.

I appreciate and applaud anyone who has a passion for knowledge. And as we know, there are many diverse formats to obtain knowledge. Furthermore, I have always appreciated your posts, and do not mean to be discouraging, but from a practical standpoint completing two years of pre med, four years of medical school, four years of residency, accruing 200,000 more in debt on top of your Psy.D. degree, not to mention 10 years of not making your full income as a psychologist, and when it’s all over you will receive a 20-25% pay raise, just doesn’t seem practical. In fact, you will likely make less money over your lifetime because of your decision to pursue psychiatry considering your background and current skills. You’re a smart guy and have probably crunched the numbers and are aware of this. There is absolutely nothing wrong with going to medical school after becoming a psychologist. In fact, I respect your level of dedication and discipline. However, from a practical standpoint, the only way a career in medicine seems sensible after completion of doctoral training in psychology would be to select a specialty that pays well (300 +). In my area, psychiatrists start out at $125,000 in the local community mental health center. I know several psychologists in private practice in my area who make around $130,000. I would love to be a forest ranger or be a lifeguard and look at pretty girls all day, the only problem is that there is no money in it. I don’t think it is healthy to be preoccupied with money, but when there are money concerns folks can become resentful and unhappy. I remember reading months ago Dr. Focker saying something like….two hundred thousand in debt, and old car, and no home ownership, yes I am concerned about psychologists prescribing. I have the utmost respect for you for continuing your education. I hope as you enter medical school and later become a physician, that you would keep an open mind about what your specialty will be.

About the neuroradiology…..I am increasingly involved in neuroscience. Among the professionals involved in interdisciplinary neuroscience, I interact with neurologists, neuropsychologists, neurosurgeons, neuroradiologists, residents, and medical students (unfortunately psychiatry only on occasion, and I don’t know why they are not more involved). The neuroradiologists are an impressive group, and steal the show at various case conferences. They are some of the most skilled diagnosticians, contribute to patient care, have excellent economic compensation, and even a better quality of life.

 

[PublicHealth]

I think this (RxP) would be much more tempting to all those eclectic therapists out there.

I disagree. Nearly all of the private practice psychotherapists (all PhDs) with whom I have discussed RxP have no interest whatsoever in prescribing. They respect the complexities of medical/psychiatric treatment and would much rather refer their patients to psychiatrists than pursue additional years of psychopharmacology training and liability concerns. Of course, all of these psychologists practice in an fairly affluent region of the country with ready access to psychiatrists. I'm sure this is not the case in other states.

 

[sasevan]

Hi PsychEval,

I appreciate and applaud anyone who has a passion for knowledge. And as we know, there are many diverse formats to obtain knowledge. Furthermore, I have always appreciated your posts, and do not mean to be discouraging, but from a practical standpoint completing two years of pre med, four years of medical school, four years of residency, accruing 200,000 more in debt on top of your Psy.D. degree, not to mention 10 years of not making your full income as a psychologist, and when it’s all over you will receive a 20-25% pay raise, just doesn’t seem practical. In fact, you will likely make less money over your lifetime because of your decision to pursue psychiatry considering your background and current skills. You’re a smart guy and have probably crunched the numbers and are aware of this. There is absolutely nothing wrong with going to medical school after becoming a psychologist. In fact, I respect your level of dedication and discipline. However, from a practical standpoint, the only way a career in medicine seems sensible after completion of doctoral training in psychology would be to select a specialty that pays well (300 +). In my area, psychiatrists start out at $125,000 in the local community mental health center. I know several psychologists in private practice in my area who make around $130,000. I would love to be a forest ranger or be a lifeguard and look at pretty girls all day, the only problem is that there is no money in it. I don’t think it is healthy to be preoccupied with money, but when there are money concerns folks can become resentful and unhappy. I remember reading months ago Dr. Focker saying something like….two hundred thousand in debt, and old car, and no home ownership, yes I am concerned about psychologists prescribing. I have the utmost respect for you for continuing your education. I hope as you enter medical school and later become a physician, that you would keep an open mind about what your specialty will be.

Thanks.
I've always appreciated your posts as well; very well thought out and respectful. I think you have been an excellent psychology ambassador in the psychiatry forum.
I decided to pursue psychiatry at the beginning of my post-doc fellowship in the Fall of 2003 and began to take the pre-med reqs in the Spring of 2004. I'll be finished with all courses by Summer 2006 and hope to start med school in the Fall of 2007. I'm already well along this course and have only become more committed to it as it has unfolded. As you can tell, I've only been a professional psychologist since the Fall of 2004 so money wise I'm not making the most amount (probably 50k annually for 30 hrs/weekly-gives me flexibility for pre-med) and not having this current income during my med school years doesn't bother me very much. I also hope to finance my med edu through the National Health Services Corp so maybe I won't have that 200k debt. Of course, I'll probably be earning 45k annually during the residency years so all in all I think I'll be financially ok. When I become a professional psychiatrist in 2015 I'll still have about 30 working years where hopefully I'll make enough (I'm thinking 150k) to enjoy a slight upgrade to my current modest but comfortable lifestyle (as you can see I've become habituated to my working student status...LOL).
Seriously, though, I did crunch the numbers (and consulted with a couple of psychologists-psychiatrists) and financially, even in the worst case scenario (200k debt, 120k annual salary), it still made sense.

About the neuroradiology…..I am increasingly involved in neuroscience. Among the professionals involved in interdisciplinary neuroscience, I interact with neurologists, neuropsychologists, neurosurgeons, neuroradiologists, residents, and medical students (unfortunately psychiatry only on occasion, and I don’t know why they are not more involved). The neuroradiologists are an impressive group, and steal the show at various case conferences. They are some of the most skilled diagnosticians, contribute to patient care, have excellent economic compensation, and even a better quality of life.

This is very interesting and I will look into it. I'm also going to pass on this info to a friend who is very interested in neuroscience but who is considering dentistry instead of medicine because of quality of life issues.
I'm really committed to psychiatry as my preferred med spec but I guess I'd be ultimately open to any med spec that can be built on my psychology background. You never know. If not, then maybe I can at least find a place as a psychologist-psychiatrist in the interdisciplinary neuroscience team.

Thanks again. Peace.

P.S. Any other info on neuroradiology (e.g., what role you've seen it play, how that has been translated to patient care, is it a neuro or rad sub-spec, does it require a fellowship) would be awesome.

 

[sasevan]

Hi Jon Snow,

That would be the way I would do it.

Cool.

I don't have confidence that would remain the case for long. I think the current model of psychiatry evolved because of reimbursement rates not because of benefit to the patient. Psychology would face the same pressures.

No doubt its definitely a risk. But wouldn't the worst case scenario be that medical psychologists would end up taking the place of PCPs providing front line med mgm? On the other hand, the best case scenario could be increasing patient access to integrated mental health services (i.e., doctoral-level mental health clinicians providing both psychotherapy and primary psychopharmacotherpy). This could result in PCPs being free of this responsibility, mid-level providers engaged in counseling, and psychiatrists providing secondary psychopharmacotherapy to the harder to treat cases and continuing to develop and implement other medical interventions such as ECT and VNS. Its a risk but isn't it worth taking?

I think med psych would be more tempting than you think to a large number of cl psychs. Many people in cl psych go into it with the notion of being a psychotherapist. Many people go in not that interested in science (especially with the prof schools) and more interested in therapy. If RxP allowed cl psychs to do psychotherapy as their primary vocation and earn at a reasonable level (unlike now), it would be a big golden carrot. Neuropsychology and forensics are not fun if you it isn't what you want to do and it's hard. I think this (RxP) would be much more tempting to all those eclectic therapists out there.

I agree, but wouldn't it still be better for patients to have increased access to doctoral level mental health clinicians that could provide them integraded treatment as opposed to seeing a PCP (or psychiatrist when available) exclusively for med mgm and perhaps sometimes (rarely?) also seeing a mid-level provider or psychologist for therapy?

Could you support the development of PhD/PsyDs having RxP if med psych were limited to a pre-doc concentration and a rigorous post-doc training (akin to neuropsych) and certification standards were established and safeguarded by a Board of Medical Psychology? Wouldn't that at least decrease the risk of the sub-specialty overrunning cl psych?

Peace.

 

[PublicHealth]

the best case scenario could be increasing patient access to integrated mental health services (i.e., doctoral-level mental health clinicians providing both psychotherapy and primary psychopharmacotherpy). This could result in PCPs being free of this responsibility, mid-level providers engaged in counseling, and psychiatrists providing secondary psychopharmacotherapy to the harder to treat cases and continuing to develop and implement other medical interventions such as ECT and VNS. Its a risk but isn't it worth taking?

This sounds like optometry and ophthalmology -- ODs providing primary eye care (eye exams, primary vision care) and MDs providing more intensive treatments, including surgery.

 

[sasevan]

This sounds like optometry and ophthalmology -- ODs providing primary eye care (eye exams, primary vision care) and MDs providing more intensive treatments, including surgery.

Hi PH,
What's your take on something like that?
To me it sounds like a way to expand psychology's practice scope while safeguarding psychiatry's medical pre-eminence.
This could also reduce the risk of the over-medicalizing of psychology while increasing patient access to integrated mental health treatment.
Peace.

 

[PublicHealth]

Hi PH,
What's your take on something like that?
To me it sounds like a way to expand psychology's practice scope while safeguarding psychiatry's medical pre-eminence.
This could also reduce the risk of the over-medicalizing of psychology while increasing patient access to integrated mental health treatment.
Peace.

 

[Logic Prevails]

<<Originally Posted by PublicHealth
This sounds like optometry and ophthalmology -- ODs providing primary eye care (eye exams, primary vision care) and MDs providing more intensive treatments, including surgery.>>

Hi PH,
What's your take on something like that?
To me it sounds like a way to expand psychology's practice scope while safeguarding psychiatry's medical pre-eminence.
This could also reduce the risk of the over-medicalizing of psychology while increasing patient access to integrated mental health treatment.
Peace.

The argument that you're trying to make here is the same as the argument I've been making for masters level practitioners. By the logic of some people on this board we would argue that Ophthalmologists don't have the same qualifications as the Optometrists and provide sub-par care for patients. This means that allowing Opthalmologists to continue caring for those with eye problems is undermining the field of eye care. Similarly, psychologists who seek RxP will be providing sub-par tx (as compared to Psychiatrists) and undermine the field of Psychiatry.

(P.S. I don't necessarily believe anything that I just wrote - I'm just trying to make a point that has been missed in the past few pages of this thread and steer the topic closer to the title of the thread)

 

[sasevan]

<<Originally Posted by PublicHealth
This sounds like optometry and ophthalmology -- ODs providing primary eye care (eye exams, primary vision care) and MDs providing more intensive treatments, including surgery.>>



The argument that you're trying to make here is the same as the argument I've been making for masters level practitioners. By the logic of some people on this board we would argue that Ophthalmologists don't have the same qualifications as the Optometrists and provide sub-par care for patients. This means that allowing Opthalmologists to continue caring for those with eye problems is undermining the field of eye care. Similarly, psychologists who seek RxP will be providing sub-par tx (as compared to Psychiatrists) and undermine the field of Psychiatry.

(P.S. I don't necessarily believe anything that I just wrote - I'm just trying to make a point that has been missed in the past few pages of this thread and steer the topic closer to the title of the thread)

Hey Brad3117,
I think you were confusing Opthalmologists with Optometrists and vice versa; the former are the MD/DOs while the latter are the ODs but I get your point.
I wasn't considering medical psychologists, in comparison to psychiatrists, as providers of sub-par patient care. I believe that psych PhD/PsyDs that are trained/certified in a post-doc MS psychopharm program will be able to provide primary pharmacological treatment equal to a psych MD/DO (and probably superior to PCPs, the current primary psychopharmacologists). However, I don't believe that medical psychologists will be equal to psychiatrists when it comes to medically managing the more complex cases (just like PCPs aren't equal to psychiatrists in that regard).
I guess the model that I envision will have medical psychologists taking over the role of PCPs in providing basic psychopharmacological treatment (primary care) and psychiatrists continuing to provide more sophisticated treatment when warranted (specialty care).
I think that such a model would serve the needs of all the stakeholders: patients would have increased access to integrated primary mental health treatment (remember that psych PhD/PsyDs will be providing pharmacological interventions in the context of psychological services); psychology will expand its scope of practice; psychiatry's current medical pre-eminence in mental health will not be threatened; and PCPs will be relieved (I believe) to not have to medically managed the majority of the mentally ill.
What do you think?
Peace.

P.S. Please clarify your point regarding the masters level providers.

 

[Logic Prevails]

Hey Brad3117,
I think you were confusing Opthalmologists with Optometrists and vice versa; the former are the MD/DOs while the latter are the ODs but I get your point.

Yup, my bad.

I wasn't considering medical psychologists, in comparison to psychiatrists, as providers of sub-par patient care.

I know you weren't - I was making this comparison to highlight my point about Master's level practitioners. I've argued throughout this thread that Master's level practitioners should be permitted to take on some roles that had been previously (and are currently in some places) reserved for PhD level Psychologists. In Canada, there are only 2-3 provinces that require a PhD in order to practice. In Many provinces we have Master's level Psychologists or "Psychological Associates/Assistants," who might do assessments or therapy as long as they are practicing within their area of competence (though often with supervision). I know registration is different in the U.S., but it has been this way in Canada for quite some time with few problems.

Anyway, another user on this board went on a lengthy rant about how allowing Masters level practitioners to provide services (even limited services) would be undermining the field of Psychology (following from the logic that PhD psychologists would have more education and could have provided better services). I don't agree at all (as this applies to limited types of services), but have extended his logic to this discussion about PhD psychologists who might do additional training to provide pharmacological treatment. Following the same logic, we would have to say that PhD Psychologists would provide sub-par services (even if these services were limited and generally applied) compared to their Psychiatric counterparts (who would have a larger background in medicine).

I believe that psych PhD/PsyDs that are trained/certified in a post-doc MS psychopharm program will be able to provide primary pharmacological treatment equal to a psych MD/DO (and probably superior to PCPs, the current primary psychopharmacologists).

In providing primary pharmacological treatment, I certainly agree.

However, I don't believe that medical psychologists will be equal to psychiatrists when it comes to medically managing the more complex cases (just like PCPs aren't equal to psychiatrists in that regard).
I guess the model that I envision will have medical psychologists taking over the role of PCPs in providing basic psychopharmacological treatment (primary care) and psychiatrists continuing to provide more sophisticated treatment when warranted (specialty care).

Sounds good to me, but this is the same argument that I've been making for Master's level practitioners providing certain types of services.

I think some people on this board dislike the idea of Master's level practitioners taking over positions that they might have otherwise filled (even though MSW's have already done so). I think if this were to happen (which I believe it should), PhD Psychologists should expand their area of expertise so that the dicipline remains in good health and the public benefits. I think this will happen by having more PhD psychologists moving to supervisory positions and further specializing (in ways such as what you've been outlining here).

I think that such a model would serve the needs of all the stakeholders: patients would have increased access to integrated primary mental health treatment (remember that psych PhD/PsyDs will be providing pharmacological interventions in the context of psychological services); psychology will expand its scope of practice; psychiatry's current medical pre-eminence in mental health will not be threatened; and PCPs will be relieved (I believe) to not have to medically managed the majority of the mentally ill.
What do you think?
Peace.

I think this makes a lot of sense. I would only worry about the extra training it would require. I think if this were to happen, you would need to seriously reassess the PhD/PsyD programs that we have already. Many schools on paper take 5-6 years to complete a MSc/PhD plus internship. In reality, it often takes longer (i.e. 7-8 years average at my school). I would worry about additional training taxing the student too much in terms of what they can be an "expert" in. I think they would be spreading themselves too thin, emotionally, cognitively, and financially.

I think in general you're on the right track here. I believe the PhD programs that we currently have in place need some serious restructuring before anything else were to happen (we don't really have PsyD programs in Canada, but I believe they are the right way to go for clinical training). I believe these changes will happen eventually, and likely as a result of changing roles for those working outside of the Universities.

My 2 cents

 

[PublicHealth]

I believe the PhD programs that we currently have in place need some serious restructuring before anything else were to happen (we don't really have PsyD programs in Canada, but I believe they are the right way to go for clinical training). I believe these changes will happen eventually, and likely as a result of changing roles for those working outside of the Universities.

I agree that restructuring at the predoctoral-level is inevitable. However, this will have to been done in a way that is sensitive to those who seek more traditional training in clinical psychology and those who wish to pursue more medical/psychiatric training.

Many clinical psychology programs have specialty tracks (e.g., neuropsychology, geropsychology, etc). No one talks about these tracks as having required "serious restructuring." They were simply specializations within the broad field of clinical psychology. A good move for the field if you ask me, as it allows students to begin to specialize at the predoctoral level. Why not simply add a "medical/prescribing psychology" track to existing doctoral programs in clinical psychology?

Why is adding medical/psychopharmacology training at the predoctoral level viewed as such a dramatic change that requires such "serious restructuring" when it is simply a track to prepare students for further training in psychopharmacology and integrated behavioral healthcare? There are multiple levels in clinical psychology training -- predoctoral, internship, postdoctoral, continuing education -- that we need to consider when discussing the incorporation of medical/psychiatric training into predoctoral clinical psychology curricula.

 

[sasevan]

Hi,

Sorry for taking so long to reply; I've been swamped with work and school (finals next week )

I know you weren't - I was making this comparison to highlight my point about Master's level practitioners. I've argued throughout this thread that Master's level practitioners should be permitted to take on some roles that had been previously (and are currently in some places) reserved for PhD level Psychologists. In Canada, there are only 2-3 provinces that require a PhD in order to practice. In Many provinces we have Master's level Psychologists or "Psychological Associates/Assistants," who might do assessments or therapy as long as they are practicing within their area of competence (though often with supervision). I know registration is different in the U.S., but it has been this way in Canada for quite some time with few problems.

Not just in Canada. I believe in many nations psychologists are masters level; Colombia and Venezuela come to mind.
I think that in the US the APA made the decision long ago that psychologists (at least clinical and counseling ones not neccessarily school ones) would be doctoral level and has labored since to ensure that. It has also labored to restrict the use of terms such as "psychologist" and even "psychological" to those practitioners regulated by the pertinent State Board of Psychology; e.g., after I got my M.S. in Psychology I worked at a State prison under the title of "Psychological Specialist" (and under the supervision of Licensed Psychologists-i.e., PhD/PsyDs).This was a position open to anyone with a masters degree in psychology, social work, or counseling. Eventually, the FL legislature, after lobbying from FPA, prohibited its use and the title is now "Mental Health Specialist." So I believe that the issue is pretty much settled here.

Nonetheless, I think that your main point is that masters level practitioners should be able to expand their scope of practice into therapy/testing just as psychologists want to expand their's into RxP. In principle I would, generally, agree. I say generally because when we're talking about masters level practitioners we're talking about different fields, i.e., MA/MS psychology, LCSW, LMHC, and LMFT. I don't see why someone with an MA/MS in psychology (Psychological Assistant?) could not function as a Physician Assistant does in medicine: i.e., providing limited assessment/treatment under the supervision of a psychologist. This was basically what I was doing when I was a "Psychological Specialist." Is this what you're proposing?
But as far as LCSWs, etc I don't know enough to offer much of opinion except to suggest that all of these different disciplines certainly have a role to play in the delivery of psychosocial interventions but probably not in the administration of psychometric measures (not that they couldn't/shouldn't but that they're not trained to do so and don't appear to be too interested in so being).

I think some people on this board dislike the idea of Master's level practitioners taking over positions that they might have otherwise filled (even though MSW's have already done so). I think if this were to happen (which I believe it should), PhD Psychologists should expand their area of expertise so that the dicipline remains in good health and the public benefits. I think this will happen by having more PhD psychologists moving to supervisory positions and further specializing (in ways such as what you've been outlining here).

I defenitely agree that PhD/PsyDs should be doing much more supervising of masters level practitioners (and even possibly of MD/DOs) in the area of therapy (and testing where applicable).

I think this makes a lot of sense. I would only worry about the extra training it would require. I think if this were to happen, you would need to seriously reassess the PhD/PsyD programs that we have already. Many schools on paper take 5-6 years to complete a MSc/PhD plus internship. In reality, it often takes longer (i.e. 7-8 years average at my school). I would worry about additional training taxing the student too much in terms of what they can be an "expert" in. I think they would be spreading themselves too thin, emotionally, cognitively, and financially.

I think you've raised an important point but I think, as PublicHealth stated, that a concentration in med psych and a 3 yr residency (1 yr intern/2 yr fellow) would ensure adequate training for RxP whithout needing to alter the current model of cl psych. Although, to be perfectly honest, I think that the current curriculum could benefit from some alterations such as increased exposure to neuroscience, pathophysiology, psychopharmacology, etc.

I think in general you're on the right track here. I believe the PhD programs that we currently have in place need some serious restructuring before anything else were to happen (we don't really have PsyD programs in Canada, but I believe they are the right way to go for clinical training). I believe these changes will happen eventually, and likely as a result of changing roles for those working outside of the Universities.

My 2 cents

Thanks. I believe you are too.

Peace.

 

[pschmom1]

Ok I have a few questions or opinions. I've heard of a lot of references to social workers or LCSWs. They are what they are. They go to school for 6yrs and practice under some supervision for 2yrs prior to be able to set up shop and have their own practice (where I'm from anyways). The point is, they provide therapy!!! Most provide "coping techniques" and that is productive for some people. I think, in my own personal opinion, that psychologists focus more on the person and the biopsychosocial model of therapy and that works for some people. As we know, LCSWs are cheaper than psychologists, and much easier to come by (at least where I'm from) so therefore, that is the direction most take when seeking therapy. I believe that LCSWs are great for some things, (ie. marriage counceling, substance abuse, family counceling) in a minor form, but psychologists are great for really understanding the person and their problems (ie. insight, compassion, and empathy). I think, keep in mind that this is just my opinion, that psychologists are great for getting down to the REAL issues and working with the person to help them understand and progress in a productive manor. Where as I see a LCSW as providing "coping techinques" or a bandaid for the real underlying maladaptive behavior or issue. But both are good for different people and problems. I just see so much degradation in the mental health field and I'm trying to make sence of it all. I am curious to know what would come of the psychologists that choose not to prescribe meds (if and when allowed). Would they be concidered "less" than prescribing psychologists? How different would the salary be? Just curious. I hear soooooo much controversy between psychologists and psychiatrists, a lot from the psych forum, but definatley from many other sources. I wonder what the big deal is? Really? It's almost like there is competition between the two. Even in my ab psych class, we had a world renowned forensic psychologist guest speaker, and he and my professor made a joke, something like, "What's the difference between a psychologist and a psychiatrist.....A psychologist has 10yrs of mental health education and a psychiatrist has 5" Ok yeah, not very funny, but at the same time it made me think. I'm majoring in psychology and plan to attend med school to specialize in psychiatry. I love psychology and I hope that one day psychology and psychiatry can all be a big happy famliy . Ok, I'm rambling and potentially a little delusional due to lack of sleep as a result of studying for finals. Please excuse my long post

 

[psych101]

I think you raise some valid points. I agree that social workers serve an important role in the field of mental health (and they have actually done a great job remaining unified and advocating for themselves, as compared to psychology). Psychiatry provides an invaluable service as well (and has also done an excellent job advocating for their field). I also think that psychologists pursuing RxP has already created a division in our field which will only worsen as the movement progresses...and, if RxP are granted across the board then those who don't have appropriate training/aren't willing to prescribe meds would likely be paid less or viewed as less useful or marketable. Seems like psychology as a whole is kind of a mess right now, headed in too many directions and operating on a fairly shaky foundation. I also agree that there is too much degradation going on amongst all these folks - guess it starts during post-grad training and is perpetuated in the "real world." It's such a shame, because a multidisciplinary team that truly works together and consists of each member (i.e., psychologist, psychiatrist, social worker, other specialists) doing their own unique thing can me an amazing thing in action. Too bad we all hate each other ;-)

 

[Kimya]

My my.. some of these posts seem to be a bit... uninformed as to what it is social workers do. I am a MSW going for my LSCW. I posted elsewhere on this forum about this and am reposting it below. It is too bad that there is so much angst about masters level providers. They are here to stay, so may as well learn about 'em!


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Whoa! Lots of responses. Noticed several people curious about what types of therapy LCSW's do. I will tell you trends I have seen in my area (which is CA). Medical social workers (i.e. inpatient, inpatient psych to a degree) usually do more supportive counseling, working with family, linking pt and family to resources, advocacy, case management. In some hospitals LCSW's do discharge planning. Some don't. Counseling in this arena is almost always short term. There are a lot of very interesting areas for medical social work-- ER, palliative care are two of my faves.

Mental health social workers are often involved in the more traditional "50 minute hour", ie outpt mental health. You will learn about the major psychotherapy theories in classwork and can choose an internship to focus specifically on this if you choose. We do have some strong proponents of psychodynamic theory, I personally prefer CBT especially since I am interested in working with adjustment disorders/PTSD. First year I was in a mental health agency, did indiv/family therapy, group therapy, all time limited. In my second year, I did mental health screenings (outpt mental health), coming up with DSM-IV diagnosis, and got to see a variety of Axis I and II disorders.

Groups are also important in both of these settings. I've done both short term group therapy and also groups that are more of an ongoing support (ie caregiver groups, chronic illness). Group dynamics are fascinating and the peer support can be incredibly helpful for clients.

I have found that background in case management has also been very useful if you are seeing clients in therapy sessions. Sometimes the most pressing thing for a client is not their mental illness but their social circumstances. It has been useful to be able to "switch hats" and focus on that first if it helps the client. For example, 2nd yr I was working with a client with MDD/PTSD. Most urgent situation was that he was getting evicted. So first sessions focused on advocating for client and helping him contest eviction. Then could focus on more mental health issues, but have built good rapport with client and shown I care what his priorities are.

Well I hope that helps. I have met many excellent therapists from many different backgrounds, LCSW, psychologists, MFT... I think the key is having a passion for the work and a willingness to always continue learning. For those who want more detail on different areas of social work, I included a more specific link:

http://www.naswdc.org/pubs/choices/default.asp

 

[Logic Prevails]

Brad,

To what level do we take that argument? Shall we have stipulations for:

PhD level psychologists
PsyD level psychologists
Masters level psychotherapists
Bachelors level psychotherapists
high school level psychotherapists
GED level psychotherapists

etc. . .

Hahaha... there's that slippery slope argument again.

Okay, I just got back from a week long psychotherapy conference so I'm a bit behind on these posts. Jon, I don't think we need to get into a debate about who has the better health care sysem (not necessary). Although we dissagree on many points, I respect what you have to say and agree with you on many others. I also think it important for all therapists to have a better understanding of the biological bases of the brain - Unfortunately, I think in most programs (unless you are in a neuropsyc track) neglect this component. At this conference, I was able to hear from Dan Seigel (M.D.), who has excellent ideas for integrating more traditional therapy with what we know about neurobiology. His theory is "interpersonal neurobiology" - I strongly recommend persons interested to check it out.

During this conference there were several very influential and heartfelt talks about medication and psychotherapy. I won't go into the details, but I guess the idea was that we would be pushing for a more "medical model" of therapy, which may not be the right way to go. Although this model would be fine to adopt for the psychiatrist, it might not fit for the psychologist. I think our goal is to be changing neurophysiology through our human interventions. Perscriptions should be used in cases where our research suggests this is the best alternative to more traditional therapies. I don't know if we can expect psychologists to be compentent in providing adequate therapy to the diverse individuals that we see AND be competent and knowledgable about organic chemistry and perscribing. I agree with the person on the board who suggests that we need more cooperation and collaboration amongst health providers. I think that would be the best solution.

On a final note, I guess I need add a bit about the Masters level practitioner. I have mixed feelings. During this week long conference I was astounded by the amount of individuals that were practicing therapy with a MA/MSc/LCSW. I've met many intelligent individuals and a few *****s who I believe are just as likely to harm as they are to help a client. I don't think that the length of a program necessarily speaks to the skills of the therapist. I've argued this already - programs are too diverse in what skills they emphasize and in how much they push the research component and whether the research has anything to do with the clinical population that the student will eventually be working with.

I don't think that someone needs a PhD in order to provide mental health interventions. On the other hand, I think that people should have more than a 2 year MSc. It really is hard to put a number on it. I met a girl from Australia who told me that she was just finishing up her "Doctorate" in clinical psychology. I was suprised because this girl looked like she was in her early/mid twenties (which would make this feat near impossible). She told me that in Australia, a "Doctroate" in clinical psychology takes a total of 3yrs graduate education (she also said that this was a new thing). I guess these individuals are called "psychologists," but are limited to therapy work, and are unable to hold a tenure academic position. I also met another individual in the U.S. who received her PhD after only completing 4 yrs of graduate work. I forget the name of the university, but it sure beats the typical 8-10 years at my university.

I'm sure many of you will disagree about this stuff - food for thought.

Out.

 

[50960]

There is a big difference between counselling, and treatment. Both are needed. One focuses on making a person feel better, and the other on helping a person to get better.

 

[Sanman]

well, I think we can all agree that indiviuduals with a doctoral degree and those with a masters are at two different levels of qualification. What I believe needs to be done is that certifications needs to be adopted to clarify the distinction between the two levels of educaition. Despite the different leveels of training the job tasks seem to be nearly uniform. Some fields (neuropsych, sleep medicine) have already adopted a certification, but it useless if it is unneccesary to get a job and not enforced by law. On the other hand certification makes it harder for psychoologists to practice more than one kind of mode of practice, so it is a double edged sword.

 

[Solideliquid]

well, I think we can all agree that indiviuduals with a doctoral degree and those with a masters are at two different levels of qualification. What I believe needs to be done is that certifications needs to be adopted to clarify the distinction between the two levels of educaition. Despite the different leveels of training the job tasks seem to be nearly uniform. Some fields (neuropsych, sleep medicine) have already adopted a certification, but it useless if it is unneccesary to get a job and not enforced by law. On the other hand certification makes it harder for psychoologists to practice more than one kind of mode of practice, so it is a double edged sword.

Oh, the irony.