Saturday, May 06, 2006


Saturday, November 19, 2005

Comptency Regulations

Below is my response to six questions about "comptency" requirements from the Michigan Dept. of community Health. More information can be found on the website of MSPP. The six questions appear in the text of this response

In 2002 the American Psychological Association published a revision to the Ethical Principles of Psychologists and Code of Conduct. Principle 2.03 Maintaining Competence states: Psychologists undertake ongoing efforts to develop and maintain their competence. I begin at this point because the current questions concerning competency involve changes to regulations of existing laws. Codes of ethics are aspirational and set higher standards than laws, which are primarily concerned with setting minimum standards for the common good. The principle from the APA code is worded broadly for good reason. Psychology is an incredibly diverse field, encompassing a wide variety of perspectives and theories concerning behavior and the mind. Although this diversity might seem confusing to those not well acquainted with psychology and the history of psychology, it is a source of great strength rather than a weakness. Note that conspicuous by its absence is any definition of competency. There is great wisdom in that omission. Understanding the human mind is so important and so complex that no single approach, model or theoretical orientation can hope to provide an encompassing understanding at any time in the near future. Even many physicists suggest that the only thing more complex than quantum mechanics is the human mind.

My preamble is intended to set the stage for suggesting that regulating competency for psychology, while seemingly noble in its intentions, is a potentially misguided form of state control over an area in which the public’s interest is best served by encouraging as much freedom and diversity as possible while having mechanisms in place for citizens to report potential problems to the state. At present the state has many laws and procedures in place to ensure a basic level of competency for those entering the profession. The profession already understands maintaining competency as an ethical obligation. The interests of the public would be served best by focusing upon those individuals found in violation of existing laws and educating them about their breaches, if possible, or denying them from practicing further. It is the policing of violations that tend to ensure public trust. Forcing conscientious practitioners to undergo further regulation when they have not been found in violation of any laws and are practicing at a high level of integrity might strike the public as a waste of taxpayer resources and too much red tape. It is especially important to note that the basic rationale being offered for the creation of new regulations is the current absence of such regulations. I suggest that too many well meaning, but unwise, professionals and regulators simply seem to believe that it is self-evident that such laws are needed and that they will accomplish their stated purposes. I suggest that we follow an old expression: if it ain’t broke, don’t fix it.

No evidence has been offered that the profession of psychology is in need of regulation apart from the evidence of the absence of such regulation. Once the state enters the regulation of format for continuing education it will become too tempting to assume that the solution to any perceived problem will be further regulation, ultimately of content. That is a function that any state or any government is simply ill suited to perform for psychology. Many of the questions below ask psychologists to define competency, so that one might conclude that the state aims to create a definition. Furthermore, merely having a set of regulations that serves as window dressing does nothing more for public safety but can erode public trust and foster cynicism among professionals.

1) What is the definition of “competency” from a psychologist’s perspective? Competency must be defined quite broadly and eludes any concrete or overly specific definition especially considering it could become a legal term used by the state. At present the field of psychology struggles to define the basics. Competency means possessing the requisite capacities and knowledge base to undertake one’s agreed upon functions with those whom a psychologist works. It means that one is able to perform in a professional manner. It includes understanding one’s abilities and limitations. One is presuming to undertake efforts to maintain one’s fitness to practice. It includes understanding if any factor enters into one’s life or situation that would preclude one from functioning to one’s agreed upon basis. Competency is individual in nature, since every individual psychologist brings unique skills and personality characteristics to every situation in which he/she functions. A skill or body of knowledge that is superfluous to one psychologist’s work might be vital to another’s. To set a uniform definition for all psychologists is meaningless, since competency can only be considered in terms of the individuals and situations to which one is applying one’s professional expertise.

Different activities require different forms of learning and self-examination. Once competency assumes a definition in law, however, it can take on a life of its own that could be antithetical to creating the conditions for flexible application of learning consistent with the ethical principles cited earlier. Competency in psychology must be understood individually because psychology is so diverse that no single and uniform definition will suit. However, regulations (and regulators) tend to be allergic to such ambiguity, and I fear that the state will attempt, at some point, to literally define competency for psychology despite perils of such a pursuit. One could ask rhetorically, what is the definition of competency for the legislators or governor, aside from securing more votes on Election Day? Since our Constitution occupies a more basic place in our state than does health care, I could even make the argument, without being too facetious, that defining competency for our elected officials and political appointees should take precedence over defining competency anywhere else. In a related vein, it is important to note that Michigan lawyers neither have mandates for competency nor for continuing education.

2) As a psychologist, how do you know if someone is competent in his or her particular field of psychology? I believe that the important word in this question is ”know.” In order to feel confident that I believe the person to be competent (in the highest sense) for a specific purpose, I need to be familiar with his/her work so that I am in a position to assess for myself whether the individual is someone I would want to refer a patient to or from whom I am receiving information. I want to be able to trust their judgment and understand how the person thinks as a psychologist. However, I would assume that a graduate of any basically reputable program who has become licensed would have some minimum level of competence in the most general and banal sense until proven otherwise. I may or may not want to refer a client to some people, but I would not assume in any manner, absent specific evidence, that the person has obtained his/her license in a fraudulent manner. I might not assume them to be qualified enough for any specific purpose I might have in mind regarding a specific client. I apply a higher standard than competence in making referrals. There I am looking for expertise and proficiency to perform the function for which I am referring.

3) Why is there a need for continuing competency in the field of psychology? There is a need for continuing competency because people change and the world changes and no one ever knows enough at any time anyway. Although some might wish to emphasize that new research and techniques spring up, I would suggest that emphasis on this represents a mere truism that does not epitomize the most important reason for continuing competence. Yes, it is important to educate oneself to new developments in the field, but looking upon psychology primarily through the lens of newer is always better misses some of the most central insights that psychology has to offer and ignores previous hard-won knowledge from psychology. To use merely one example, none of us are yet able to escape the effects of aging, and at some point each of us might be called upon to recognize that we must hang it up—at least to some degree or for some activities. We can count ourselves fortunate that we can have much longer careers than athletes, but the clock catches us all at some point. Essentially psychologists must follow Socrates’ maxim: know thyself.

Although Socrates has not published anything lately and never received an NIMH Grant to the best of my knowledge, I believe that some psychologists would be better off reading him than reading the latest inconclusive research report in an arcane area of the field. Nonetheless I respect the autonomy of others to educate themselves in accordance with their professional judgment and ethical standards. I simply ask for the same respect in return. I use this example simply to illustrate that self-knowing is a life-long experience that is crucial for psychologists to undertake. How will the state know that I know enough about myself? Should the governor become my analyst? Becoming a psychologist is a life-long educational journey that will include learning “old” stuff as well as new and even stuff not taught in psychology departments, no matter how high their rankings. Yet psychologists should determine for themselves what areas they need work on. Being a professional entails tremendous responsibility. Society is better off permitting the widest degree of liberty possible in exchange for holding professionals accountable for their actions in the most complex areas of human endeavors. Professionals learn a substantial body of knowledge during and after formal schooling. But they must practice in situations that never replicate the textbook. Any attempts to concretize competency prematurely risk cultivating a group of psychologists who come to think more and more like over-educated technicians rather than as professionals who must undertake an extraordinary amount of interpretation and exercise discretion in performing their duties.

4) Should continuing competency be mandatory for fully licensed and limited license psychologists? In other words, should the state mandate a mechanism and set of procedures for requiring psychologists to report their efforts toward maintaining competency to the state? In a word, no. Threatening to punish people that are intrinsically motivated to undertake self-education runs counter to everything we have come to understand about the importance of autonomy to maintaining intrinsic motivation for difficult activities. Expecting that this will serve as a corrective kick in the pants to the proverbial lazy psychologist is wishful thinking at best. Instead those few psychologists that devalue themselves and psychology will only have the means to make it appear as if they are doing something. It is only the truly foolish that don’t show documentary evidence that this will nab, although the lack of documentation does not automatically mean incompetence to practice in a chosen area. In other words, I contend currently available psychological research suggests that this kind of coercion of professionals is not sound. Making unsound ideas the law of the land hardly seems like the most stable route to securing the Public Trust. Making counterproductive measures the law of the land, however, seems like a recipe for public cynicism. For psychologists to ask to be regulated in this way, to actively disregard psychological research and to eschew their positions as self directed and thinking professionals should only be the stuff of ironic novels.

The question is also problematic to answer without knowing any of the proposed mechanisms by which the state ascertains that the psychologist is keeping competent and without knowing the definition of competency that the state settles on. Is the state going to define competency the way some industries do, namely in terms of excellence? If the government is willing to leave the definition of competency open to the interpretation of each and every psychologist, then why have reporting requirements at all? What do such reporting requirements mean? There is no evidence driving the current impetus toward competency requirements. The case is being made via rhetoric, not evidence. However, when the government makes its case based upon rhetoric without using any evidence, then what will be the standard needed to change the regulations? It will likely be a rhetorical standard and thus too much beholden to political pressures not directly related to this activity. Psychologists have had licensure for over thirty years, why is this being introduced now? How is the rhetorical argument somehow stronger today than it was thirty years ago?

5) What key areas should be covered in continuing competency? My prior responses probably indicate to the reader where I am heading. I understand the reasoning behind the question, and it seems like a perfectly reasonable question to ask of Respiratory Therapy (another profession that is part of the pilot project). However, as it pertains to psychology, I contend that the question is awry. There aren’t “key” areas because the field is too diverse for that. It is important that all psychologists are familiar with the Ethical Principles cited earlier, but they are supposed to be when they receive a license in the first place. However, the fact that this question has entered consideration at all suggests that the state could be even more eager than advertised to actually consider mandating content for the profession of psychology. As a state and as a society, how much regulatory power do we wish the state to have over the content of a “mental health” profession? What shall the state define as psychopathology, as proper therapy, as the only permissible therapy for any diagnosis and so forth? Is that the place we want to go after struggling for over 40 years of a Cold War against a system that knew all too well how state control of psychiatry and psychology serves other functions besides understanding people? Yes, I recognize I am making a slippery slope argument and that we are not near the nightmares of the Soviet bloc. I just prefer that we keep it that way. Of course, once upon a time those who worried that the Social Security Number would be transformed into a national identity number were considered foolish or worse.

6) What’s the best approach to do continuing competency? I suggest that the state provide a copy of the Ethical Principles and Code of Conduct of the American Psychological Association to every psychologist that takes the licensing exam. Underline Principle 2.03 if you must. If something further is needed have each psychologist that becomes licensed pledge to maintain continuing competency. Follow the proper procedures when a psychologist is reported to the Board of Psychology. Undertake remediation for any psychologist found in breach of the laws and rules pertaining to psychology. Communicate to the citizens of Michigan that there are clear procedures to follow if any wishes to file a complaint against a psychologist. Analyze the data concerning reports to licensing board to discern if there are any trends of concern.

Link

Monday, October 31, 2005

Organized Psychology says, "Bend Over!"

I have been following a debate, with some amusement, among psychologists in my state. The American Psychological Association is pushing prescription privileges for psychologists, and there are many of my colleagues who are hot and heavy to get them. I have a lengthy reply to the position paper of the state psychological organization that can be viewed by following this link: Feedback on Prescription Privileges

How much freedom does a psychologist have to dissent from APA? This issue came up when one psychologist suggested that there is no fence in APA. That is, APA has democratically decided to be in favor of prescription privileges. Thus, any organ of APA cannot take a position against this publicly. For example, Section 3 of Division 12 (Clinical Psychology) took a survey of members. The majority were opposed to prescription privileges for psychologists. APA forbade them from putting this on their website. APA is within its legal rights to do so, although this is where membership in a professional organization may start to feel like a straight jacket. There was a great deal of debate about this on the listserv.

But the "debate" has moved to an interesting place. The argument morphed into the idea that any individual psychologist who exercised his/her civil liberties to lobby the legislature (as an individual or member of a different organization) would harm all psychologists! My, my. Because APA would have put so much money and time and sweat into schmoozing legislators, anyone who dissents from the party line (even if you are not a member of the party) is a traitor.

This is what much of organized psychology appears to be heading toward, a loyalty test. It is interesting that "organized psychology" could be so threatened by individual testimony at odds with them. After cultivating those cherished relationships with lawmakers, many in large organizations appeared worried they could be undone by mavericks. If the legislative initiatives of organized psychology are so anemic that they can be snuffed out like a used up cigarette, then they've got bigger problems on their hands than keeping order in the ranks.