What does APAPO/APA need to do to help our profession most effectively?

[Rivi]

Hello everyone,

There seems to be a lot of discontent with the APA Practice organization (on my part as well). I was wondering what the APAPO/APA needs to do to better advocate for our field. Ideal solutions would be ones that benefit all practitioners, such as higher reimbursement rates for psychotherapy, assessment, etc. I have a few ideas:

-It seems that many neurologists, etc. are not using neuropsych testing as they are not fully aware of the benefits of testing, and the valuable functional data it can provide. I am concerned that a lot of potential referrals are lost due to ignorance of physicians or a lack of advocacy on our part. I don't have much firsthand experience here, but I heard a few post-docs complaining about that at my last externship.

-Educating counselors, and other Master's level clinicians on reasons for psychological testing, and some of the benefits of psychological testing that can help them help their clients. Perhaps we can work with CACREP (the accreditation system that sets the curriculum for counseling programs) to help train counselors how and when to refer for psych testing. The same can apply for psychiatrists as well.

-Polling our referral sources (psychiatrists, neurologists, etc.) to see how often they use psych testing, and what would be most helpful for them, what sorts of needs do they have that we can better address, etc. It seems that if we made psychological testing more user-friendly and less pedantic, it would be utilized more often.

- There NEEDS to be a better line of communication between APA and APA members, particularly when it comes to advocacy. The APA seems to insulate themselves, and a cost of this is that they push for things that don't necessarily mesh with the desires of the field. I don't see a lot of attempts on their part to take polls, votes, etc. to see what is most important to practitioners, and how we feel APAPO is meeting our needs.

-Establishing psychologists role in psychotherapy. One avenue here is supervision of master's level providers. We have training in research and supervision and can help train Master's level counselors to meet their hours for obtaining their license. Also, polling referral sources (psychiatrists, physicians) to determine how often then refer for therapy (my guess is that this will be lower than it should be), and determining ways of improving that rate.

All of my solutions focus on generating more volume, but don't necessarily increase the payments for our services, as managed care is squeezing the costs these days. I don't have much of an idea about how to address that problem, which is a large one to tackle. Is there a way we can get more money out of managed care for our services? Is psychiatry doing something here that we are not?

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[MBellows]

-Educating counselors, and other Master's level clinicians on reasons for psychological testing, and some of the benefits of psychological testing that can help them help their clients. Perhaps we can work with CACREP (the accreditation system that sets the curriculum for counseling programs) to help train counselors how and when to refer for psych testing. The same can apply for psychiatrists as well.

As someone who identifies primarily as a counselor, I'd like to add that I would like to see more of this as well. I've worked for neuropsychologists for a few years, and I'm always for getting a more solid evaluation. I think that all of the professional advocacy boards need to push for one-stops so that we can have an integrated group of service providers (MA/MSW/PHD/MD) that can meet the dynamic needs of each client without having to refer them to different places, sometimes in completely different cities and so that we can all learn what we can from eachother in case reviews.

-Establishing psychologists role in psychotherapy. One avenue here is supervision of master's level providers. We have training in research and supervision and can help train Master's level counselors to meet their hours for obtaining their license. Also, polling referral sources (psychiatrists, physicians) to determine how often then refer for therapy (my guess is that this will be lower than it should be), and determining ways of improving that rate.

This. You're going to see a lot of resistance from probably both counselors and social workers against this. This is because psychologists tend to approach therapy differently and because those two groups have a strong sense of professional identity. Personally, I think that's ridiculous, if I'm practicing and 2/3's of my clients are SCI's, then wouldn't I be committing a rather heinous ethical violation not to be getting supervision from someone in that specialty? And what if that specialty happens to be a psychologist/iatrist? As things are currently set up, the system is stupid.

Anywho, I really wish you guys (and perhaps myself in the future) a lot of luck with these issues. To paraphrase AA from the other APAPO thread, psychologists are uniquely trained. The importance of their role in mental health should be undeniable and they should always have a place in service provision. I don't think that any of the multidisciplinary teams that seem to be the goal of the new healthcare system will be complete without at least one psychologist.

 

[Pragma]

This. You're going to see a lot of resistance from probably both counselors and social workers against this. This is because psychologists tend to approach therapy differently and because those two groups have a strong sense of professional identity.

I actually have taught in a CACREP program before as an adjunct and found it quite interesting. Faculty seemed quite focused on theory, not concerned about data, and definitely were not versed in basic assessment principles. I am sure this varies from place to place, so I assume that not all counselors are anti-evidence. But I get the sense that many are mostly (somewhat rigidly) fixated on theoretical issues and are more concerned with just practicing humanism as opposed to using an EBT. Am I off the mark here? Theory and nonspecific therapist variables vs. those things + EBT is how I would describe the differences in training.

Social workers seem quite eclectic in their approach to therapy, but their idenities seem more united to me when compared to counselors. But I only know the people I know so I might be off base in drawing a generalization.

 

[MBellows]

I actually have taught in a CACREP program before as an adjunct and found it quite interesting.

I really don't have much experience with CACREP beyond reviewing their educational standards. I can say that, as a whole, the field of counseling is having a huge internal debate about EBT, and I think you know what side of that struggle I'm on.

Faculty seemed quite focused on theory, not concerned about data, and definitely were not versed in basic assessment principles.

I think most counselors learn some very basic assessment along with a Wechsler scale or two. I don't know if all of us are taught in any great detail. This is an area where I really do think that Psychologists earn their keep in a big way. They are uniquely trained in assessment and evaluating assessment materials and no one who hasn't had that degree of specialized training should be providing assessment services, especially not in cases where there's likely to be some major brain involvement (cognitive problems, psychomotor issues, emotional and personality disturbances post TBI).

Am I off the mark here? Theory and nonspecific therapist variables vs. those things + EBT is how I would describe the differences in training. Social workers seem quite eclectic in their approach to therapy, but their idenities seem more united to me when compared to counselors. But I only know the people I know so I might be off base in drawing a generalization.

There are counselors out there at the Ph.D. level doing outcome research. I've been looking at different paths for continuing my education a few years down the road, and that's generally the area that I'm interested in. Social workers are also starting to see an internal push towards EBT, especially at the research level. Social work researchers also have a strong history in outcome research when it comes to policy decisions.

You're right in saying that counseling is a fractured field and some specializations see themselves as independent entities. Rehabilitation is one of the biggest ones, we even have a separate accrediting body for our programs that has suffered at the heavy hand of CACREP advocacy.

On a more personal level, the programs that I'm looking into are mixed. Some are in rehabilitation, some counseling, and a few psychology programs, it's really about the research match for me and has little to do with professions as a whole. I just know it will feel really sucky in the future if people are so professionally drawn apart that they are biased against evidence based on the profession of the person producing it when there are huge variations in training within each profession. I mean, would a Psy.D. from a non-traditional non-research focused program really be that much better at outcomes measurement than someone from a different profession who has training in quantitative research and has been studying therapeutic outcomes for years?

 

[Pragma]

On a more personal level, the programs that I'm looking into are mixed. Some are in rehabilitation, some counseling, and a few psychology programs, it's really about the research match for me and has little to do with professions as a whole. I just know it will feel really sucky in the future if people are so professionally drawn apart that they are biased against evidence based on the profession of the person producing it when there are huge variations in training within each profession. I mean, would a Psy.D. from a non-traditional non-research focused program really be that much better at outcomes measurement than someone from a different profession who has training in quantitative research and has been studying therapeutic outcomes for years?

No!

Yeah I know it isn't fair to generalize TOO much. I recognize that both counselors and social workers have folks that are heavily involved in doing outcomes research. But I guess that just isn't what I think about when I think of your "average Joe" counselor.

The field fracturing/politics part of the licensing/accreditation is pretty interesting to me. But I can't help but think that more CACREP dominance will be fairly ineffective, much like APA accreditation has been. Not that APA accreditation isn't important - but just look at how many programs exist that are not accredited. If it were that strong of a program credential, then programs without it would not survive.

Last time I checked, FSPS pump out a lot of counselors too!

 

[Pragma]

-Polling our referral sources (psychiatrists, neurologists, etc.) to see how often they use psych testing, and what would be most helpful for them, what sorts of needs do they have that we can better address, etc. It seems that if we made psychological testing more user-friendly and less pedantic, it would be utilized more often.

- There NEEDS to be a better line of communication between APA and APA members, particularly when it comes to advocacy. The APA seems to insulate themselves, and a cost of this is that they push for things that don't necessarily mesh with the desires of the field. I don't see a lot of attempts on their part to take polls, votes, etc. to see what is most important to practitioners, and how we feel APAPO is meeting our needs.

I picked these two out because I think they are both really important.

The successful assessment people already poll their referral sources. You can definitely tell the difference between a psychologist that knows their audience and actually answers the referral question constructively from a psychologist who is overly-obsessed with interpreting the WAIS. Some reports are so obnoxious to read. Part of this is on training programs.

Communication between APA and APA members should be better period. I completely agree that they isolate themselves and take on initiatives that are not going to help the field. Maybe if they seemed to care about asking members for their input about how to allocate resources, I might be inclined to invest more $.

 

[MBellows]

Last time I checked, FSPS pump out a lot of counselors too!

They do! Some of them from their Psy.D. programs because they can't pass the EPPP or get internships! Fortunately, are being pushed to accept CACREP-CORE only model to prevent this.

As for your "Average Joe" counselor, I've noticed a lot of problems that need to be addressed generally in the field, things that you don't see as much of with Ph.D.'s or M.D.s. The ratio of EMDR practiced by counselors as opposed to psychologists, for instance. Or the belief in some mystical energy that can neither be reliably measured or experimentally tested. These are all things that I noticed before going into my master's program, which leads me to suspect that you don't need a Ph.D. to look at something and go, "that's stupid," and then go looking for why that's stupid. Then again, unlike some folk who love Adler or some other great figure in the history of the field, my heroes are Steven Jay Lynn, Scott O. Lilienfeld, and Jeffrey M. Lohr for their suggestions on how to improve the field in Science and Pseudoscience in Clinical Psychology. I just don't think that it should be limited to clinical psychology or psychology in general.

 

[Pragma]

Which states require CACREP or CORE to get licensed? I thought CACRrEP was only in half the states. I am aware of licensure boards that will rubber stamp people with those accreditations to sit for the exam, but it isn't like it is required to get licensed.

 

[MBellows]

Which states require CACREP or CORE to get licensed? I thought CACRrEP was only in half the states. I am aware of licensure boards that will rubber stamp people with those accreditations to sit for the exam, but it isn't like it is required to get licensed.

I fixed that statement. It's not required by most states, but I've heard of a few, South Dakota for instance, that aren't saying CACREP, but your courses have to have the same type of required content areas. It's certainly on CACREP's agenda.

Places that do require CACREP to practice though are interesting. Apparently the feds/VA likes them, but they're still good with CORE folk doing rehabilitation counseling. I'm not sure about what all the list of duties are between the two positions they have, but I wouldn't mind someone letting me know.

 

[Therapist4Chnge]

The successful assessment people already poll their referral sources. You can definitely tell the difference between a psychologist that knows their audience and actually answers the referral question constructively from a psychologist who is overly-obsessed with interpreting the WAIS. Some reports are so obnoxious to read. Part of this is on training programs.

+1.

I get 95% of my referrals from physicians, and they want my "bottom line." I am an expert, they trust me, and they just want an answer. They don't care about %'s, and they really don't care for long-winded reports. They want a short paragraph and my recommendations...which is what I give them. The stuff before it is a paper trail, but it is rarely read. It has taken me awhile to beat out all of the extraneous stuff. It is amazing how many referrals I get bc I actually ask what the referrer wants, how they want it, and where they want it sent.

 

[PHD12]

+1.

I get 95% of my referrals from physicians, and they want my "bottom line." I am an expert, they trust me, and they just want an answer. They don't care about %'s, and they really don't care for long-winded reports. They want a short paragraph and my recommendations...which is what I give them. The stuff before it is a paper trail, but it is rarely read. It has taken me awhile to beat out all of the extraneous stuff. It is amazing how many referrals I get bc I actually ask what the referrer wants, how they want it, and where they want it sent.

Makes sense. Does your salary depend on # of assessments you complete? They need to have a bonus system for people who are more efficient and effective.

 

[Therapist4Chnge]

Makes sense. Does your salary depend on # of assessments you complete? They need to have a bonus system for people who are more efficient and effective.

I get a base faculty salary, and then an additional salary that is dependent on how much revenue I create from my clinic and related contracts (e.g. Worker's Comp, forensic, etc). I prefer this setup because I can scale up/back as needed. Right now I'm working ~30hr/wk and I'll probably bump it up to ~40hr/wk. The more efficiently I can bill for my core responsibilities, the more "extra" time I have to put towards earning more money w/o increasing my total hours by that much more. Working smarter, not harder.

 

[JeyRo]

You can definitely tell the difference between a psychologist that knows their audience and actually answers the referral question constructively from a psychologist who is overly-obsessed with interpreting the WAIS. Some reports are so obnoxious to read. Part of this is on training programs.

I think of that as the developmental progression from a psychologist-in-training doing assessments to an experienced psychologist. I'm guessing most of our reports were more long-winded and obsessional when we were just starting out (at least, mine were).

If an experienced psychologist is unable to do a brief report that succinctly answers a referral question when it's required, that's arrested development, and probably relates back to training issues.

 

[Ollie123]

I think of that as the developmental progression from a psychologist-in-training doing assessments to an experienced psychologist. I'm guessing most of our reports were more long-winded and obsessional when we were just starting out (at least, mine were).

This has certainly been my experience. As I've progressed through grad school, my cases have gotten more and more complicated but my reports/writing have gotten more and more concise. I've often joked that in undergrad success is being able to take one paragraph of information and stretch it into 10 pages while everywhere else it is taking 10 pages and making it 1 paragraph.

There is still a great deal of variability by supervisor - some prefer long reports initially, which I can kind of understand since its their license, they weren't necessarily there, and they want to make sure they have all appropriate information. Most are in favor of whittling it down as time goes on and they get more comfortable with you though, which I think is how it should work.

I'm looking forward to getting more of this on internship. I've increasingly come to like assessment, but given I'm not planning on having clinical work make up a substantive portion of my time I'm not certain its worth it to pursue formal post-docs, etc. and internship may be my last chance to really get into it.