Scope Creep: How Does This Impact Clinical / Counseling Psychology

[edieb]

I don't think Jon Snow was insulting you when he asked whether or not you're a psychologist. I, too, wondered if you were or not, especially when you you argue that test interpretation can mostly be done using computer print-outs, that anyone should be able to do therapy, etc. I don't know about others, but I find your post pretty insulting as I am not spending 8 years in school to obtain a PhD for someone to say that my job can be done by someone who has one year of training (per your last post) or by a computerized scoring program spitting out a printout. I can imagine the latter comment would be ESPECIALLY insulting to someone like JonSnow, a neuropsychologist. Maybe if you have such a low opinion about psychologists and the value of the extra years in school and more rigorous training, you should have just gotten your MSW and been done with it.....

Which is great, but so what? You can't change a profession's focus by ranting about it online, and you're unlikely to change people's minds by making empty arguments that have little outcome research support.

I also think the basis for your argument is questionable. Is there a finite economy for mental health professionals, or is it an ever-expanding profession comprised mostly of various types of professionals who mostly work together, get along, and respect one another's professional perspectives?

If it's a finite, closed economy, then yes, professionals will have to scratch and claw amongst themselves for competition and to rally against each group from infringing on what they view as their rightful areas of expertise.

But I'd argue we don't live in such a closed system, that instead we live in a very dynamic and ever-changing system. This could be evidenced by the decline of docs specializing in psychiatry, giving psychologists an in-road to prescription privileges. Or by psychologists who "out source" the actual psychological testing to interns or other far-less-qualified individuals than a full-fledged psychologist (because they view the actual test-giving as menial and not as important as test interpretation, which can often largely be done by computer program now).

We don't need to make this a battle between professions and I think that's the exact opposite direction that the rest of the world is going in, especially as patients themselves become better educated and informed not only about their disorders, but possible treatment and treatment techniques. It's becoming an increasingly collaborative environment amongst clients and their therapists, and I'd suggest it's far more productive for professions to also collaborate rather than to raise the drawbridge and declare some sort of silly war.

Unlike some who've posted to this thread, experience has taught me that each profession brings something valuable and unique to the table. And if some clinical social workers are branching more and more into diagnosis and treatment of serious mental disorders, well, more power to them. Time and research will tell whether this is a good thing or not.

Psychoanalysts frowned upon the explosion of behaviorists in the 1950s and the 1960s in America, suggesting that because they didn't have the extensive training (sometimes 10+ years postdoc) that analysts had, they were less qualified to diagnose and treat mental disorders. I see this kind of argument being no different than what is being argued here, simple turf wars that have been repeated for decades and will likely continue for decades to come.

John

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[docjohng]

My angle? My angle is simply to stop the useless turf wars you bring up every few months to defend your particular brand of what a Real Psychologist(tm) should be. Now it's expanded into what a Real Psychotherapist(tm) should be. An empiricist should argue from the data, not from conjecture alone. And you well know what the data say on this topic.

Oh, but then we can just claim the studies themselves are flawed (as must be the peer-review process since they appeared in peer-reviewed journals). All of which may be true, but then we build upon a house of cards going down that messy road.

As you also know, doctoral training programs vary widely. While video/audio taping is regularly done in virtually all professions' therapy training programs, what supervisor is reviewing hours of videotape every week for every student? Perhaps some do, but most focus on what you bring to them as a "problem." And of course, using this logic, any clinical social work program that does the same is meeting the same standards.

I did not say "Anyone can do psychotherapy," nor did I make the claim that *only* a computer program is necessary to interpret psychological batteries. I merely pointed out that without a clear metric ahead of time of what constitutes what makes psychotherapy most effective for the client, you can't go around claiming other professions don't have that or can't provide for that in their training models.

And of course a computer program alone won't take the place of a psychologist who has years of experience interpreting test data. I should've said what I meant -- test scoring, rather than test interpretation -- when I wrote the original post.

John

 

[docjohng]

Gosh, if I believe the lowest common denominator standard like you say I do, why would I bother with my own doctorate degree? You make no sense.

You're taking my argument to a logical absurd conclusion ("reductio ad absurdum") and introducing a false dichotomy I never suggested -- that the only way we can obtain knowledge in this area is by experimenting on the unsuspecting public. As though hundreds of research studies aren't conducted every year on the "public" via traditional and accepted research protocols and IRBs.

Of course we can obtain valuable knowledge in the course of determining what amount of education and training is necessary to obtain a sufficient knowledge in the practice of psychotherapy without doing so in an unethical manner. In fact, you could design such a study today with existing professionals in existing practice and have data in a year's time that could provide you with some interesting insights into this question.

In the Jon Snow Ideal World(tm), we all would go to Jon Snow's Perfect Doctoral Program(tm) and any program that didn't adhere to everything in the Jon Snow Ideal World(tm) would be declared "unethical" and subpar. Only psychologists would provide psychotherapy and if you couldn't afford one, oh well, you're out of luck.

John

PS - "Empirical data" does not equal "double-blind control study"... certainly there are other kinds of empirical data, no?

 

[Therapist4Chnge]

MOD NOTE: Jon and John....both of you need to be more professional in this discussion, as name calling and inflammatory posting is against the rules at SDN. -t4c

 

[PsyDr]

just when it was getting good too.

 

[docjohng]

Michael et al. (2005) put it far better than I can:

Other therapist variables, including level of training and years of experience, have also been examined to determine their potential contribution to treatment outcome (e.g., Kolko, Brent, Baugher, Bridge, & Birmaher, 2000). In order to determine whether an association exists between the level of training and outcome, researchers have often selected a sample of studies (e.g., professionals versus paraprofessionals), calculated an overall effect size (ES) for each study, and coded differential levels of training across the various studies. However, the findings from the majority of these studies are not only equivocal, but also unsettling given that a number of studies support the assertion that paraprofessionals and/or lesser trained practitioners are equally effective and, in some cases, more effective than their more highly trained colleagues (e.g., Berman & Norton, 1985; Stein & Lambert, 1984; Durlak, 1979; Hattie, Sharpley, & Rogers, 1984).

In a review of related literature, Christensen and Jacobson (1994) suggested poignantly, "years of study and training should dramatically alter a person's ability to conduct professional work. In most professions, it would be ludicrous to compare a trained and an untrained person. It is hard to imagine a study comparing trained and untrained surgeons, or trained and untrained electricians for that matter" (p. 9). Indeed, the very notion that lesser trained clinicians produce equivalent or superior outcomes probably strikes fear in the hearts of clinical training directors everywhere. If spending substantial amounts of time, money, and energy to become more "expert" in the field of psychotherapy does not translate into appreciable benefits for clients and society at large, it begs the question, why bother? Alternatively, it might be true that a professional psychotherapist provides a significant and worthwhile service to those in need well above and beyond what a layperson or lesser trained individual can produce, yet we are unable to substantiate these claims of enhanced effectiveness in an empirically responsible way given confounds and limitations in the data.

Stein and Lambert (1995) pointed out that in most studies where the relationship between training level and outcome was examined, this issue was not the primary hypothesis and so clear delineations between various levels of training were not typically conducted. (p. 224)

Based upon the results obtained in this study, it does not appear that professional therapists produce better outcomes when treating children and adolescents with depression. These data are not consistent with the findings from at least two previous and large meta-analytic reviews involving children and adolescents (Weisz et al., 1987, 1995) which indicate that professionals produce better outcomes when treating internalizing problems in children and adolescents. This suggests that while professional therapists appear to have the edge when treating a broadly-defined rubric of internalizing disorders, the differential effects essentially disappear when depression interventions are considered alone.

Despite the divergence of these data with some of the findings from large child and adolescent meta-analytic reviews (Weisz et al., 1987; 1995), in two recent studies involving depressed adolescents, researchers reported non-significant interactions based upon other relevant therapist variables (e.g., specialized versus non-specialized background, years of experience). In an open trial of 25 adolescents with moderate to severe depression, Santor and Kusumaker (2001) analyzed the effectiveness of therapists with more "specialized" psychotherapy backgrounds (i.e., defined as doctoral psychologists, psychiatric residents) versus therapists with less specialized backgrounds (i.e., clinical nurses, social workers). Their analyses did not reveal any statistically significant differences between groups on any of several outcome measures. In another recent trial of 103 depressed adolescents, Kolko et al. (2000) reported that therapist experience (in years) did not interact with outcome across any of the dependent measures. Thus, in more circumscribed investigations of depressed youth (including the present study), more or increasingly specialized training does not appear to be related to better outcomes for the children and adolescents. (emphasis added, p. 232)

Indeed, the beliefs that "more education = better therapy outcomes for difficult cases" or "more education = necessary to diagnosis & differential diagnosis" are well-held within the profession. Yet they don't have the strong empirical support one would expect from a profession that prides itself on its rich history of research.

Contrary to the assertions made on my behalf, I also hold similar beliefs (likely due to my direct personal benefits of having attained a doctoral degree, which is a conflict of interest in such a discussion). But I find it disquieting that my profession has done little research in this area to demonstrate actual, real (as opposed to perceived) benefits for clients.

There was a time when I believed psychotherapy could only be done most successfully via a doctoral degree. I now believe that, by and large, much mainstream psychotherapy done in a grounding of cognitive-behavioral techniques can be done by others who do not necessarily hold a doctorate.

Reference:

Michael, K.D., Huelsman, T.J. & Crowley, S.L. (2005). Interventions for Child and Adolescent Depression: Do Professional Therapists Produce Better Results? Journal of Child and Family Studies, 14(2), 223-236.

PS - I'm not sure what a random advertiser via Google Adwords on my site has to do with this argument. Should we also disclose that your salary comes from the very same programs you defend so much here? So add financial incentives to your pile of motivations as well, since without such programs, you might be out of a job.