NYT Carlat Article - Mind Over Meds

[positivepsych]

http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html?ref=health&pagewanted=all

While the article's overall thesis is that psychiatrists have become too much psychopharmacologists, and should be doing more therapy, I was more struck by Carlat's view (or at least echoing of the public/professional view) of psychologists:

Some choice quotes from the article:

One young woman I saw was referred to me by a nurse practitioner for treatment of depression that had not responded to several past antidepressants. She was struggling to raise two young children and was worried that she was doing a poor job of it. Her husband worked full time and was rarely available to help. She cried throughout our initial interview. I started her on Effexor and referred her to a social-worker colleague.

I find it ironic that several psychiatrists like Carlat I have talked to, refer their patients to social workers for therapy because "they are cheaper" than psychologists. I accept the possibility that some social workers may provide equal quality therapy as a psychologist, but when I inquire, these psychiatrists really have no idea what the social worker is doing or the quality of care they are providing. These psychiatrists don't find any hypocracy in the fact that they charge an exorbitant amount for an initial eval/medication management themselves, but encourage the patient to skimp financially on the therapy.

While patients only see psychiatrists 1x/month vs. 1x/week for therapy, the range of quality of psychotherapy (unlike an SSRI) varies greatly, and you do get what you pay for much of the time. I still value the expertise of psychiatrists, and I'm pretty sure my psychiatrist colleagues wouldn't want me to refer my patients to a nurse practitioner for meds, but they don't see any issue in doing that to us.

Like the majority of psychiatrists in the United States, I prescribe the medications, and I refer to a professional lower in the mental-health hierarchy, like a social worker or a psychologist, to do the therapy. The unspoken implication is that therapy is menial work — tedious and poorly paid.

I just want to point out that this is the perception of our field that gets published in the NYT. Despite the fact that we (and the more open-minded psychiatrists) recognize that therapy is just as (if not more) important than medication for most non-severe cases, psychologists are still lumped in with social workers and are generally considered "beneath" psychiatrists.

We'd like to believe we're at least equal, and just play different roles, but our job options and salaries don't reflect that. Furthermore, he's right about therapy, despite its value and difficulty to do well, we are poorly reimbursed for it. Isn't it kind of ironic that he's advocating psychiatrists do more therapy, and psychologists want to prescribe more meds? I agree with Carlat that there needs to be a revival of the D.M.H. (Doctor of Mental Health) degree (combined psychology and psychiatry training in two years at UC Berkeley and a three-year psychiatric residency at UCSF), because the current divide is silly.

Caveat Emptor (Buyer Beware), to anyone who wants to enter this field. This is the reality that you will continually face in both public and professional perception. Even if you're a smart and successful "Dr.", get used to being treated and paid like you're a 2nd class citizen in the health care field.

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[cara susanna]

Ughhhhh.

 

[AlaskanJustin]

http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html?ref=health&pagewanted=all

While the article's overall thesis is that psychiatrists have become too much psychopharmacologists, and should be doing more therapy, I was more struck by Carlat's view (or at least echoing of the public/professional view) of psychologists:

Some choice quotes from the article:


I find it ironic that several psychiatrists like Carlat I have talked to, refer their patients to social workers for therapy because "they are cheaper" than psychologists. I accept the possibility that some social workers may provide equal quality therapy as a psychologist, but when I inquire, these psychiatrists really have no idea what the social worker is doing or the quality of care they are providing. These psychiatrists don't find any hypocracy in the fact that they charge an exorbitant amount for an initial eval/medication management themselves, but encourage the patient to skimp financially on the therapy.

While patients only see psychiatrists 1x/month vs. 1x/week for therapy, the range of quality of psychotherapy (unlike an SSRI) varies greatly, and you do get what you pay for much of the time. I still value the expertise of psychiatrists, and I'm pretty sure my psychiatrist colleagues wouldn't want me to refer my patients to a nurse practitioner for meds, but they don't see any issue in doing that to us.



I just want to point out that this is the perception of our field that gets published in the NYT. Despite the fact that we (and even more open-minded psychiatrists like Carlat) recognize that therapy is just as (if not more) important than medication for most non-severe cases, psychologists are still lumped in with social workers and are generally considered "beneath" psychiatrists.

We'd like to believe we're at least equal, and just play different roles, but our job options and salaries don't reflect that. Furthermore, he's right about therapy, despite its value and difficulty to do well, we are poorly reimbursed for it. Isn't it kind of ironic that he's advocating psychiatrists do more therapy, and psychologists want to prescribe more meds? I agree with Carlat that there needs to be a revival of the D.M.H. (Doctoral of Mental Health) degree (combined psychology and psychiatry training in two years at UC Berkeley and a three-year psychiatric residency at UCSF), because the current divide is silly.

Caveat Emptor (Buyer Beware), to anyone who wants to enter this field. This is the reality that you will continually face in both public and professional perception. Even if you're a smart and successful "Dr.", get used to being treated like you're a 2nd class citizen in the health care field.

rofl yet again today... I am loving what I am reading today

 

[citypsych]

I had almost the same reaction. I gasped when I read about the hierarchy.

I wonder, do all social workers believe they're on par with psychologists? At least the people I know do. I heard some snide comments about "getting a doctorate to make more $" and "get called a Dr."

These psychiatrists don't find any hypocracy in the fact that they charge an exorbitant amount for an initial eval/medication management themselves, but encourage the patient to skimp financially on the therapy.

Of course such psychiatrists just want to make sure their clients have $ available for their UTMOST important services. *sarcastic smile*

 

[Blue86]

Ughhhhh.

X 2

Is this true only for the US? I heard that in Europe/UK things are not like this. Can someone who knows more about this confirm whether it is true or not?

 

[robinsena]

Interesting article; but it's not a new development. Yes, it's not fair, yes, it makes me angry, etc etc etc, but if all I am living for is money and what I think is due respect/admiration from others, I already know I'm going to end up a very bitter woman. Personally, I am going to let my own work with clients speak for itself. I feel really fortunate that I find my work rewarding (through no merit of my own... totally chose psych out of the lesser of all evils in school).

For those who chose to be psychologists for money or renown... my condolences. We can try to change public perception, for sure, but it's never a good idea to base one's happiness off wealth and others' perceptions of one's worth.

 

[Blue86]

Interesting article; but it's not a new development. Yes, it's not fair, yes, it makes me angry, etc etc etc, but if all I am living for is money and what I think is due respect/admiration from others, I already know I'm going to end up a very bitter woman. Personally, I am going to let my own work with clients speak for itself. I feel really fortunate that I find my work rewarding (through no merit of my own... totally chose psych out of the lesser of all evils in school).

For those who chose to be psychologists for money or renown... my condolences. We can try to change public perception, for sure, but it's never a good idea to base one's happiness off wealth and others' perceptions of one's worth.

Not trying to disagree with you, I also enjoy the field and feel grateful for finding something that fits me so well; however, I do believe that clinical psychologist do deserve respect. I am not taking about fame, money or intense admiration. But some respect, and showing that they understand that getting a PhD is not the same as being a social worker who wants to be called a doctor. I have respect for social workers, and I know they do a lot of other things better, but they don't receive quite the same training on therapy, assessment, etc. So I do believe there should be some understanding and respect for that. That's just my opinion though

 

[futureapppsy2]

ughhhhh.

x 3

 

[robinsena]

Not trying to disagree with you, I also enjoy the field and feel grateful for finding something that fits me so well; however, I do believe that clinical psychologist do deserve respect. I am not taking about fame, money or intense admiration. But some respect, and showing that they understand that getting a PhD is not the same as being a social worker who wants to be called a doctor. I have respect for social workers, and I know they do a lot of other things better, but they don't receive quite the same training on therapy, assessment, etc. So I do believe there should be some understanding and respect for that. That's just my opinion though

I agree with that, but for me it's difficult to balance the thought that I 'deserve respect' without falling too much into the pitfall of becoming dependent on people's validation for my personal satisfaction of my work. Does that make sense? I think if I AM really better than a social worker, my immediate professional circle will be able to see that from my work - so while the field may still suffer from some injustice, at least personally I think I can minimize that to some extent. But I do agree we need to advocate for our field and not just "go with the flow."

 

[phillydave]

For those who chose to be psychologists for money or renown... my condolences.

I agree with your sentiment, however, this type of economic martyrdom that psychologists often let seep into their way of thinking about the unfair pay scale is part of the overall problem. As someone else pointed out in a similar discussion recently, you won't easily find an MD saying "It's okay that I don't make as much as I think I should, it would have been foolish to think that I was going to make good money in this field." We need to be able to admit that it's not always okay that we sacrifice good pay for the sake of "it's just what we make, oh well."

robinsena, not an attack on you, it's something we hear constantly in the field. I wholeheartedly agree with your call for advocacy.

 

[Therapist4Chnge]

The average pay in psychology is woeful. Unfortunately only the minority of clinicians actually get paid in line with the level of training. I believe the blame is shared equally between providers who don't fight for the money and the lack of support from the APA and related organizations that are supposed to represent and protect the profession. Don't despair though, I think the APA is going to have another task force to figure out why the pay is so bad...check back in 3 years for the report (I "borrowed" this joke from JN or Ollie...I forgot which).

As for Carlat's article....he is right about the importance of therapy + meds, but he is wrong about who is best positioned to provide Dx'ing and therapy. I'll comment more when I have time.

 

[phillydave]

Agree on where the blame lies, although I feel it might lean slightly more towards us. As Mark said a few threads ago about pay, "poverty is not one of my core values," but so many in this field think it should be. And to quote edieb in that same thread,

"Part of the problem is that psychologists expect too little. A lot of previous posters seem to believe that helping others cannot pay well.. Don't they realize that higher paying professions, such as M.D.s, also help people? When we tell others we are willing to accept less money for our training, we just expedite the downward spiral we are currently enduring."

It's so true, and until that thread began, I had never really begun to think in these terms, which tells me that there are a lot of people in the field who accept the status-quo without really questioning it.

 

[PHinisheD]

The average pay in psychology is woeful. Unfortunately only the minority of clinicians actually get paid in line with the level of training. I believe the blame is shared equally between providers who don't fight for the money and the lack of support from the APA and related organizations that are supposed to represent and protect the profession. Don't despair though, I think the APA is going to have another task force to figure out why the pay is so bad...check back in 3 years for the report (I "borrowed" this joke from JN or Ollie...I forgot which).

As for Carlat's article....he is right about the importance of therapy + meds, but he is wrong about who is best positioned to provide Dx'ing and therapy. I'll comment more when I have time.

I totally agree that the pay is woeful. I wish there was an easy solution to this problem--some legislation or change in regulations that would tilt the playing field more favorably, or less unfavorably, in our direction. But I don't recall ever hearing a feasible solution.

Because of market forces, we are simply not in a position to demand more money for our time. Until we can create a demand for talk therapy that rivals the demand for meds, we can't expect to compete. And even then, we have to differentiate the quality of therapy we provide from that of social workers and MFT's. (And this may not be possible. There are many non-psychologists who are effective clinicians, or at the least, market themselves well). And even if we are able to do this, we may have difficulty driving up our salaries because the market is flooded with psychologists (at least in my urban CA home). There will always be those small number of wildly successful practitioners who do very well, but I doubt very much we'll see significant changes across all practitioners.

Sorry to be a downer. Maybe, hopefully, I'm wrong about this. I've met so many psychologists who are dedicated and motivated and caring. I'd love to see this field differentiate and market itself more effectively, resulting in an increase in money and respect for us, and more effective treatment delivered to the public. Just not sure how this can happen.

 

[phillydave]

I totally agree that the pay is woeful. I wish there was an easy solution to this problem--some legislation or change in regulations that would tilt the playing field more favorably, or less unfavorably, in our direction. But I don't recall ever hearing a feasible solution.

Because of market forces, we are simply not in a position to demand more money for our time. Until we can create a demand for talk therapy that rivals the demand for meds, we can't expect to compete. And even then, we have to differentiate the quality of therapy we provide from that of social workers and MFT's. (And this may not be possible. There are many non-psychologists who are effective clinicians, or at the least, market themselves well). And even if we are able to do this, we may have difficulty driving up our salaries because the market is flooded with psychologists (at least in my urban CA home). There will always be those small number of wildly successful practitioners who do very well, but I doubt very much we'll see significant changes across all practitioners.

Sorry to be a downer. Maybe, hopefully, I'm wrong about this. I've met so many psychologists who are dedicated and motivated and caring. I'd love to see this field differentiate and market itself more effectively, resulting in an increase in money and respect for us, and more effective treatment delivered to the public. Just not sure how this can happen.

Well said. Differentiation in terms of quality of services seems to be the key to the issue. My initial thought is that a shift to more specialization in services would help the situation, as apposed to the thought that if one has to choose between generalized services from a master's level and a doctoral level, one (being insurers) would choose the cheaper of the two.

 

[Therapist4Chnge]

Well said. Differentiation in terms of quality of services seems to be the key to the issue. My initial thought is that a shift to more specialization in services would help the situation, as apposed to the thought that if one has to choose between generalized services from a master's level and a doctoral level, one (being insurers) would choose the cheaper of the two.

This is why specializing is so important. There are definitely supply side issues (MA/MS/MSW + Ph.D./Psy.D.), though there are still areas where psychologists can carve their niche. Mid-level encroachment, dwindling reimbursements, and poor advocacy are additional areas of concern.

In addition to specializing, being formally boarded in an area can also help. I am a big supporter of ABPP certification for a way to differentiate between providers. Unfortunately there are many vanity boards (for both Masters and Doctoral professionals) that muddy the waters, though ABPP is the gold-standard. ABCN is an alternative boaring for neuropsychology that also has some strong support. In a medical setting, boarding is particularly useful because most physicians are boarding in their speciality.

I know in the area of rehabilitation psychology, there are ~120 ABPPs total. The people who go through the process differentiate themselves from their colleagues, which gives them a leg up for most jobs. It is a smaller field than something like neuropsychology, though these numbers are still only a small fraction of all doctoral pracitioners.

At the end of the day we have to differentiate ourselves or accept less pay and less respect. I personally am not willing to let my training be marginalized, though many people seem perfectly okay with it.

 

[Metta]

Unfortunately there are many vanity boards (for both Masters and Doctoral professionals) that muddy the waters...

For those of us who are still trying to familiarize ourselves with all of the various options, would you be willing to "name names" here? I've seen discussions on SDN about a few of the reputable boards, but I don't recall ever seeing any of the vanity boards mentioned by name.

 

[Therapist4Chnge]

I'll poke around. I have looked up some in the past that I've seen listed on CVs and private practice websites. I'll also include some of the fringe "credentialing"/"certifications" that seem to pop up out there.

I am always skeptical if it isn't one of the well known boards/certs, though there are definitely some niche organizations that offer legitimate certifications....they are just lesser known to people outside of the area.

 

[edieb]

What I don't understand is how familes with children make do on a psychologist's income. I am working in a V.A. right now as an entry-level psychologist and making $57K. I am very very lucky because this is probably 2 standard deviations above the mean in regards to entry level psychologist income. I am very fortunate to be living in a state with no state income tax, too.

At one point, I thought this was good/decent money (contrast effect from making $18K) and living on more than this would be excess. However, I now realize how wrong I was. After I make my $500 student loan payment and my modest living expenses (rent, car payment, insurance), I have very little left. I can't even build a savings account.

I guess I could fall back on the "at least I get to do what I love" argument but, at least where I work, we get 30 minutes with a patient and see the patient once/month at best. Therefore, I am more a case manager than a psychologist. Therefore, I am not even getting to use much of my training...

I don't know how people with familes or a lot of student loan debt get by. It is VERY disillusioning to spend 7 years in school (including internship) scraping by on a small stipend to come out and still be poor.

At one point I thought I would be ok with a monastic lifestyle. I now realize that having enough $$ is not about Ferraris and Mercedes. It is about security. I now realize that I would like to make enough drive a dependable, safe car, have enough to buy a house, have children, have a decent amount of savings in case I get sick, be able to take vacations.

 

[Featheredwyngs]

What I don't understand is how familes with children make do on a psychologist's income.

Well if you're talking single-parent families I can totally see that. But (if they have dependents to support etc.) I assume most rely on a spouse to bring in just as much or more to live comfortably (and actually I'd be curious to know how many psychologists marry other psychologists... ^_^). I also imagine it matters where you live as to how far that income will go (as 100k annual household income in let's say NC will go a lot further than in NY). Granted even with a two-person household income, if both are paying off heavy debts (student loans etc.) it won't go very far.

 

[erg923]

What I don't understand is how familes with children make do on a psychologist's income. I am working in a V.A. right now as an entry-level psychologist and making $57K. I am very very lucky because this is probably 2 standard deviations above the mean in regards to entry level psychologist income. I am very fortunate to be living in a state with no state income tax, too.

At one point, I thought this was good/decent money (contrast effect from making $18K) and living on more than this would be excess. However, I now realize how wrong I was. After I make my $500 student loan payment and my modest living expenses (rent, car payment, insurance), I have very little left. I can't even build a savings account.

I guess I could fall back on the "at least I get to do what I love" argument but, at least where I work, we get 30 minutes with a patient and see the patient once/month at best. Therefore, I am more a case manager than a psychologist. Therefore, I am not even getting to use much of my training...

I don't know how people with familes or a lot of student loan debt get by. It is VERY disillusioning to spend 7 years in school (including internship) scraping by on a small stipend to come out and still be poor.

At one point I thought I would be ok with a monastic lifestyle. I now realize that having enough $$ is not about Ferraris and Mercedes. It is about security. I now realize that I would like to make enough drive a dependable, safe car, have enough to buy a house, have children, have a decent amount of savings in case I get sick, be able to take vacations.

I am not surprised by the salary (all i can say is get married like the rest of us, haha), but am surprised by the VA experience. VA have mixed reps in general, but are generally known for having strong psychology services departments, (especially if they have an internship program), with outstanding psychologists who are often the model of the true "scientist-practioner." I am surprised their are not more opps for real clincial work there (ie., PTSD work, exposure therapy, groups, couples counseling, etc)?

 

[Therapist4Chnge]

I am not surprised by the salary (all i can say is get married like the rest of us, haha), but am surprised by the VA experience. VA have mixed reps in general, but are generally known for having strong psychology services departments, (especially if they have an internship program), with outstanding psychologists who are often the model of the true "scientist-practioner." I am surprised their are not more opps for real clincial work there (ie., PTSD work, exposure therapy, groups, couples counseling, etc)?

That is where the VA is trending, based on various directives handed down in the past year, though most facilities are still ramping up to get certified (by the VA) trainers in each EBT. Group work (psych-ed, process, support) also seems quite common in the VA system, though the current push is for more 1:1 therapy.

As for being strong S-P psychologists....I think that varies by facility and how you define S-P practice within a hospital setting. I think the push for EBTs helps that, as does the opportunity to do research (at most VAs), though there is still red tape and procedures that need to be navigated.

I will say that it has been my experience that the benefits available to VA employees compare favorably to public and private hospitals. A number of people I know sought out VA positions for the health benefits (for family). It is far from the panecea that people make it out to be sometimes, but it can offer some stability.

I believe outside of the VA is much more problematic, particularly in CMHCs, college counseling centers, etc. I originally planned on sticking around the VA, though I'm going to give academic medicine a shot and see how it compares.

I would be very concerned if I was a generalist, as many positions offered out in the community and in non-medical settings seem to group together mid-level and doctoral-level therapists. Be wary of any advertisements that do not differentiate between the responsibilities of the providers and be aware that many "therapy" jobs are being given to cheaper providers.

 

[PHinisheD]

I'll poke around. I have looked up some in the past that I've seen listed on CVs and private practice websites. I'll also include some of the fringe "credentialing"/"certifications" that seem to pop up out there.

I am always skeptical if it isn't one of the well known boards/certs, though there are definitely some niche organizations that offer legitimate certifications....they are just lesser known to people outside of the area.

I agree with you about the value of ABPP credentialing, insofar as it 1) aims to ensure clinical competence above and beyond the watered-down and irrelevant criteria that are tested on the ABPP and 2) requires an exceptional dedication to a S-P orientation (at least in the Clinical Psychology and Cog. and Beh. Psychology boards). I'm all for these things.

HOWEVER, ABPPs won't help us advance our field or obtain adequate compensation unless we can communicate its value to stakeholders outside the field. We could all get ABPPs and think mighty highly of our skills, but the average patient or hospital administrator really has no reason to care unless we demonstrate value.

Does anyone know what the average bump in salary is for ABPP psychologists, relative to their non-ABPP peers, in most institutions? I don't know. A few grand a year? It certainly isn't bringing psychologist salaries anywhere in line with those of psychiatrists or other similarly trained healthcare professionals. As much as I like the idea of the ABPP for its own sake, I'm skeptical that it will help our bottom line. After seeing the dim financial prospects awaiting those who attain the BA, MA, PhD, internship, postdoc, and licensure credentials, I'm skeptical that a few more letters after my name will make the difference. Starting to feel like Charlie Brown kicking that football.

 

[edieb]

I agree with you about the value of ABPP credentialing, insofar as it 1) aims to ensure clinical competence above and beyond the watered-down and irrelevant criteria that are tested on the ABPP and 2) requires an exceptional dedication to a S-P orientation (at least in the Clinical Psychology and Cog. and Beh. Psychology boards). I'm all for these things.

HOWEVER, ABPPs won't help us advance our field or obtain adequate compensation unless we can communicate its value to stakeholders outside the field. We could all get ABPPs and think mighty highly of our skills, but the average patient or hospital administrator really has no reason to care unless we demonstrate value.

Does anyone know what the average bump in salary is for ABPP psychologists, relative to their non-ABPP peers, in most institutions? I don't know. A few grand a year? It certainly isn't bringing psychologist salaries anywhere in line with those of psychiatrists or other similarly trained healthcare professionals. As much as I like the idea of the ABPP for its own sake, I'm skeptical that it will help our bottom line. After seeing the dim financial prospects awaiting those who attain the BA, MA, PhD, internship, postdoc, and licensure credentials, I'm skeptical that a few more letters after my name will make the difference. Starting to feel like Charlie Brown kicking that football.

Beyond the V.A. which gives approximately a few thousand dollars/year bump to ABPP psychologists, I am pretty sure boarding will give no increase in your salary with any employers. However, I imagine it could help in the private practice realm, especially if being an expert witness is part of your practice.

The primary thing that is going to increase psychologist salaries is our expanding our scope of practice. With the exception of pre-eminent persons in our field (Linehan, Judith Beck), psychotherapy rates are going to continue their downward course. With the age of "better care = cheaper and faster", psychological testing will also continue in its downward direction. IMO, the only hope is to gain prescriptive authority. THis power will give us a seat at the table to push for increased respect for testing and therapy. However, RxP has to be agenda item #1.

It is SO important that everybody join their state psychological association and the APA. While it may not seem the APA does much for you, the money you contribute helps to advocate for professional psychology's position in the healthcare environment.

 

[Therapist4Chnge]

Beyond the V.A. which gives approximately a few thousand dollars/year bump to ABPP psychologists, I am pretty sure boarding will give no increase in your salary with any employers. However, I imagine it could help in the private practice realm, especially if being an expert witness is part of your practice.

I'm not sure there would be a big direct bump, but I think it will make people more competitive for top positions, which can offer more money. I think it opens the door for administration level positions and/or to head a program. I am not familiar outside of medical settings, though other healthcare professions understand the importance of boarding. It is also a clear differential between mid-level clinicians and psychologists/neuropsychologists/rehab psychologists,etc.

 

[docjohng]

Insurance companies pay no more for an ABPP psychologist as opposed to a non-ABPP one. It may open career doors for you in very specific instances, but in most cases, it isn't going to do anything for your salary.

Don't shoot the messenger, in this case, Carlat. He's only speaking what most psychiatrists think and do.

John

 

[Metta]

I'll poke around. I have looked up some in the past that I've seen listed on CVs and private practice websites. I'll also include some of the fringe "credentialing"/"certifications" that seem to pop up out there.

I am always skeptical if it isn't one of the well known boards/certs, though there are definitely some niche organizations that offer legitimate certifications....they are just lesser known to people outside of the area.

Thanks!

One I've been curious about is the National Register of Health Service Providers in Psychology; are you familiar with the reputation of their credentialing program at all?

 

[Therapist4Chnge]

Insurance companies pay no more for an ABPP psychologist as opposed to a non-ABPP one. It may open career doors for you in very specific instances, but in most cases, it isn't going to do anything for your salary.

It will help the profession though. Many clinicians wouldn't pass, and better or worse....it would separate the top from everyone else. Some people don't like the requirements, but they are not that bad when you really consider "competency". Many wouldn't qualify, which has to be a concern. Some will say that since it isn't "required", they shouldn't care....but that is a bad way to approach a profession.

Most neuropsychology positions that are advertised, for example, on the npsych listserv, require at least board eligibility to apply. That's the right direction. Stop accepting the status quo in the field and make a new one that isn't low standards and apathy.

This is probably the most common place you see ABPP make a difference. The have and have nots in certain places. I'm lined up to be double board eligible in my specialty areas, and while I probably won't go for both, one will make a difference for my current path (academic medicine). If I was at a counseling center....it'd be a harder sell.

 

[phillydave]

If not for a bump in salary, isn't the bigger picture the potential clients' choice in choosing between an ABPP and a non-ABPP? Raising standards could slowly trickle down into a client driven raising of the status-quo, which seems desirable to me.

 

[PHinisheD]

If not for a bump in salary, isn't the bigger picture the potential clients' choice in choosing between an ABPP and a non-ABPP? Raising standards could slowly trickle down into a client driven raising of the status-quo, which seems desirable to me.

Seems desirable to me, too. But it's unlikely, IMO. The average client--in fact, the average non-psych healthcare provider--doesn't quite understand what we do or how we're different from mid-level practitioners to begin with. I don't see how another credential changes that. It's just more quality service that they won't appreciate

It seems to me that the typical response offered to this problem is to create subsets of particularly specialized/qualified people (such as ABPPs or prescribing psychs) who will be set apart from the "low standards and apathy" of the rest. (This mirrors what I often hear in academic psych circles, which is that the rest of the psychology world is incompetent, except for us clinical PhD researchers. I'm not saying I feel this way, but it's a common sentiment. As if we'd all be treated and paid like psychiatrists if not for all those PsyD's making us look bad. But I digress.) But I've come across some incredibly knowledgeable and capable clinicians in medical settings who, at the end of the day, are still paid like psychologists.

In other words, I'm not sure it's a matter of us not being good enough at what we do. I think it's more that we don't make a case for the importance of what we do. Or maybe we just collectively are not so good at the business or politics of it.

 

[phillydave]

In other words, I'm not sure it's a matter of us not being good enough at what we do. I think it's more that we don't make a case for the importance of what we do. Or maybe we just collectively are not so good at the business or politics of it.

Yes, to me it is all of that above, plus forces at work outside of the clinical psych realm (media, government, public perception of mental health, etc, etc) and then multiplied by a lack of stones, so to speak. It just seems like we aren't loud enough, as a group. Maybe a fault/characteristic of our own personalities that brought us into the profession in the first place.

 

[Buzzwordsoldier]

Seems desirable to me, too. But it's unlikely, IMO. The average client--in fact, the average non-psych healthcare provider--doesn't quite understand what we do or how we're different from mid-level practitioners to begin with. I don't see how another credential changes that. It's just more quality service that they won't appreciate

It seems to me that the typical response offered to this problem is to create subsets of particularly specialized/qualified people (such as ABPPs or prescribing psychs) who will be set apart from the "low standards and apathy" of the rest. (This mirrors what I often hear in academic psych circles, which is that the rest of the psychology world is incompetent, except for us clinical PhD researchers. I'm not saying I feel this way, but it's a common sentiment. As if we'd all be treated and paid like psychiatrists if not for all those PsyD's making us look bad. But I digress.) But I've come across some incredibly knowledgeable and capable clinicians in medical settings who, at the end of the day, are still paid like psychologists.

In other words, I'm not sure it's a matter of us not being good enough at what we do. I think it's more that we don't make a case for the importance of what we do. Or maybe we just collectively are not so good at the business or politics of it.

I can't but feel that the continued us vs. them mentality serves to defeat the cause. The idea of expanding our scope is interesting but I wonder if we need to think vertically as well as horizontally. The martyr syndrome is a cancer of the industry, which rots from the bottom up. Many who work in the trenches simply take the crap conditions of their work as the price they pay for the privilege of giving back/making a difference/etc. Too often the top continues to sell out the bottom since the bottom just drags the bottom line down anyway, and the whole thing winds up chasing its own tail.

Psychologists need to learn to be effective leaders -- not just clinicians: stewards of the industry in the same sense as union stewards. An injury to one is an injury to all.

Being very literal for a moment, I am encouraged by an initiative to treat violence against care providers as a crime on a par with violence against officers of the law.

 

[Therapist4Chnge]

I hope this new generation of psychologists coming out do something different, but I fear that we will follow the same path of apathetic activism.

 

[positivepsych]

See the letters to the editor, in response to this article... I'm glad a psychologist took the time to stand up for our field and educate the public:
http://www.nytimes.com/2010/05/09/magazine/09Letters-t-MINDOVERMEDS_LETTERS.html

Clinical psychologists like myself receive a doctorate degree after completing at least six years of postbachelor’s training in the theory, science and practice of mental-health treatment. This involves thousands of hours of patient contact, supervision with licensed psychologists and course work. Many receive an education devoted specifically to empirically supported treatments, like cognitive-behavioral therapy. As Daniel Carlat says, “psychopharmacology was infinitely easier to master than therapy.” Of course, many psychiatrists seek additional training and supervision after their residencies in order to become excellent therapists, but not all do. If I were seeking a therapist for myself, I would certainly want someone who possesses a specialized training in therapy.

Moreover, integrated treatment does not have to be provided by the same practitioner. Rather, it could entail a treatment team that regularly consults one another on changes in the patient’s symptoms and life circumstances, as well as medication noncompliance or side effects. As a psychologist specializing in the treatment of eating disorders and depression, I believe it is imperative that I regularly speak with the internists, psychiatrists and nutritionists involved in my patients’ care. While this approach to treatment may not save money in the short term, it may ensure improved outcomes and lower rates of relapse, making it a better approach for our patients in the long term.
RENE D. ZWEIG, PH.D.
New York

 

[Therapist4Chnge]

A well written response to a rather polarizing topic.