Psychotherapy certifications: The good, the bad, and the grifty

[R. Matey]

Setting aside 95% of the PESI catalogue for trainings in internal polyvagal complex intergenerational trauma systems therapy that the biased science can't possibly measure, how necessary are psychotherapy certifications for responsible, independent practice? For instance, if I've received training and supervision in both cognitive therapy and mindfulness skills, do I really need to now become certified in mindfulness based cognitive therapy or can I just put those two things together after reading a book and getting a consultation to be sure that I'm integrating the two skills correctly. I'm sure the floor ethic is 'whatever you can defend in court,' but I'd like to understand how folks practicing perceive their own psychotherapeutic competence as well as the steps they took to achieve it.

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[The Cinnabon]

Setting aside 95% of the PESI catalogue for trainings in internal polyvagal complex intergenerational trauma systems therapy that the biased science can't possibly measure, how necessary are psychotherapy certifications for responsible, independent practice? For instance, if I've received training and supervision in both cognitive therapy and mindfulness skills, do I really need to now become certified in mindfulness based cognitive therapy or can I just put those two things together after reading a book and getting a consultation to be sure that I'm integrating the two skills correctly. I'm sure the floor ethic is 'whatever you can defend in court,' but I'd like to understand how folks practicing perceive their own psychotherapeutic competence as well as the steps they took to achieve it.

I truly wonder how many psychotherapists we would lose overnight if we actually mandated EPBs be utilized, in order to keep one's license, and only after the psychotherapist receives quality training in said modality?


I know this is pretty tangential to what you were asking, but it's something that dwells on my mind every time I look on Psychology Today.

 

[AbnormalPsych]

Those certifications are meaningless and for mid-levels to feel some sort of basic competence and like they got something for their money.

If you are practicing at the doctoral level I would assume by being familiar with the literature and having received supervision in a specific area you are thinking about, would lead you to have a pretty good judgement of your level of competence and what your peers would say about you.

We are the most highly trained MH professionals, so I think we generally can figure it out, or spend the time to learn and consult to be able to do something better than most others in the field. This obviously is complex because it varies a lot based on other variables. Are you the only psychologist in a rural area that within 250 miles knows anything about OCD treatments? Does your employer force you into a general MH clinic role even though you know much more about treating specific phobias as compared to cluster B PDs? Are you taking on a high risk anorexia private practice patient by yourself just because of $$$ and your student loan debt when there is an eating disorder IOP down the street and your only training is a PESI seminar and read an article one time in grad school?

 

[borne_before]

I think ABPP is dumb.

 

[WisNeuro]

I think ABPP is dumb.

Dumb or not, the money I've been able to make because of those letters has been substantial.

 

[Sanman]

I think ABPP is dumb.

Dumb or not, the money I've been able to make because of those letters has been substantial.

I find the ABPP in neuropsych, forensic psych, and clinical psych to have some utility. Certainly, it plays a role in forensic cases overall. However, I am seeing much less utility in the other areas of ABPP because, frankly, the field has done a terrible job providing consistent training pathways and carving out consistent jobs in these specialty areas. There is no ABPP in autism assessment and the one in addiction does not seem to hold much water from what I see. Not to mention, there is so much crossover between some specialties that I feel it is pointless. Given my history, I should be an easy sell for ABPP in gero. Except I already have one of the best "jobs" in gero without any board cert and have plenty of offers. The only use case that I can see if if I want to do legal work or am bored and want the VA step bonus (if my hospital honors it). I am not sure if getting a gero ABPP would do much if anything over a clinical psych ABPP.

 

[Sanman]

Setting aside 95% of the PESI catalogue for trainings in internal polyvagal complex intergenerational trauma systems therapy that the biased science can't possibly measure, how necessary are psychotherapy certifications for responsible, independent practice? For instance, if I've received training and supervision in both cognitive therapy and mindfulness skills, do I really need to now become certified in mindfulness based cognitive therapy or can I just put those two things together after reading a book and getting a consultation to be sure that I'm integrating the two skills correctly. I'm sure the floor ethic is 'whatever you can defend in court,' but I'd like to understand how folks practicing perceive their own psychotherapeutic competence as well as the steps they took to achieve it.

You can collect as many certs as you want. But don't forget that by virtue of your degree, you are better trained than 90% of clinicians already. I think that reality gets lost in the academic echo chamber.

 

[BuckeyeLove]

Historically your license should have been enough. I’m inclined to say ABPP but I know plenty that are boarded in various specialities who are still meh. Word of mouth is what we’re left with.

 

[AcronymAllergy]

I think in most instances, what you've described is probably sufficient for most psychologists with a decent foundation. The more far afield from your knowledge base the new therapy is, and/or the more moving parts involved, the more work you'll probably need. I don't think anyone is really going to be administering biofeedback after reading a book and seeking out supervision, for example.

I wouldn't say a certification is ever really necessary unless required by law. But some interventions may have a more established training pathway than others, and its then on you to justify why your training was equivalent if you went a different route.

I think for folks in VA, there's something (personally and professionally) to be said for their training and certifications. Even forensically, it could sound nice in some instances to say, for example, that you're certified in PE and CPT via VA.

 

[cara susanna]

Yeah, I think VA certifications are definitely worthwhile.

 

[Sanman]

Yeah, I think VA certifications are definitely worthwhile.

The problem with VA certifications is that you are generally limited in which trainings you can attend by the position you are in due to the way the application process works and if you fail to complete the training are banned from future trainings. However, the training is good and they are a great way to move up the ranks if you do well and become a trainer, etc.

 

[Shiori]

There has been a good bit of flexibility for us. I wonder if it's a site by site thing. We're a smaller site and there is less demand.

 

[Sanman]

There has been a good bit of flexibility for us. I wonder if it's a site by site thing. We're a smaller site and there is less demand.

For the larger national trainings or something local? For the national trainings I have done, they usually ask about the number of cases you can see total to select you for the training and you have to complete a number of consultation cases within a set period. If you can't accommodate that within your position, it is a no go.

 

[Shiori]

For the larger national trainings or something local? For the national trainings I have done, they usually ask about the number of cases you can see total to select you for the training and you have to complete a number of consultation cases within a set period. If you can't accommodate that within your position, it is a no go.

These have been national trainings. In my last training, there was a person who wasn't able to finish the first time because they couldn't get enough people to participate. They brought them back in for another round. It was CBT-D and both of my training partners were from PCT. I don't know as many HBPC folks, so their experiences might be different. SUD-C, PCT, and PCMHI here regularly get whatever trainings they're interested in. We get (aggressive) reminders about training opportunities. I will say, I'm not far from a bigger VA and their experiences have been different.

I'm in MHC, so we get access to a lot of trainings first, but a lot of us have been passing because we were swamped. The opportunities were passed on to other clinics.

 

[R. Matey]

I think for folks in VA, there's something (personally and professionally) to be said for their training and certifications. Even forensically, it could sound nice in some instances to say, for example, that you're certified in PE and CPT via VA.

CPT is one area that I have some interest in, but didn't really get exposure to until postdoc. Even so, this I think falls in a grey zone for me since I have a lot of experience with cognitive therapy for depression from which CPT seems to draw many of its principles. So I feel like I could probably figure it out, but if I were in PP, for instance, I wouldn't advertise myself as offering CPT nor I bill myself as treating PTSD given that I've really only had some supervised practice in PE and WET. I know there are people in my locale that offer supervision for EBPs for trauma, so I think that would be my play if I wanted to develop the specialty. I know there is a lengthy and costly certification process, but again, is this really all that necessary?

 

[WisNeuro]

CPT is one area that I have some interest in, but didn't really get exposure to until postdoc. Even so, this I think falls in a grey zone for me since I have a lot of experience with cognitive therapy for depression from which CPT seems to draw many of its principles. So I feel like I could probably figure it out, but if I were in PP, for instance, I wouldn't advertise myself as offering CPT nor I bill myself as treating PTSD given that I've really only had some supervised practice in PE and WET. I know there are people in my locale that offer supervision for EBPs for trauma, so I think that would be my play if I wanted to develop the specialty. I know there is a lengthy and costly certification process, but again, is this really all that necessary?

I imagine @cara susanna would know best, as I think they are officially trained here. I was formally trained in PE, and informally trained in CPT, but did not go through certification. Like you, I feel like I could do CPT therapy if I wanted to with some brushing up and some supervision at first and remain ethical and efficacious.

 

[PsyDr]

Setting aside 95% of the PESI catalogue for trainings in internal polyvagal complex intergenerational trauma systems therapy that the biased science can't possibly measure, how necessary are psychotherapy certifications for responsible, independent practice? For instance, if I've received training and supervision in both cognitive therapy and mindfulness skills, do I really need to now become certified in mindfulness based cognitive therapy or can I just put those two things together after reading a book and getting a consultation to be sure that I'm integrating the two skills correctly. I'm sure the floor ethic is 'whatever you can defend in court,' but I'd like to understand how folks practicing perceive their own psychotherapeutic competence as well as the steps they took to achieve it.

Let's assume you are competent in a therapy.

Patient is looking for a therapist. What are the chances that this patient knows the name of a specific therapy? What are the chances that they know the credentials associated with being certified in that therapy? If they do know, what are the chances that they are complicated patients? What are the chances you have any extra space in your calendar for more work? What are the chances of an insurance company paying you more for a credential? Does your peers' opinions of you have any effect on your income? Does being certified change your drop out rate? etc.

In short, those certifications are for your peers.

 

[cara susanna]

CPT is one area that I have some interest in, but didn't really get exposure to until postdoc. Even so, this I think falls in a grey zone for me since I have a lot of experience with cognitive therapy for depression from which CPT seems to draw many of its principles. So I feel like I could probably figure it out, but if I were in PP, for instance, I wouldn't advertise myself as offering CPT nor I bill myself as treating PTSD given that I've really only had some supervised practice in PE and WET. I know there are people in my locale that offer supervision for EBPs for trauma, so I think that would be my play if I wanted to develop the specialty. I know there is a lengthy and costly certification process, but again, is this really all that necessary?

I'm certified in CPT as well as a CPT trainer! We always recommend pursuing formal training and certification in CPT. It's actually a pretty rigorous training even outside of the VA, with a two-day workshop and 6 months of consultation.

For context, I was trained in PE on post doc (like, my supervisor listened to audio recorded sessions and everything) and I still pursued certification later on. I would say that I still learned a lot even then.

 

[Sanman]

CPT is one area that I have some interest in, but didn't really get exposure to until postdoc. Even so, this I think falls in a grey zone for me since I have a lot of experience with cognitive therapy for depression from which CPT seems to draw many of its principles. So I feel like I could probably figure it out, but if I were in PP, for instance, I wouldn't advertise myself as offering CPT nor I bill myself as treating PTSD given that I've really only had some supervised practice in PE and WET. I know there are people in my locale that offer supervision for EBPs for trauma, so I think that would be my play if I wanted to develop the specialty. I know there is a lengthy and costly certification process, but again, is this really all that necessary?

Why not? If you have had supervision and been trained in PE, you certainly can treat PTSD. You might not be an expert, but treat it? There are folks out there with no training trying to see trauma patients. One of my folks was looking for community care and only one person trained in any EBT for trauma (PE). Most took a PESI course on EMDR.

 

[R. Matey]

Why not? If you have had supervision and been trained in PE, you certainly can treat PTSD. You might not be an expert, but treat it? There are folks out there with no training trying to see trauma patients. One of my folks was looking for community care and only one person trained in any EBT for trauma (PE). Most took a PESI course on EMDR.

I did internship/postdoc during the early phase of the pandemic where a lot of the planned formal didactics were scuttled or significantly curtailed. So I received didactic instruction and week-to-week case supervision of PE, but my supervisors had no capacity to listen to my sessions, for instance. I also maybe saw like 5 trauma cases at most during internship\postdoc since I was technically there (at postdoc) for a primary care fellowship, but got sidelined into general outpatient due to high patient volumes. I feel much stronger in my capacity to offer WET because (and correct me if I'm wrong) the treatment appears to be more accessible for generalist practice and I've done it more times. Still, I'd be more inclined to use this with depression case with sub-acute trauma than PTSD per se.

 

[Shiori]

This thread reminds me that I have noticed a trend of treatment manuals pushing clinicians to just jump in without rigorous additional training if they have a solid foundation of similar treatment modalities.

 

[Sanman]

I did internship/postdoc during the early phase of the pandemic where a lot of the planned formal didactics were scuttled or significantly curtailed. So I received didactic instruction and week-to-week case supervision of PE, but my supervisors had no capacity to listen to my sessions, for instance. I also maybe saw like 5 trauma cases at most during internship\postdoc since I was technically there (at postdoc) for a primary care fellowship, but got sidelined into general outpatient due to high patient volumes. I feel much stronger in my capacity to offer WET because (and correct me if I'm wrong) the treatment appears to be more accessible for generalist practice and I've done it more times. Still, I'd be more inclined to use this with depression case with sub-acute trauma than PTSD per se.

This thread reminds me that I have noticed a trend of treatment manuals pushing clinicians to just jump in without rigorous additional training if they have a solid foundation of similar treatment modalities.

I think that getting training is a good thing if the training is quality. In the case of @R. Matey, I don't know if I would jump into treating complex cases of PTSD in solo private practice. However, being an early early career clinician, I think this is more about having a good supervisor to rely on than needing a training course unless the the course has some ongoing consulting with an actual expert. I am all for gold standard practice. However, I don't think that should let the perfect be the enemy of the good. At some point, we have to accept that taking on cases is the best way to gain expertise and there is a shortage of appropriately practiced clinicians. However, I also come at this from the point of view of someone that has been working in underresourced and understaffed areas for decades. Often, the choice will be your treatment or no/worse treatment. If there is genuine expertise out there and available, refer it out. I often have to provide treatment to my folks, because it has been me or no treatment. Mind you, this was before telehealth. I think younger clinicians often underestimate that the reality of the MH landscape is often far worse than they know.

 

[Therapist4Chnge]

Yeah, I think VA certifications are definitely worthwhile.

I never got any certificates! I'm not sure when PE & CPT were widely taught in the system, but I did my internship in '09 and we had to be trained in both and demonstrate competency as part of our intern requirements.

 

[Sanman]

I never got any certificates! I'm not sure when PE & CPT were widely taught in the system, but I did my internship in '09 and we had to be trained in both and demonstrate competency as part of our intern requirements.

Would you like us to send you one? I'm sure we could dummy one up. Maybe I should just start the SDN certification program. I could use a good grift.

 

[cara susanna]

I never got any certificates! I'm not sure when PE & CPT were widely taught in the system, but I did my internship in '09 and we had to be trained in both and demonstrate competency as part of our intern requirements.

Oh man, now you get a certificate AND a clipboard for CPT (it looks like an ABC sheet and it's delightful)! They used to send you the DVD of the educational video on it, but times have changed.

 

[R. Matey]

At some point, we have to accept that taking on cases is the best way to gain expertise and there is a shortage of appropriately practiced clinicians. However, I also come at this from the point of view of someone that has been working in underresourced and understaffed areas for decades. Often, the choice will be your treatment or no/worse treatment. If there is genuine expertise out there and available, refer it out. I often have to provide treatment to my folks, because it has been me or no treatment. Mind you, this was before telehealth. I think younger clinicians often underestimate that the reality of the MH landscape is often far worse than they know.

Appreciate that perspective, thanks. I think was the only psychologist in 100 mi. that could reasonably do a half-way decent job at PTSD, it might be worth getting a consultation and putting my big pirate trauma pants on. I still probably wouldn't advertise it as a specialty unless I was in either regular supervision while reading about it or going through some kind of certification process though. It sounds like either play is socially responsible practice for developing a new technique.

 

[Sanman]

Appreciate that perspective, thanks. I think was the only psychologist in 100 mi. that could reasonably do a half-way decent job at PTSD, it might be worth getting a consultation and putting my big pirate trauma pants on. I still probably wouldn't advertise it as a specialty unless I was in either regular supervision while reading about it or going through some kind of certification process though. It sounds like either play is socially responsible practice for developing a new technique.

No one said you have to advertise it as your specialty and I think you are being overly restrictive. No one is traveling 70 miles each way every week for psychotherapy. If someone can't get care within a 30 mile radius or without less than a 6 month wait, screen them, take the less severe cases, and get some consultation. Be honest and upfront about your training with the clients. That does not mean you cannot continue to learn and gain expertise. This is not school anymore.

 

[NeuroTrope]

Board certification in neuropsych = $$$.

 

[WisNeuro]

Board certification in neuropsych = $$$.

Depending on what you want to do. If you just want to do 100% clinical, won't move the needle all that much. But, there are clinical jobs that require board cert within x amount of time, so you'd just have more options. The real boon comes in terms of legal/forensic issues. You can still do that without board cert, but there are some options only open to board certified people, and many lawyers will only hire those who are board certified.

 

[smalltownpsych]

I haven’t obtained any certificates but I’ve attended a lot of trainings, received lots of supervision and have quite a few areas where I feel competent to practice independently and supervise others. As an independently licensed doctoral level provider of treatment and assessment, it is up to me to determine my level of competency and when to consult, receive additional training, and when to refer out. I don’t think ABPP is necessarily stupid although it would be a waste of time for my practice, but I do think certificates are and when I see a lot of certifications I think the person with them probably is.

 

[R. Matey]

Aside from rehab and neuro, does anyone hold a ABPP that they find useful or beneficial to their day-to-day practice?

 

[Sanman]

Aside from rehab and neuro, does anyone hold a ABPP that they find useful or beneficial to their day-to-day practice.

Even for rehab, it is largely for the major rehab hospitals and spinal cord centers. I have worked in plenty of sub-acute rehabs without ABPP and most who do are not boarded or have even completed a post-doc in the area.

 

[WisNeuro]

Aside from rehab and neuro, does anyone hold a ABPP that they find useful or beneficial to their day-to-day practice?

I see the general Clinical Psych one somewhat regularly in legal settings, and see the occasional job postings for wanting police and public safety. But, the latter is more uncommon.

 

[R. Matey]

I see the general Clinical Psych one somewhat regularly in legal settings, and see the occasional job postings for wanting police and public safety. But, the latter is more uncommon.

As in forensic evaluators with a general clinical ABPP?

 

[WisNeuro]

As in forensic evaluators with a general clinical ABPP?

Yes, when a psychiatric diagnosis is part of the suit.

 

[Sanman]

I see the general Clinical Psych one somewhat regularly in legal settings, and see the occasional job postings for wanting police and public safety. But, the latter is more uncommon.

That is one of the few that make sense to me.

 

[Ollie123]

Forensics holds some utility from what I've heard, mostly as an additional buffer against your credentials being questioned by lawyers.

Literally everyone I know who has pursued it in recent history was in neuro/rehab. Beyond that, I know a couple general clinical and health psych boarded folks, but most are very senior psychologists who were basically the early adopters when boarding first became a "thing" but who don't really have any need for it.

My impression is no one outside neuro/rehab and forensics cares even a tiny bit. I've asked about boarding at basically every location I've worked at since grad school. Invariably, I have been told some form of not to bother, no one gets boarded, being boarded doesn't "get" you anything, no one in leadership even thinks about boarding, etc.

 

[MCParent]

I’m abpp in counseling psych. When I was in academia it was nice for the program to have faculty who were licensed and boarded, but it didn’t really do anything for me. Mildly nice to be able to list board certified in my PP, but I was already full and turning down patients anyway. I’d had some asks to do expert witness stuff for which it would have been helpful but I ended academia and PP before those came to fruition. It wasn’t an arduous process for me so it didn’t take much, but no major benefit for me on the road I ended up taking.

 

[Sanman]

I’m abpp in counseling psych. When I was in academia it was nice for the program to have faculty who were licensed and boarded, but it didn’t really do anything for me. Mildly nice to be able to list board certified in my PP, but I was already full and turning down patients anyway. I’d had some asks to do expert witness stuff for which it would have been helpful but I ended academia and PP before those came to fruition. It wasn’t an arduous process for me so it didn’t take much, but no major benefit for me on the road I ended up taking.

I am not accomplished enough to be hired for many academic positions or rich enough to take such a massive pay cut if hired. I guess I can cross that reason off of my list for being boarded.