Know your role...

[Psyclops]

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As the field continues to change and evolve, what should emerge as the role of the expert psychologist? One argument could be that there are a variety of roles, any one practitioner might do any one thing more than another. Others might see the role as being multi faceted, and being comprised of some combination of therapy, testing, expert witness, and even possibly RxP. But with the advent of mid-level therapists, and the third-party payers penchance for chosing them over PhDs, and with psychiatrists already having most of the prescribing market covered (spotty coverage, like early cell-phones), should the role of the psychologist be so difuse? One could argue that it might benefit the profession to eschew their participation as therapists and RxP providers and instead focus on what psychologists do better than everyone else, namely assessment and testing. I would be inclined to think that a greatert focus on psych testing and assessment should be the field's bread and butter and to leave the rest to the MA/MSs and MDs. This focus on performing psych testing would pay off in the courtroom as psychologists would emerge as the premier behavioral consutants leaving Mds out in the cold. How can the mental status exam compare with a full battery of personality inventories, neuropsych evals, etc. I'd love ot hear your thoughts...

 

[50960]

For your scenario to work at all there has to be a ready source of reimbursement for such services, and currently outside of legal proceedings there is not. Most insurance companies will not pay for or authorize extensive psych testing, and most people needing it cannot afford to pay. There are always exceptions. The point I am making is why should we limit our scope to something very few are paying for?

 

[Psyclops]

That is a very good point, and the pragmatics should always be taken into consideration. I do think there is qiute a bit of testing to be done as well in questionable malingering cases, and I think it should be more routine, period.

However, setting aside the $ issue, what about from a more abstract standpoint, should we limit our scope to something we clearly do better then the rest. Why water down our practice with that which is not our clear expertise?

 

[PublicHealth]

Psychology's survival as a healthcare discipline depends on its ability to medicalize itself. Predoctoral training in clinical psychology is WAY too psychosocial in nature. One course in "biological bases of human behavior" is crap. Programs with concentrations in neuropsychology and health/medical psychology are in high demand.

 

[Psyclops]

I both agree and disagree with you. I agree that one course on bio is absurd. But I also think that reduction to biology isn't going to answer all of the problems psychologists try to tackle, nor will it ensure the viablity of the profession. The fact that a person's behavior can be altered with chemicals isn't that interesting, a 14 year old who just experienced alcohol for the first time has essentially figured out the big picture, all that's left are just details. The fact that psychotherapy interventions can acheive the same results, with often times lower levels of relapse, is much more impresive and frankly interesting. Nor does knowing that someone has issues with thier seratonin system tell me anything aboput how they are functioning interpersonally. With the exception of a few disorders biology should not be the primary discipline through which to look at the problems. many of the disorders are chrinic and may require a long-term Rx, but that shouldn't be the default. I agreee that psychology will continue to "medicalize" itself, but that will not be it's defenintion as a discipline.

 

[edieb]

In my opinion, this article is the epitome of what practicing psychology in the 21st Ctry. should be like. She is prescribing, conducting CBT, and collaborating with other healthcare professions....

http://www.division42.org/MembersArea/IPfiles/Winter06/practitioner/prescribing.php

I both agree and disagree with you. I agree that one course on bio is absurd. But I also think that reduction to biology isn't going to answer all of the problems psychologists try to tackle, nor will it ensure the viablity of the profession. The fact that a person's behavior can be altered with chemicals isn't that interesting, a 14 year old who just experienced alcohol for the first time has essentially figured out the big picture, all that's left are just details. The fact that psychotherapy interventions can acheive the same results, with often times lower levels of relapse, is much more impresive and frankly interesting. Nor does knowing that someone has issues with thier seratonin system tell me anything aboput how they are functioning interpersonally. With the exception of a few disorders biology should not be the primary discipline through which to look at the problems. many of the disorders are chrinic and may require a long-term Rx, but that shouldn't be the default. I agreee that psychology will continue to "medicalize" itself, but that will not be it's defenintion as a discipline.

 

[50960]

I consider myself to have expertise is psychopharmacology, testing and assessment, and child-adolescent psychotherapy. I would not want to limit myself. Knowing bio-psych does not mean you reduce everything to that. However, every memory, though, projection, behavior etc that our pts express has a corresponding neurophysiology and neurochemistry, not to mention effects on the endocrine system etc. NOT knowing that, and understanding it is the real risk.

 

[PublicHealth]

I both agree and disagree with you. I agree that one course on bio is absurd. But I also think that reduction to biology isn't going to answer all of the problems psychologists try to tackle, nor will it ensure the viablity of the profession. The fact that a person's behavior can be altered with chemicals isn't that interesting, a 14 year old who just experienced alcohol for the first time has essentially figured out the big picture, all that's left are just details. The fact that psychotherapy interventions can acheive the same results, with often times lower levels of relapse, is much more impresive and frankly interesting. Nor does knowing that someone has issues with thier seratonin system tell me anything aboput how they are functioning interpersonally. With the exception of a few disorders biology should not be the primary discipline through which to look at the problems. many of the disorders are chrinic and may require a long-term Rx, but that shouldn't be the default. I agreee that psychology will continue to "medicalize" itself, but that will not be it's defenintion as a discipline.

Agreed. No disorder -- psychiatric and otherwise -- is 100% genetic or 100% non-genetic/environmental. Unfortunately, no one in mental health (the exception being psychologist-psychiatrists and psychiatrist-psychologists) is trained to evaluate and treat both biological and psychosocial causes of psychiatric disorders to the fullest extent. Adding psychopharmacology training at the postdoctoral level will NEVER equal the level of psychopharmacology training that psychiatrists attain, just like adding a few residency rotations in psychotherapy will NEVER equal the level of psychotherapy training that psychologists attain. There is a need for a "middle-ground" practitioner who is trained in both psychopharmacology and psychotherapy. Who will it be? What is the level of training required for such practice?

 

[Psyclops]

Who will it be?

A Psychologist.

What is the level of training?

That is the interesting question. It almost makes me want to answer with....a professional degree in psychology that spends alot of the time that is usually devoted to research to pharmacology....like, I don't know.....we could call it a....a...PsyD or something. Except, we know what happens there. I think that both the academic and practice degree should fall under the PhD umbrella. Psychology will ultimately always be philosophical in nature, and it needs science to hold that in check. By philosophical I mean, what does it mean to be a person in our times, what is normal, what should be normal, what is right, what is wrong, what is abnormal but acceptable, who should be treated, how should all of this be conceptualized, etc.... But at this point in history these questions need to be firmly ensconced in science and empiricism, regardless of the nature of the question, bio, psycho, social. I don't think that other training models give that balance (I could be wrong). I don't think those involved in the field should be so technically (practice) oriented as to miss the big picture. And I do also believe that this holds true for everyone, even those who are practitioners because their participation will ultimately leed to how the field is engaged by all.

 

[PsychEval]

The thing I hated most about my Ph.D. program was that the faculty seemed stuck in the philosophy dept. The never ending deconstructing of everything becomes exhausting and boring.

 

[mmcarson]

Isn't the reason for the many emerging subspecializations in psychology (health, neuropsych, forensic, etc.) to meet the increasing diversifying needs in practice and research? I think psychology can continue to thrive in basic and clininal research as well as in purely clinical settings if psychologists of disparate areas are willing to communicate with each other. I think there will still be a role for master's level counselors and psychomotrists within these subspecializations.

 

[PublicHealth]

Isn't the reason for the many emerging subspecializations in psychology (health, neuropsych, forensic, etc.) to meet the increasing diversifying needs in practice and research? I think psychology can continue to thrive in basic and clininal research as well as in purely clinical settings if psychologists of disparate areas are willing to communicate with each other. I think there will still be a role for master's level counselors and psychomotrists within these subspecializations.

Diversifying needs AND struggling to remain relevant in the healthcare marketplace and make a buck.

 

[Psyclops]

Isn't the reason for the many emerging subspecializations in psychology (health, neuropsych, forensic, etc.) to meet the increasing diversifying needs in practice and research? I think psychology can continue to thrive in basic and clininal research as well as in purely clinical settings if psychologists of disparate areas are willing to communicate with each other. I think there will still be a role for master's level counselors and psychomotrists within these subspecializations.

Although I think that psychology will continue to thrive in some form or another I'm not sure where the next few years and decades will take us. I am certain that there will always be a place for academic psychologists and basic researchers. But those spots are few and far between. Most clinical psychologists continue to go into practice or the workforce in some way. However, some scary statistics that were wuoted on the psychiatry forum show a decrease in the average salary of a psychologist of .7% from the years of 1997-2003. I frankly don't like that, and it makes me think that something is not going the way it should. There could be (and I'm sure are) a variety of reasons for that. One being that research generally shows that doctoral level clinicians are no better than physics professors or your grandmother let alone master's level clinicians at getting results from therapy (with some exceptions of course). So why not pay the MA/MS fee which is cheaper and just as good. So that makes me think that shouldn't be our primary focus as a profession. Sure we might as well learn how to do it because any one can, but not stake our name on it. Psychology in general, even clinical psychology does not have it's roots in therapy. It's roots are in testing, assessment and evaluation. It might be time to get back to our roots. There is of course more than one reason psychologists have been getting paid less as time goes on. Some suggest that the market is too saturated, while getting into a PhD program remains next to impossible. Aditionally the advent of good clean psychopharmaceuticals make people want to know why they should spend the time and money in therapy when they can just take a pill. But regardless, I think the field needs to do some real introspection and needs to decide how it is going to remain relevant and lucrative to quote PH.

 

[sasevan]

I really like how this thread is going, i.e., a very civil discussion of differences regarding the evolution of psychology.

One could argue that it might benefit the profession to eschew their participation as therapists and RxP providers and instead focus on what psychologists do better than everyone else, namely assessment and testing. I would be inclined to think that a greatert focus on psych testing and assessment should be the field's bread and butter and to leave the rest to the MA/MSs and MDs.

There is a part of me that can definitely sympathize with this sentiment since I believe it is really about giving psychology a unique role in mental health but I believe the reason why our discipline is developing the way that it is, is because this model was not maintainable.

For your scenario to work at all there has to be a ready source of reimbursement for such services, and currently outside of legal proceedings there is not. Most insurance companies will not pay for or authorize extensive psych testing, and most people needing it cannot afford to pay.

Agreed.

Psychology's survival as a healthcare discipline depends on its ability to medicalize itself.

Agreed.

In my opinion, this article is the epitome of what practicing psychology in the 21st Ctry. should be like. She is prescribing, conducting CBT, and collaborating with other healthcare professions....

http://www.division42.org/MembersAr...prescribing.php

Thanks.

Knowing bio-psych does not mean you reduce everything to that. However, every memory, though, projection, behavior etc that our pts express has a corresponding neurophysiology and neurochemistry, not to mention effects on the endocrine system etc. NOT knowing that, and understanding it is the real risk.

Great point. I believe that psychology's quest for RxP is due to its appreciation of the bio in the biopsychosocial model. I hope that even if med psych does not become widespread that at least most clin psych become proficient in the biomedical as well as the psychosocial dimensions of mental illness. In my opinion, if they don't, they will be compromising the credibility of their evaluations and interventions; not to mention the health, mental and otherwise, of their patients.

Agreed. No disorder -- psychiatric and otherwise -- is 100% genetic or 100% non-genetic/environmental. Unfortunately, no one in mental health (the exception being psychologist-psychiatrists and psychiatrist-psychologists) is trained to evaluate and treat both biological and psychosocial causes of psychiatric disorders to the fullest extent. Adding psychopharmacology training at the postdoctoral level will NEVER equal the level of psychopharmacology training that psychiatrists attain, just like adding a few residency rotations in psychotherapy will NEVER equal the level of psychotherapy training that psychologists attain. There is a need for a "middle-ground" practitioner who is trained in both psychopharmacology and psychotherapy. Who will it be? What is the level of training required for such practice?

Totally agreed. But what is that proper level? The current post-doc ms in psychopharm model(s) I believe is doing a disservice to the quest for RxP since it is very vulnerable to the accusation that it is an inadequate level of training as it is not even on a par with the DoD model.

Although I think that psychology will continue to thrive in some form or another I'm not sure where the next few years and decades will take us. I am certain that there will always be a place for academic psychologists and basic researchers. But those spots are few and far between. Most clinical psychologists continue to go into practice or the workforce in some way. However, some scary statistics that were wuoted on the psychiatry forum show a decrease in the average salary of a psychologist of .7% from the years of 1997-2003. I frankly don't like that, and it makes me think that something is not going the way it should.

Agreed. I believe the answer is for a significant number of clinical psychologists to sub-specialize as med psych and serve as those aforementioned "middle-ground" practitioners.

 

[Psyclops]

It's hard to disagree with all of your agreeing. But I'm still not sure that it should be a clinical psychologists role to treat mental health issues. That may sound absurd, and I'm not an idiot, i know it's been happening for years, But I'm not convinced that should be our role. I am willing to consider a psychologists role to be an expert in mental health, and an expert in diagnosing, and assessing mental variables, but maybe leave the treating for the psychiatrists and therapists. To steal the metaphor from the hawaii RxP article, we don't need a pilots liscence to design the aircraft (it kinda works).

The stongest argument for remaining as treaters of MH issues would be if we could be the middle ground practitioners. Although my vote would be to get out of treating, stay in assessment, testing, overall expertise and consulting. Thoughts?

 

[Neuro-Dr]

The discussion of the role of psychologists is not a particularly new one. The APA continually posts concerns regarding specialists versus generalists and my concern has always been that we train generalists first and then let people take advanced training from there. This is also the ABPP model for which there are currently 13 specialties in professional psychology. BTW, the movement in this area, which is the elite of the field is generally made up of practitioners, since that is the mission of the board in Professional Psychology.

Your suggestion in some ways is to return to the field of 60-70 years ago, when psychologists took 10 hour intakes and wrote elaborate reports, that were generally of little use. We developed a license in psychology to allow psychologists to offer services to the public.

Most people do not need psychological testing, to be honest. As a neuropsychologists, that is about all I do, and I would still agree with that statement.

In addition, as one who holds a dual appointment at a University and a neurology clinic, I am often entertained by the "experts" in academia. When you ask them whether their patients ever experience (insert clinical anecdote here) they say, "Oh I don't see patients!" Frankly, I wouldn't want to learn about an instrument, condition or intervention from someone who never put it into practice. Or when did, used rather outdated information.

I am not a philosopher and never set out to be. What annoys me most is that I have to pay an additional $125 per year of APA dues because I actually see patients everyday.

 

[Psyclops]

The discussion of the role of psychologists is not a particularly new one. The APA continually posts concerns regarding specialists versus generalists and my concern has always been that we train generalists first and then let people take advanced training from there. This is also the ABPP model for which there are currently 13 specialties in professional psychology. BTW, the movement in this area, which is the elite of the field is generally made up of practitioners, since that is the mission of the board in Professional Psychology.

Do you mean to say that we shouldn't train gneralists first? I'd be intrested to hear other proposed training models.

Your suggestion in some ways is to return to the field of 60-70 years ago, when psychologists took 10 hour intakes and wrote elaborate reports, that were generally of little use. We developed a license in psychology to allow psychologists to offer services to the public.

I wanted to generate some discussion on where the field would go. Frankly I think that we can be too watered down. I find it hard to reconcile the fact that for the most part evidence has shown that the level of practitioner doesn't affect the outcome of therapy. So why make it the center piece of our profession.

Most people do not need psychological testing, to be honest. As a neuropsychologists, that is about all I do, and I would still agree with that statement.

I agree. I'm coming from a perspective of working in psychiatric hospitals and doing intake work in addition to pretty much every other position, and I felt that the clients did not receive adequate assessment of thier psychopathology.

In addition, as one who holds a dual appointment at a University and a neurology clinic, I am often entertained by the "experts" in academia. When you ask them whether their patients ever experience (insert clinical anecdote here) they say, "Oh I don't see patients!" Frankly, I wouldn't want to learn about an instrument, condition or intervention from someone who never put it into practice. Or when did, used rather outdated information.

I can't agree more, there are two sides to the boulder model, and the academics can certainly be remiss in thier duties to remain current and actively working with patients.

I am not a philosopher and never set out to be. What annoys me most is that I have to pay an additional $125 per year of APA dues because I actually see patients everyday.

I think we are all philosphers of some kind, like it or not, that is if we are doing any work towards advancing the field.

 

[Neuro-Dr]

I have always been in favor of the generalist first, specialist second and again my boards demanded that I have competency in generic psych and clinical psych.

I'm still not sure why anyone wouldn't learn all appropriate means for treatment and that means an in-depth understanding of meds and tx applications as well as why/why not to use other more experimental methods and when.

You seem troubled by this level of training piece and I'm not sure why. The data simply states that the variance of success in treatment is not best explained by degree status. It does not mean that MA practitioners make equal clinicians or that they perform as well in the real world under conditions where they have to diagnose the patient and then treat them. You don't have to be more successfull each time, just successful more of the time.

I also don't think you can make a statement that "we are all philosphers of some kind, like it or not, that is if we are doing any work towards advancing the field"
This implies that the field is driven by philosophy and I just don't agree. Whether it is a staff meeting, triage, case conference or research, I really don't think that this is the aspect that pushes the field. I think science pushes the field. rigorous approaches to problems and the application of sound theories to generate hypotheses, to then be tested. But that is just my opinion

 

[Psyclops]

I wholeheartedly agree with you that psychologists should be trained in as many treatment modalities as possible, including RxP, and I think you would agree that this extends to basic knowledge as well. I think that to the extent possible, people should be informed by as many dimensions as possible. That said RxP concerns me a little in how it will be implemented and I think there is a potential for psychologists to turn into pill pushers which I think would be a shame. But some of the annectodal evidence seems to show the very promissing trend of a well rounded, fully informed, mental health practitioner.

About the philosopher stuff, I think that the field, and those in it, inherently ask questions that deal with the existential nature of being human. What is normal, what is abnormal, how is life experienced, what drives us, etc. Of course, I think that that is best anchored and pursued through the lens of science. So it's really phillosophy per se but deals with the same issues. don't know if that fits but that's how i feel.

 

[PublicHealth]

I also don't think you can make a statement that "we are all philosphers of some kind, like it or not, that is if we are doing any work towards advancing the field"
This implies that the field is driven by philosophy and I just don't agree. Whether it is a staff meeting, triage, case conference or research, I really don't think that this is the aspect that pushes the field. I think science pushes the field. rigorous approaches to problems and the application of sound theories to generate hypotheses, to then be tested. But that is just my opinion

Umm...what does Ph.D. stand for?

 

[Neuro-Dr]

Which philosophy courses were in your PHD, none in mine? Should we call all of the PsyDs and tell them they are not psychologists or are not advancing the field because only philosophers do that? Is our professor of neuroanatomy (PhD) studying the philosophy of anatomy?

Psychlops - I think we agree more than not and I appreciate your posts.

 

[PublicHealth]

Tangent:

I haven't read much of this thread, but I did happen upon this last post.
Did you read Meehl, Feigl, and Popper in your program? Philosophy of science is an important topic for doctors in my opinion. My graduate program did include it.

Every branch of science arose from philosophy. William James, the "Father of American Psychology," was both a psychologist and philosopher.

 

[Psyclops]

Which philosophy courses were in your PHD, none in mine? Should we call all of the PsyDs and tell them they are not psychologists or are not advancing the field because only philosophers do that? Is our professor of neuroanatomy (PhD) studying the philosophy of anatomy?

Psychlops - I think we agree more than not and I appreciate your posts.

I also agree that we agree more than not. But I would also categorize the neuroanatomists as philosphers, I'm currently reading Conciousness: a neurobiological perspective by Chistoph Koch. Anyway my point is that unless they are strictly mapping out cell structures with a complete disregard for function (doubtful) I would consider them engaging in some sort of philosophy. I think we are getting down to semantic here. As for the PsyDs, I would imagine they are engaging in some sort of philosophy if tehy put any thought into their craft, which I'm sure some do (I say that with a wink).

As for the philosophy of science, I haven't started my PhD yet, but in my Master's program we read Chalmers and Meehl. Both were good, I think Meehl is a must read for psychologists.

 

[mmcarson]

I think you are all correct. If you want to get technical, philosophy just means 'love of wisdom', which can be interpreted in a myriad of ways. I think the fact that we are on this forum, that we love psychology, shows that we are all philosophers to an extent. Knowledge gained through research is just as valuable as knowlegde acquired through practice, and vice versa. As I mentioned before, I think the future of the field will be in the continuation of the integration of research and practice, like what is done in medicine.