Independent practice for LPAs?

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I also find it interesting that what I read on SDN isn't really indicative of the real world. In other words, I don't tend to hear these sorts of arguments between psychologists, social workers, and psychiatrists in the filed. Perhaps it is easier to do so from the shield of an online environment; or perhaps these sorts of threads tend to attract the minority. I don't know the answer, but for the most part, it seems that in everyday life, professionals tend to get along fairly well in spite of their obvious differences. Which I must say is a relief, because if I had to do this on a daily basis, while also working with clients, I would probably say "screw it" and become a computer programer or perhaps a librarian...:)

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That's a fair point. I guess it's somewhat of a semantic issue. Opening up scope of practice I don't like (RxP, LPA's), but what I have taken issue with in this thread, which was brought up early, was the idea of restricting scope of practice away from those that already have it.

That is very easy to say when you are practicing within a discipline that is not yet drowning in alphabet soup. I have read, experienced, and heard various accounts of incompetent psychotherapeutic practices. And it does not come from just one discipline. That is why I (nor any others here) am not suggesting increased standards for just certain disciplines of psychotherapists, but across the board. It is funny how the endorsement of ABPP certification for psychologists and advanced fellowship training for psychiatrists keeps getting overlooked. I suppose it is just easier to stick with the "prove the master's level people are bad" approach. Also, I am far less concerned with hurting a practicing clinician's feelings than I am with improving the state and quality of care provided to patients. So if there is a therapist (with whatever credentials) out there who has been working with SMI populations for 20 years who is asked by his/her employer to seek board certification in the area who is unable to pass the whiff test and he/she gets the boot, I say :thumbup::thumbup:

he path of discussion in this thread involved a reaction to the expansion of LPA's in texas, and then proposing at a point that psychologists are the only one who have enough training to be therapists (that was unfortunately what I took from it).

That may be what you took from it, but I am having a hard time actually finding that statement or anything like it.

So I became reactionary, but also turned to the literature. While I agree that psychologists usually have the most training in therapy at baseline, if we're going to restrict practice we'd better damn well have evidence that the way we're restricting it has benefit for patient outcome, as opposed to being part of a turf war.

And yet you do not seem to be interested in studies that would actually compare psychiatrists' competence in medication management versus a psychologist who sought advanced training in psychopharmacology for Rx privileges before so steadfastly (and appropriately) resisting.

At the end of the day, increased or streamlined standards cannot HURT patients. So the turf war posturing seems to be from the side of those who oppose it.
 
To play devil's advocate, one argument could be that the initial expansion of the scope of practice for master's level providers was inappropriate and also not based on patient outcomes, but more due to the shortage of providers. If this were the case, then I think a limiting of scope is appropriate.

Excellent point.
 
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That is very easy to say when you are practicing within a discipline that is not yet drowning in alphabet soup. I have read, experienced, and heard various accounts of incompetent psychotherapeutic practices. And it does not come from just one discipline. That is why I (nor any others here) am not suggesting increased standards for just certain disciplines of psychotherapists, but across the board. It is funny how the endorsement of ABPP certification for psychologists and advanced fellowship training for psychiatrists keeps getting overlooked. I suppose it is just easier to stick with the "prove the master's level people are bad" approach. Also, I am far less concerned with hurting a practicing clinician's feelings than I am with improving the state and quality of care provided to patients. So if there is a therapist (with whatever credentials) out there who has been working with SMI populations for 20 years who is asked by his/her employer to seek board certification in the area who is unable to pass the whiff test and he/she gets the boot, I say :thumbup::thumbup:

That may be what you took from it, but I am having a hard time actually finding that statement or anything like it.

And yet you do not seem to be interested in studies that would actually compare psychiatrists' competence in medication management versus a psychologist who sought advanced training in psychopharmacology for Rx privileges before so steadfastly (and appropriately) resisting.

At the end of the day, increased or streamlined standards cannot HURT patients. So the turf war posturing seems to be from the side of those who oppose it.

I actually would love to see outcome studies on prescribing psychologists. I'm all in favor of guidelines that improve outcomes.
I'd love to see everyone has more therapy training. And maybe creating a higher standard is the way to nudge people into it. God knows the insurance system isn't helping.

I'm not sure though that the outcome will be what you desire.
 
In general, I think that all of the various mental health professions have an identity crisis. Psychologists feel belittled by psychiatrists, social workers feel belittled by psychologists. At the end of the day, my guess is that little has to do with protecting patients, and most has to do with elevating our own status and self-worth. Perhaps some psychologists are put off by the audacity that masters level clinicians might consider themselves equal to their psychology counterparts, and are demanding similar practice rights, therefore marginalizing the psychology training model. I would also imagine that many psychiatrists are put off by the idea of non-medical practitioners demanding prescription rights, thus minimizing their medical education. Is it really about the patients? Because if it is, the evidence doesn't suggest that harm is occurring.

What really "chaps my ass" is the hypocrisy that some psychologists have participated in. You complain about masters level clinicians invading your turf, but are essentially doing the same thing to psychiatry. Some of you have suggested that social work programs, for example, aren't comparable to psychology programs, but support the argument that with 2+ years of post doc education, psychology is equal to psychiatry. How can you use the same argument to oppress one profession and encroach upon another, especially considering you have no data to support your argument?
 
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To play devil's advocate, one argument could be that the initial expansion of the scope of practice for master's level providers was inappropriate and also not based on patient outcomes, but more due to the shortage of providers. If this were the case, then I think a limiting of scope is appropriate.

Another point of contention is the independent practice thing. PAs are ultimately supervised by physicians. Our master's level counterparts are not. I would bet that the same arguments for PA supervision would apply in this arena.

Nailed it. But like all expansion of scope of practice, the argument for shortage of supply is the political face on it. I'd like to see how much it leads to benefit in areas with shortages. Sad to say the rural areas are always underserved, and most mental health providers like cities. Or so I've heard.
 
But to say the training in general is equal would be an overstep.

i would absolutely agree! But just the same, we cannot make the argument that psychology education with 2 years of pharma education is = to medical education either.
 
There is no evidence one way or the other, objectively at least (I have tons of anecdotal stories of providers causing harm by way of shoddy treatment delivery). But just because no one has compiled objective data, it does not mean that harm is not being done. .
Again, I also concur; however, limiting the scope of practice of clinicians without any empirical support for an action is a scary idea. Should we base standards on a model that hasn't been proven to be superior?
 
I never made such an argument. If you had actually read my previous posts instead of desiring to lump all psychologists into that group, you would see that I've already said I'm against RxP for psychologists in any form. In fact, I'm not sure that anyone on this thread has stated they agree with it (maybe T4C did, but prefaced that they don't agree with the current model for it).

Ok, fair enough. There have been several posters that have supported the movement. I didn't necessarily mean to imply that you were in that crowd. Also, if you notice in my post, I said many psychologists. I wonder though, if there was a national bill passed tomorrow that granted prescribing rights to all clinical psychologists, without any further education, how many do you think would go for it? My guess is that we would see an immediate increase in antidepressant sales, and the allegiance to best practice and gold standards would be down the toilet. But what is also scary is the idea that if insurance companies began reimbursing LCSWs for psychological testing, I would imagine many would jump on that band wagon as well. Supporting gold standards of care and arguing for stricter regulations is fine and dandy when it supports our status quo, but when we find ourselves on the other end of the coin, oh how our song and dance change.
 
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I actually would love to see outcome studies on prescribing psychologists. I'm all in favor of guidelines that improve outcomes.
I'd love to see everyone has more therapy training. And maybe creating a higher standard is the way to nudge people into it. God knows the insurance system isn't helping.

I'm not sure though that the outcome will be what you desire.

What I desire is hopefully what you desire, improved care.


What really "chaps my ass" is the hypocrisy that some psychologists have participated in. You complain about masters level clinicians invading your turf, but are essentially doing the same thing to psychiatry. Some of you have suggested that social work programs, for example, aren't comparable to psychology programs, but support the argument that with 2+ years of post doc education, psychology is equal to psychiatry. How can you use the same argument to oppress one profession and encroach upon another, especially considering you have no data to support your argument?

Have you actually been reading this thread? The majority of people have stated that they are NOT in support of the current push for Rx rights for psychologists.

Again, I also concur; however, limiting the scope of practice of clinicians without evidence of harm is a scary thought. Should we base standards on a model that hasn't been proven to be superior?

I have no problem saying that psychology has contributed more to the development of psychotherapy as we know it than any any other discipline and that psychologists have the most training by virtue of the foundation of training (developmental psych, social psych, cognition and learning, etc), scientific/diagnostic/assessment skills, training model (supervised practice through accredited practica, internship, and postdoctoral fellowship) and years invested in training. Psychology is the foundation of the practice and you are asking for someone to prove to you that the psychology training approach is the most thorough? Is it just me, or is this totally ridiculous?

I wonder though, if there was a national bill passed tomorrow that granted prescribing rights to all clinical psychologists, without any further education, how many do you think would go for it? My guess is that we would see an immediate increase in antidepressant sales, and the allegiance to best practice and gold standards would be down the toilet.

That is really sad and I think it says a lot more about you than the people you are accusing of being so wreckless.
 
Really? You think that a substantial number would practice outside of their competence just because they can? And you also believe they don't cause harm to people? Your reasoning is all over the place.

No, I didn't say that they don't cause harm. My point is that economics and ego tend to be large predictors of behavior. If other professionals are willing to cross professional boundaries into unknown territory (when you accuse a masters level therapist of providing potentially harmful services, you are saying that you believe these clinicians have chosen economics and/or ego over concern for patient care), why not psychologists? Many have accused social workers and masters level therapists of placing their patient's safety at risk by providing inadequate services.
 
What I desire is hopefully what you desire, improved care.




Have you actually been reading this thread? The majority of people have stated that they are NOT in support of the current push for Rx rights for psychologists.



I have no problem saying that psychology has contributed more to the development of psychotherapy as we know it than any any other discipline and that psychologists have the most training by virtue of the foundation of training (developmental psych, social psych, cognition and learning, etc), scientific/diagnostic/assessment skills, training model (supervised practice through accredited practica, internship, and postdoctoral fellowship) and years invested in training. Psychology is the foundation of the practice and you are asking for someone to prove to you that the psychology training approach is the most thorough? Is it just me, or is this totally ridiculous?



That is really sad and I think it says a lot more about you than the people you are accusing of being so wreckless.

But you are accusing social workers of being reckless by insinuating that we are practicing outside our scope of practice. Do you see what it is like to be on the other side? It is pretty insulting to have another professional belittle your training and insinuate that you are placing patients at harm without any proof to support that claim. If we social workers are so prone to careless acts (which we must be if 70% of the therapists in the nation are LCSWs), than why not psychologists as well? What makes us susceptible to poor choices and not you?
 
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No, I didn't say that they don't cause harm. My point is that economics and ego tend to be large predictors of behavior. If other professionals are willing to cross professional boundaries into unknown territory (when you accuse a masters level therapist of providing potentially harmful services, you are saying that you believe these clinicians have chosen economics and/or ego over concern for patient care), why not psychologists? Many have accused social workers and masters level therapists of placing their patient's safety at risk by providing inadequate services.

You are arguing from a position of assumed universal corruption. Which is concerning for a number of reasons but that is not what we are here to discuss. I certainly have not accused master's level therapists or social workers of purposely placing patients at risk. For all I know, they probably think their services are appropriate or that their training is adequate (whether it is or not). To use a recent example posted here are SDN of an LCSW (?) trying to provide behavioral therapy for a patient with dementia, I would not assume she is purposely practicing in a manner that is simply billing the man for nothing worthwhile. I would give her the benefit of the doubt in that she really thinks she is providing therapy. If anyone is to "blame" for loose standards that may put patients at risk, it is the insurance companies that offer incentives for the lowest cost options possible.
 
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You are arguing from a position of assumed universal corruption. Which is concerning for a number of reasons but that is not what we are here to discuss. I certainly have not accused master's level therapists or social workers of purposely placing patients at risk. For all I know, they probably think their services are appropriate or that their training is adequate (whether it is or not). To use a recent example posted here are SDN of an LCSW (?) trying to provide behavioral therapy for a patient with dementia, I would not assume she is purposely practicing in a manner that is simply billing the man for nothing worthwhile. I would give her the benefit of the doubt in that she really thinks she is providing therapy. If anyone is to "blame" for loose standards that may put patients at risk, it is the insurance companies that offer incentives for the lowest cost options possible.

But that is my point exactly. If we are so easily swayed by lenient policies and insurance reimbursements, then why not psychologists? What makes social workers so prone to this sort of behavior that psychologists have managed to resist against?

I am not sure why you mean by universal corruption...
 
But you are accusing social workers of being reckless by insinuating that we are practicing outside our scope of practice. Do you see what it is like to be on the other side? It is pretty insulting to have another professional belittle your training and insinuate that you are placing patients at harm without any proof to support that claim. If we social workers are so prone to careless acts (which we must be if 70% of the therapists in the nation are LCSWs), than why not psychologists as well? What makes us susceptible to poor choices and not you?

Training. That is what. Psychologists do not always have the right answers. That is impossible. But in terms of what is available, psychologists have the most training in more pertinent areas than other disciplines to provide the most informed care through therapy. Do you really think that scientific training, diagnostic/assessment skills, and more theoretical training in human behavior mean nothing in the context of therapy? You keep hinting that this is the case. You may as well come out and say it.
 
You are really hanging on the my individual phrases without acknowledging the bigger picture.

When you purport that social workers are providing services without proper training (whether they are aware of it or not) you are accusing them of malpractice.

You admit that lenient standards of care and economic influences contribute to the potential poor choices of social workers, but you don't believe that psychologists are prone to the same kinds of poor choices....:confused:
 
Training. That is what. Psychologists do not always have the right answers. That is impossible. But in terms of what is available, psychologists have the most training in more pertinent areas than other disciplines to provide the most informed care through therapy. Do you really think that scientific training, diagnostic/assessment skills, and more theoretical training in human behavior mean nothing in the context of therapy? You keep hinting that this is the case. You may as well come out and say it.

I don't believe that they mean nothing. Just as I am sure psychiatric trained therapists have something to add to the mix of therapy that psychologist can't add, but that doesn't mean that either is inferior or causing harm. There are many different approaches to psychotherapy and not a single one has been proven superior. In fact, the most predictive aspect of therapy tends to be the therapeutic alliance.
 
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Empathy, warmth, and genuineness

Patterson, C. H. (1984). Empathy, warmth, and genuineness in psychotherapy: A review of reviews. Psychotherapy: Theory, Research, Practice, Training, 21(4), 431-438. doi:10.1037/h0085985
 
You are really hanging on the my individual phrases without acknowledging the bigger picture.

When you purport that social workers are providing services without proper training (whether they are aware of it or not) you are accusing them of malpractice.

You admit that lenient standards of care and economic influences contribute to the potential poor choices of social workers, but you don't believe that psychologists are prone to the same kinds of poor choices....:confused:

You know what? I think we have reached an impasse and at this point we are just repeating ourselves. I don't think you've paid attention to much of what has been expressed here. I am all for stringent standards for psychologists. In this thread I endorsed the ABPP push along with several others. A quick search for professional school threads on this forum would also reveal that I and many others here fully acknowledge limitations of psychologists as well.


I have firsthand experience with LPCs and LCSWs who have engaged in practices that are simply not supported by the literature. Want examples? I do not think you can throw CBT at every patient, even those that are actively psychotic, I do not think that supportive therapy alone (interpersonal therapy at best) is appropriate for someone with bipolar and severe substance dependence, I think it is nearly criminal to diagnose someone with a personality disorder on the basis of a clinical interview alone... all of these things I have witnessed or heard of from reliable sources.

In terms of the real meat and potatoes of what you and I have discussed over the past several days, the social worker/psychologist debate: I find it beyond silly for you to question the value of advanced psychology training while in effect wanting to practice psychology. At the end of the day, a clinical social worker who provides psychotherapy is doing just that-- practicing psychology. If you don't get that, then I really worry for your survival in the field. Earlier you said:

And I agree that resource connection is very important, but not all social workers specialize or are even trained in it. Also, one doesn't really need a masters degree in order to connect clients with resources. So, I guess the part that frustrates me the most is that we, as social workers, tend to get pigeon holed into that arena when we aren't necessarily trained in it. The extent of my abilities as a resource connector is how to dial 2-1-1.

I am going to wear the hat of a patient for a second. Let's say I am introduced to you, Mr. BSWDavid, LCSW. You and I meet and have a great first session where we discuss my depression and panic attacks. Toward the end I say: "Look, can you help me with figuring out how to get extra in-home care for my dad. He suffered a major stroke and trying to provide full-time care for him along with my 3 kids and husband is really overwhelming." If your response to me was, "The extent of my abilities as a resource connector is how to dial 2-1-1," I would flip out. Really, I would. Because to me, as Ms. Jane Doe in need of services I do expect a certain ability from a professional social worker. At some point you are going to have to deal with that. Right now, your posturing as a defensive psychologist practicing with a social work degree while poo-pooing advanced training in psychology but seeking an online PhD in psychodynamic therapy does not bode well for anyone.

With that, I think I should step away from this discussion with you.
 
You know what? I think we have reached an impasse and at this point we are just repeating ourselves. I don't think you've paid attention to much of what has been expressed here. I am all for stringent standards for psychologists. In this thread I endorsed the ABPP push along with several others. A quick search for professional school threads on this forum would also reveal that I and many others here fully acknowledge limitations of psychologists as well.


I have firsthand experience with LPCs and LCSWs who have engaged in practices that are simply not supported by the literature. Want examples? I do not think you can throw CBT at every patient, even those that are actively psychotic, I do not think that supportive therapy alone (interpersonal therapy at best) is appropriate for someone with bipolar and severe substance dependence, I think it is nearly criminal to diagnose someone with a personality disorder on the basis of a clinical interview alone... all of these things I have witnessed or heard of from reliable sources.

In terms of the real meat and potatoes of what you and I have discussed over the past several days, the social worker/psychologist debate: I find it beyond silly for you to question the value of advanced psychology training while in effect wanting to practice psychology. At the end of the day, a clinical social worker who provides psychotherapy is doing just that-- practicing psychology. If you don't get that, then I really worry for your survival in the field. Earlier you said:



I am going to wear the hat of a patient for a second. Let's say I am introduced to you, Mr. BSWDavid, LCSW. You and I meet and have a great first session where we discuss my depression and panic attacks. Toward the end I say: "Look, can you help me with figuring out how to get extra in-home care for my dad. He suffered a major stroke and trying to provide full-time care for him along with my 3 kids and husband is really overwhelming." If your response to me was, "The extent of my abilities as a resource connector is how to dial 2-1-1," I would flip out. Really, I would. Because to me, as Ms. Jane Doe in need of services I do expect a certain ability from a professional social worker. At some point you are going to have to deal with that. Right now, your posturing as a defensive psychologist practicing with a social work degree while poo-pooing advanced training in psychology but seeking an online PhD in psychodynamic therapy does not bode well for anyone.

With that, I think I should step away from this discussion with you.

First, I am not seeking an online degree. Second, my point with the 2-1-1 example is that I am not trained as a case manager. If my client is interested in those services, then I would refer him or her to the case manager. Third, I have no doubt that there are inadequate social workers, but I don't buy into the idea that there aren't bogus psychologists as well. So is a psychologist that prescribes medication not in fact practicing psychiatry?
 
First, I am not seeking an online degree. Second, my point with the 2-1-1 example is that I am not trained as a case manager. If my client is interested in those services, then I would refer him or her to the case manager. Third, I have no doubt that there are inadequate social workers, but I don't buy into the idea that there aren't bogus psychologists as well. So is a psychologist that prescribes medication not in fact practicing psychiatry?

Anyone here of this degree program at the Institute for Clinical Social Work? They have a Ph.D program, that is also offered online, in clinical social work. It is heavily psychodynamic focused, and most of the courses are therapy related, not research related. They don't require the GRE. I am thinking this might be a good degree for me. For admission they require an MSW plus two years of clinial experience. Also, they require the applicant to be licensed in the state. Any thoughts about the program?

http://www.icsw.edu/

You are seeking a PhD that one can attain online. Play semantics all you want. Everything else you said has already been addressed in this thread several times. Go back and take a peak. Take care.

Edit: Just for grins and giggles, per the ICSW website:

"Personal therapy experience is not required as a prerequisite for admission, though such experience is favorably considered"

But remember:
For admission they require an MSW plus two years of clinial experience. Also, they require the applicant to be licensed in the state.

Nothing makes sense with you. It seems like you just alter reality to match whatever position you are arguing at the moment. This discussion has been enlightening, though. I am more resolved than ever to support better quality control among providers.
 
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You are seeking a PhD that one can attain online. Play semantics all you want. Everything else you said has already been addressed in this thread several times. Go back and take a peak. Take care.

Yes, I had asked about the online degree because I was curious; however, after interviewing with the program I opted for the onsite program instead.
 
What really "chaps my ass" is the hypocrisy that some psychologists have participated in. You complain about masters level clinicians invading your turf, but are essentially doing the same thing to psychiatry. Some of you have suggested that social work programs, for example, aren't comparable to psychology programs, but support the argument that with 2+ years of post doc education, psychology is equal to psychiatry. How can you use the same argument to oppress one profession and encroach upon another, especially considering you have no data to support your argument?

Again...LPAs want to expand without further training or ANY proof, while psychologists are attempting to pursue additional training and provide some supportive data. I'm not sure it is enough of either at this moment (IMHO), but I know pushing to expand scope without ANY of the latter is not enough.
 
No, I didn't say that they don't cause harm. My point is that economics and ego tend to be large predictors of behavior. If other professionals are willing to cross professional boundaries into unknown territory (when you accuse a masters level therapist of providing potentially harmful services, you are saying that you believe these clinicians have chosen economics and/or ego over concern for patient care), why not psychologists? Many have accused social workers and masters level therapists of placing their patient's safety at risk by providing inadequate services.

From day 1 of doctoral training, scope of practice/ethics is harped on to every doctoral student. It is a huge area of emphasis in training. After putting in 6-8+ years of training before being able to practice independently will make pretty much any provider (including physicians) very gun shy to jump into anything that isn't clearly in their wheelhouse for fear of losing their license that they spent the better part of a decade earning.
 
Again...LPAs want to expand without further training or ANY proof, while psychologists are attempting to pursue additional training and provide some supportive data. I'm not sure it is enough of either at this moment (IMHO), but I know pushing to expand scope without ANY of the latter is not enough.

I agree that this is a key point--in the case of those psychologists pushing for RxP, they've at least attempted to gain input and support from the authorities in the field of interest (i.e., physicians). The classes themselves, to the best of my knowledge, are taught by physicians, and I believe (although could be mistaken) that the qualifying exam(s) were created in consultation with physicians. Additionally, physicians initially sat (and may still sit) on the licensing panels. It's not as though psychologists came right out and said, "hey guys, we get lots of education in psychopathology and have plenty of real-world exposure to psychotropic meds, so we should probably be able to prescribe these things effectively without causing anyone significant harm."
 
I agree that this is a key point--in the case of those psychologists pushing for RxP, they've at least attempted to gain input and support from the authorities in the field of interest (i.e., physicians). The classes themselves, to the best of my knowledge, are taught by physicians, and I believe (although could be mistaken) that the qualifying exam(s) were created in consultation with physicians. Additionally, physicians initially sat (and may still sit) on the licensing panels. It's not as though psychologists came right out and said, "hey guys, we get lots of education in psychopathology and have plenty of real-world exposure to psychotropic meds, so we should probably be able to prescribe these things effectively without causing anyone significant harm."

Just to add to this point, I am not pro RxP movement. i do not think it is called for at this point and I am not too jazzed about the idea of pursuing additional training and having to take out additoinal insurance in order to provide meds that in many cases are not even all that effective. But if (big if) I ever wanted to pursue it, I couldn't imagine resisting/rebuffing/complaining about recieving training from medical doctors or having to sit before a panel that includes medical doctors. So the entire aversion to psychologists taking a lead role in psychotherapy quality control (which as of now is only a hypothetical discussion on this forum) is astounding to me.
 
Again, I agree that more education for LPA's should be necessary.

For RxP issue, while it's definitely better to have physicians training them than not training them, I don't personally consider that an endorsement of quality.

Like I tell my patients who come in telling me they're ADHD and have to have adderall when really they do not have ADHD -- If you look long enough you'll find a doctor that'll prescribe you whatever you want. That doesn't make it right.

The standards for good med management and good medical care are sadly looser than they should be. We're limited by minimal parameters -- The legal system and risk of litigation, catastrophic poor outcomes, and community standard of care. The former is minimal in psychiatry (we have good relationships with our patients and are thus rarely sued). The middle is uncommon because many medications have decent therapeutic windows. The latter is rarely enforced.

So sure it's nice physicians are involved in RxP, but I don't personally view that as a sign of quality or of safety for that matter.
 
Additionally, physicians initially sat (and may still sit) on the licensing panels. It's not as though psychologists came right out and said, "hey guys, we get lots of education in psychopathology and have plenty of real-world exposure to psychotropic meds, so we should probably be able to prescribe these things effectively without causing anyone significant harm."
I unfortunately think this is a little rosy colored view of RxP's. Do you think the LPA's consulted psychologists before pushing legislation to expand their own scope of practice? Do you think the poor opinion from psychologists would deter them? Since we're drawing parallels.

Well I don't know about NM and LA, but other states attempts at passing legislature has been kinda like that, actually. Here in CA they tried to pass legislature SB1427 which involved 450 hours of classroom, and 45 hours instruction in physical assessment. Forget that there isn't training in the physiology underlying that physical exam.
 
I unfortunately think this is a little rosy colored view of RxP's. Do you think the LPA's consulted psychologists before pushing legislation to expand their own scope of practice? Do you think the poor opinion from psychologists would deter them? Since we're drawing parallels.

Well I don't know about NM and LA, but other states attempts at passing legislature has been kinda like that, actually. Here in CA they tried to pass legislature SB1427 which involved 450 hours of classroom, and 45 hours instruction in physical assessment. Forget that there isn't training in the physiology underlying that physical exam.

To the best of my knowledge, there were a decent number of physicians who supported RxP privileges for psychologists (at least in LA), which is one of the reasons the legislation passed in that state. And while I definitely don't think that simply consulting with physicians and including them in the credentialing process is a necessary and sufficient criteria to ensure quality, I'd also make the argument that doing so would certainly lead to better training and outcomes than not doing so. Whether or not the current training is adequate, however, is another issue entirely.

As for LPAs consulting psychologists before attempting to expand scope of practice, I honestly have no idea if this occurred. I did not hear of that happening prior to what's currently going on with master's-level practitioners in Texas, for example, but I also don't live in Texas, so it's possible that it simply wasn't publicized.
 
Certainly not a diploma mill. Many of the faculty are well respected in the psychoanalytic field. Also, several of their faculty members were on a PDM task force. I inquired extensively into the program before applying and even Nancy McWilliams spoke highly of the program. Additionally, I am familiar with the PsyD program director at the University of Indianapolis who also recommended the program. This has NOTHING to do with circumventing the route to a clinical psych program as it doesn't lead to psych licensure. The individual remains licensed as an LCSW; the point of the program is to increase psychodynamic therapy skills - what's wrong with that? Many of you have already stated you don't believe a masters degree is enough training, so why would you disapprove of an individual attending a PhD program just because it is different than your own? You continue to criticize social work training and masters programs in general, and then proceed to continue to criticize an attempt to increase clinical competence. I don't get it! It really does appear that in general, many posters believe that the psychology training model is the golden standard, and that anything different is unacceptable. As of this may, my education will be considered sufficient, by the State of Indiana, to apply for the LCSW once I have completed 2 years of supervised practice. So if I want to receive additional training in psychodynamic therapy, what's the big deal? I am not asking to become licensed as a clinical psychologist. Wouldn't any additional training only enhance my clinical skill set? BTW - the ICSW program is modeled after the psychoanalytic training institutes, with an added research component.

A rational discussion of alternative training models on this board is not going to happen. Primary process thinking appears to dominate these discussions. I hope the behavior attitudes and emotions exhibited on the internet bears no relation to actions and attitudes exhibited in real clinical or professional settings. I would hate to work with many of the people who post on this and other forums if the narcissism, sense of entitlement and arrogant disregard of others bleeds over into the real world. I shudder to think how some persons could competently engage in professional practice when their interpersonal skills seem so stunted. However we know from social psychology research that anonymity increases hostility and aggression so some of the unpleasant posting one sees online is a reflection of those social-psychological processes. Also given that this is a forum for Ph.D. students and most students in traditional programs are in their mid 20's, there are some developmental issues associated with that age cohort as well. That being said, I think your decision to pursue psychoanalytic training should serve you well in the long run.
 
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A rational discussion of alternative training models on this board is not going to happen. Primary process thinking appears to dominate these discussions. I hope the behavior attitudes and emotions exhibited on the internet bears no relation to actions and attitudes exhibited in real clinical or professional settings. I think your decision to pursue psychoanalytic training should serve you well in the long run.

:rolleyes:

Right. Cause discouraging someone from pursuing a distance learning/remote campus/online clinical PhD in a modality that is relies heavily on an intimate therapy context from a program that charges ~$17K/year and accepts students without even a GRE is extremely irrational.
 
A rational discussion of alternative training models on this board is not going to happen. Primary process thinking appears to dominate these discussions. I hope the behavior attitudes and emotions exhibited on the internet bears no relation to actions and attitudes exhibited in real clinical or professional settings. I would hate to work with many of the people who post on this and other forums if the narcissism, sense of entitlement and arrogant disregard of others bleeds over into the real world. I shudder to think how some persons could competently engage in professional practice when their interpersonal skills seem so stunted. However we know from social psychology research that anonymity increases hostility and aggression so some of the unpleasant posting one sees online is a reflection of those social-psychological processes. Also given that this is a forum for Ph.D. students and most students in traditional programs are in their mid 20's, there are some developmental issues associated with that age cohort as well. That being said, I think your decision to pursue psychoanalytic training should serve you well in the long run.

For the last time, this is NOT a therapy room. I don't know about you, but I treat peer colleagues who make poor decisions and/or provide poorly supported/thought-out arguments, much differently than I treat patients who do the same. You now why? Because the unconditional regard and safety of the therapy hour is NOT how the world functions. It neccessary and beneficial in the therapuetic context, but its not very reflective of real word interactions. Strong personalties are part of being human. Deal with it.
 
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I like that its automatically irrational. I've tried to have a rational discussion, but its pretty tough when people will just scream "ITS JUST AS GOOD, YOU HATE CHANGE AND NEW IDEAS. ITS NOT MY FAULT I <did bad in undergrad>, <like it here>, <want to work full-time>" whenever they are asked questions.

How many times did I post, and re-post, and re-post the same questions about these programs without ever getting an answer that went beyond what appeared to be a copy & paste from the school brochure without any actual information, or other obvious attempts to evade describing the training:laugh: I think I got up to 5 or 6 before someone even made an attempt at providing information.
 
:rolleyes:

Right. Cause discouraging someone from pursuing a distance learning/remote campus/online clinical PhD in a modality that is relies heavily on an intimate therapy context from a program that charges ~$17K/year and accepts students without even a GRE is extremely irrational.

Not an online program. Does the GRE really matter all that much?
 
Its an objective and standardized metric (unlike GPAs, LORs, motivation, etc.) that has moderate predictive power for success in the first year of grad school that has been replicated for many years now. So, you tell me...Do you think it should be used? If not, what instrument would you replace with? Gut intuition?
 
Not an online program. Does the GRE matter really all that much?

It correlates with some graduate school outcome statistics, and many programs just see it as a sort of quality "gatekeeper" due to its standardized development. Given its widespread inclusion in graduate school admissions criteria, I'd question the rationale for not requiring it. The knee-jerk reaction by critics would be that the program is catering to individuals who performed poorly on the exam, and who thus may not be appropriate for doctoral-level study.
 
Its an objective and standardized metric (unlike GPAs, LORs, motivation, etc.) that has strong predictive power for success in the first year of grad school that has been replicated for many years now. So, you tell me...Do you think it should be used? If not, what instrument would you replace with? Gut intuition?

Do you have any empirical evidence that the GRE has "strong predictive power"?
 
So you think grad school admission committees all over the country use this based on the honors system?

Yes, many articles exist..they have for years. Look em up yourself if you wanna critique the methodology. Here's a summary though..page 6 and 7. Especially first sentence of question 4 on page 6.
http://www.ets.org/Media/Tests/GRE/pdf/gre_0809_value_of_gre.pdf

PS: I changed it to "moderate", a "strong" is indeed to strong of a word
 
Do you have any empirical evidence that the GRE has "strong predictive power"?

Here's a relatively recent one:

Kuncel, Nathan R.; Wee, Serena; Serafin, Lauren; Hezlett, Sarah A. (2010). The validity of the Graduate Record Examination for master's and doctoral programs: A meta-analytic investigation. Educational and Psychological Measurement, 70(2), 340-352.

"Extensive research has examined the effectiveness of admissions tests for use in higher education. What has gone unexamined is the extent to which tests are similarly effective for predicting performance at both the master's and doctoral levels. This study empirically synthesizes previous studies to investigate whether or not the Graduate Record Examination (GRE) predicts the performance of students in master's programs as well as the performance of doctoral students. Across nearly 100 studies and 10,000 students, this study found that GRE scores predict first year grade point average (GPA), graduate GPA, and faculty ratings well for both master's and doctoral students, with differences that ranged from small to zero. (PsycINFO Database Record (c) 2010 APA, all rights reserved)"
 
It correlates with some graduate school outcome statistics, and many programs just see it as a sort of quality "gatekeeper" due to its standardized development. Given its widespread inclusion in graduate school admissions criteria, I'd question the rationale for not requiring it. The knee-jerk reaction by critics would be that the program is catering to individuals who performed poorly on the exam, and who thus may not be appropriate for doctoral-level study.

Again, you have to first prove that individuals who did poorly on the exam also do poorly in grad school. From what I understand, most universities require the GRE in order to compete for fellowships etc. which is part of the reason why individual departments require it. However, independent institutes are obviously in a different situation. Interesting, I took the GRE once a couple of years ago and didn't do so well. I spent about a year studying, took it again and did very well. How can it really be a predictor of grad school success if all I needed to do was study to do well?
 
I spent about a year studying, took it again and did very well. How can it really be a predictor of grad school success if all I needed to do was study to do well?

Think about that real hard. You just answered your own question. I provided you with a hint.
 
Do you have any empirical evidence that the GRE has "strong predictive power"?

:boom:*loud, high-pitched scream*



Is this really the go-to defense to decredit any and all metrics of competence?

YES, BSWDavid, proving you are willing to study hard to earn a good score is kinda a plus if you are wanting to pursue an advanced degree.
 
Think about that real hard. You just answered your own question.

Exactly. The GRE is not an aptitude test. As such, it doesn't purport to measure innate ability, nor does it state that an individual's score will be stable across time if the individual takes appropriate steps to prepare for the exam.

Like erg points out, and in my opinion as well, one insight the GRE can provide is how well an individual can prepare for, and perform on, a somewhat-stressful standardized measure. I don't think any graduate department would expect an individual to walk in and naturally do well on the GRE; part of what they'd like to determine is how able you are to adequately study for the exam.
 
:boom:*loud, high-pitched scream*



Is this really the go-to defense to decredit any and all metrics of competence?

YES, BSWDavid, proving you are willing to study hard to earn a good score is kinda a plus if you are wanting to pursue an advanced degree.

Well, you can't state that something has "strong predictive power" without evidence.
 
Take, for instance, how well -- or, rather, how poorly -- graduate and professional tests predict performance in academic
settings and beyond. Data from 1,000 graduate departments covering some 12,000 test-takers show that GRE scores could
explain just 9 percent of the variation in grades of first-year graduate students. That's according to data compiled by E.T.S.,
which produces the GRE. By comparison, the SAT I accounts for an average of 17 percent of the variation in first-year college
grades. Another, independent meta-analysis of 22 studies covering 5,000 test-takers over nearly 40 years found that GRE
scores could explain only 6 percent of the variance in first-year graduate performance. The finding prompted the study's
authors, Todd Morrison at Queens University and Melanie Morrison at the University of Victoria, to report in Educational
and Psychological Measurement that the predictive validity of the GRE was so weak as to make the test "virtually useless."
 
ITHACA, N.Y. -- The Graduate Record Examination (GRE) does little to
predict who will do well in graduate school for psychology and quite likely
in other fields as well, according to a new study by Cornell and Yale
universities.
Of the three subtests of the GRE (verbal, quantitative and analytical) and
the GRE advanced test in psychology, only the analytical subtest predicted
any aspect of graduate success beyond the first-year grade point average
(GPA), and this prediction held for men only. The verbal subtest and
psychology test predicted first-year GPA, but this prediction vanished by
the second year's GPA.
"With these exceptions, the GRE scores were not useful as predictors of
various aspects of graduate performance, including ratings by primary
advisers of analytical, creative, practical, research and teaching
abilities by primary advisers and ratings of dissertation quality by
independent faculty readers," said Wendy M. Williams, associate professor
of human development at Cornell University.
Williams and her colleague, Robert J. Sternberg of Yale University -- both
experts on measures and theories of intelligence -- reported their findings
in the June issue of American Psychologist (Vol. 52, No. 6, pp. 630-641).
The researchers strongly suspect that the GREs may prove to lack validity
in predicting performance in other fields as well.
"We know from other researchers' work that the GREs also have failed to
predict success in the field of physics, and we suspect that the GREs will
fail to prove predictive for the humanities as well," Williams said.
"Instead of relying so heavily on the GREs -- and many applicants aren't
even considered if their GRE scores are not in the top group -- we need to
develop and use tests that measure meaningful performances in specific
areas. The GREs, including the one specifically for psychology, do not
assess many of the types of abilities required for succeeding as a
professional psychologist," Williams said.
She also pointed out that applicants from less privileged backgrounds, who
are not as likely to do as well on the GRE as applicants from good
preparatory schools, lose out even though they may have the appropriate
skills for the profession they desire. "Graduate programs rely so heavily
on GREs to make their initial cuts, many well-qualified applicants who are
strong in the appropriate areas aren't even being considered. This is a
huge disservice to the applicants, the graduate programs and society at
large."
The researchers set out to test the validity of the GRE, working within the
broader framework of the triarchic theory of human intelligence. The
triarchic theory distinguishes academic or analytical abilities from
creative and practical abilities.
"Academic-analytical abilities are used when one analyzes, compares and
contrasts, evaluates, judges or critiques," said Sternberg, who has
published widely on the theories of intelligence. "Creative abilities are
used when one invents, discovers, supposes, hypothesizes or theorizes.
Practical abilities are used when one applies, uses or implements."
To assess the validity of GREs in predicting success or failure of graduate
students, the researchers asked 40 faculty members of psychology at Yale to
provide ratings on five scales of the 166 graduate students they had had
since 1980. In addition, the researchers looked at GPAs of students in
their first and second years of graduate training and overall evaluations
of dissertations by outside, independent raters.
When the researchers looked at GRE scores and GPAs, they did find a
marginal relationship between the scores and grades in the first year of
graduate study. When they looked in more detail at the GRE subtests and
the genders separately, they found only one of them (the analytical test
score) successfully predicted more consequential evaluations of student
performance (dissertation reader ratings) -- but this was only true for
men. For women, there was no prediction.
"This study suggests the need to reflect on the use of tests before they
become firmly -- and, as it sometimes seems, irrevocably -- entrenched.
Too often, we believe, the use of a test becomes self-perpetuating, without
serious attempts to verify its effectiveness," the psychologists wrote.
"We believe that our results underscore the need for serious validation
studies of the GRE, not to mention other admissions indexes, against
measures of consequential performances, whether of students or of
professionals."
Next, Williams hopes to look at GRE scores of men and women in the social
sciences, natural sciences and humanities. GREs are developed by the
College Board of the Educational Testing Service.
The study was supported in part by the U.S. Department of Education.
 
The results of Morrison and Morrison’s (1995) meta-analytic study suggest that the quantitative and verbal components of the GRE possess minimal predictive validity for graduate school performance, and yet most graduate schools continue to use this standardized test as a “gate-keeping” mechanism. Ingram (1983) examined 10 studies on the relationship between GRE scores and success in graduate school and found little evidence that GRE scores consistently predict graduate school success. Similarly, a study by Milner, McNeil, and King (1984) reported findings that the GRE was not a valid predictor of success in graduate school and that the elimination of its use did not appear to lower the quality of graduate students, as measured by graduate GPA and attainment of a degree. Another group of studies yielded findings that weakly support the usefulness of GRE in predicting graduate students’ success. In a study of the validity of the GRE in relationship to the GPA, Ji (1998) found that GRE scores were weakly related to graduate GPA of students in education, which supports the previous findings of Kirchner (1993), and of Matthews and Martin (1992).
In a recent study (Tang, Page, Shupe, & Stock, 2000) researchers collected archival data from files of a counseling training program to investigate the relationship of the GRE and the undergraduate grade point average (UGPA) with the subsequent academic and clinical performance scores of graduate counseling students. The results of the correlation analysis revealed that GRE scores were significantly correlated with graduate student academic work as indicated by the GPA and comprehensive exams. However, the findings did not support any significant relationship between the GRE and clinical performance. Such results are not surprising considering the GRE was developed to predict academic potential for graduate level coursework.
 
The GREs are criticized for not being a true measure of whether a student will be successful in graduate school. Robert Sternberg (now of Oklahoma State University–Stillwater; working at Yale University at the time of the study), a long-time critic of modern intelligence testing in general, found the GRE general test was weakly predictive of success in graduate studies in psychology.[31] The strongest relationship was found for the now-defunct analytical portion of the exam.
 
However, the findings did not support any significant relationship between the GRE and clinical performance.

Um, did you read the sentence after it. As the sentence after it reinforces...thats not why admissions commitees use it! As has been stated before, research supports its use due to the fact that it adds predictive power to admissions decisions. And yes, yes, we all know there are other studies that dont find this (you've obvioulsy been googling to find evidence against the GRE-and guess what, its there-SHOCKING!), but as you are well aware, research on almost any topic is never all one sided. However the proponderance (ie., majority) of the evidence suggests that it very much is a useful predictor. That is not really debatable.

Its for academic achievement purposes..and that what universities want and need to know about...that the people they choose can hack it academically. No, it has no relationship to therapist competence or how well you play the guitar, etc. And Its not supposed to!!
 
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I think what you're mssing here is the bigger picture, BSWdavid. What does it mean to you that a graduate school doesn't require the GRE? To me, it suggests they are trying to tap into a demographic who may not want to bother with it (doing as little as necessary to get a degree), or who may not be able to do well on it now matter how much they study (not intellectually adaquate for the Ph.D.). In other words, they are purposely and consciously tapping into the bottom rung of potential grad school applicants. Do you think thats a good thing or a bad thing for the field/for the program?
 
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