Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
Continuing Education (MCE):
Patrick B. Kavanaugh, Ph.D.
[Note: This essay is continued in the essay "Mandatory Continuing Education (MCE): The Question of Ethics and Ethical Discussions in the Psychological Community")
In early 1994, I was privileged to chair a committee for the Michigan Psychological Association (MPA). At the request of the MPA president, Dr. Judith Kovach, a committee was formed comprised of Drs. Lyle Danuloff, Robert Erard, Marvin Hyman, and Janet Pallas. Our purpose was to develop a position paper for the MPA, given the rapid emergence of three disconcerting trends impacting the profession and practice of psychology: the industrialization of the health care professions, national health care policy premised on a bio-reductionistic way of thinking, and the adoption of the managed care model for the delivery of healthcare services. Psychologists were facing unprecedented challenges to their professionalism, professional autonomy, and professional integrity due to the profound and, all too often, unrecognized impact of these trends of the healthcare reformation. One of the most far reaching challenges posed by these trends was identified by the committee as the gradual transformation of the profession into a craft. This threat to the psychologist’s professional status and autonomy was the organizing focus of the subsequent position paper, “Psychology: A Profession and Practice at Risk” (available at www.academyprojects.org/lempa1.htm).
We made the distinction that a profession, as distinguished from a craft, is a vocation characterized by the exercise of professional discretionary judgment. Indeed, this discretionary judgment was identified as one of the central and defining characteristics of the profession of psychology. And one of its greatest strengths. In return for its devotion to the values to which it subscribes, society grants the profession certain essential and defining rights and privileges including the right of self regulation, autonomy of function in pursuit of professional objectives, the right of discretionary judgment in the performance of professional activities, and the right of privacy in the best interests of those whom the profession serves. In exchange, there are certain expectations and responsibilities attendant to professional life as a psychologist, embodied in the APA code of ethics, which include the psychologist’s involvement in a continuing process of education, consultation when indicated, and the continuous development and refinement of clinical skills. Continuing education is, and always has been, a defining aspect of professional life as a psychologist.
“Psychology: A Profession and Practice at Risk” rested on a basic tenet: the industrialization of the profession and practice of psychology brings with it a corresponding intolerance for the exercise of professional discretionary judgment in its bureaucratized milieu. With industrialization comes the increased centralization of information, authority, and decision-making power in various bureaucracies. And also, an increased uniformity of policies and procedures that define so-called quality in ethics, practice, and education. The committee rather boldly asserted that the regulation of professional activities, formularized treatment plans, and the implementation of the formulary becomes the institutionalized adversary of discretionary judgment; an erosion of the defining characteristics of the profession inevitably follows. Such industrializing trends remove individual discretionary judgment from the psychologist, the clinical situation, and professional activities. An essential question was posed to our colleagues: At what cost do we limit our collective response to simply adapting to policymakers and legislative actions? To do so, we suggested,
Bureaucratization is the institutionalized adversary of individual discretionary judgment; the psychologist’s professional judgment must be preserved and protected.
“Psychology: A Profession and Practice at Risk” was unanimously adopted by the MPA board in July of 1994. Its principles and thinking were to inform MPA’s legislative agenda, guide its legislative efforts, and contextualize its legislative objectives.
Leadership teams, philosophies, and objectives change with the changing composition of an organization’s boards and with the times. It seems to me, however, that the MPA’s proposal for mandatory continuing education for the Michigan practice community represents a radical and dramatic shift in both its understanding of psychology as a profession and its view of the psychologist’s professional responsibilities in matters of continuing education.
MPA’s Pursuit of Mandatory Continuing Education
The MPA defends its pursuit of a mandatory continuing education requirement based on the arguments that MCE shows that Michigan psychologists are upholding “the highest standards of practice,” that such measures are necessary to protect the public from incompetent, outdated, or unscrupulous practitioners, and, that “more education is better” (MSPP News, June 2002, 4). MPA’s rationale for mandatory CE deserves further consideration as it seems to be in opposition to the principle of preserving and protecting the essential and defining characteristics of our profession.
Mandatory continuing education “shows that Michigan psychologists are upholding ‘the highest standards of practice.’” In 1994, the MPA adopted a position based on the recognition of the inherent intolerance of the psychologist’s discretionary judgment in a bureaucratized milieu. And yet in April of 1999, the MPA drafted a position paper supporting the establishment of MCE requirements for Michigan psychologists. And recommended to the Board of Psychology, the legislature, and other such bureaucracies the regulation of the psychologist’s continuing educational activities with her or his license renewal contingent on verification of CE attendance records. Further, the MPA recommended that the kinds of continuing education experiences to fulfill MCE requirements be those that receive APA-approved credits. Is bureaucratic regulation of professional activities not the institutional adversary of individual discretionary judgment? How did the times—and, MPA policy—change so quickly? Has the MPA changed its position about the essential and defining characteristics of the profession of psychology?
And to whom does mandatory continuing education show that Michigan psychologists are upholding the “the highest standards of the profession”? Is the MPA playing to--or rather, playing with—the public’s perceptions of psychology, particularly when there is no empirical evidence to support such a claim? Or, does mandatory continuing education show the insurance industry that Michigan psychologists are upholding “the highest standards of the profession?” And in so doing, does this increase MPA’s negotiating stance with that industry? Mandatory continuing education is one of the industrializing trends that narrowly restricts, if not curtails, the psychologist’s exercise of individual discretionary judgment and contributes to the deprofessionalization of psychology. In a relatively short period of time, the MPA seems to have joined forces with those who would industrialize the profession of psychology by centralizing educational information, authority, and decision making power with the American Psychological Association (APA) and the Michigan Board of Psychology. Such thinking seems to be at odds with the psychologist’s exercising her or his professional judgment in professional activities such as continuing education. Has the MPA changed its position about the ethical responsibilities of the psychologist? or, his or her willingness to meet such responsibilities?
Occupying a central position in the MPA’s rationale is the notion that, “such measures are necessary to protect the public from incompetent, outdated, or unscrupulous practitioners.” If certain psychologists are determined by the licensing board or the MPA ethics committee to be incompetent, outdated, or unscrupulous, each bureaucratic entity already has policies and procedures in place to mandate remedial education. How is it that mandatory continuing education becomes the educational standard for all Michigan psychologists? In speaking of the incompetent or unethical psychologist, the Director of Professional Affairs states that her perception of the likelihood that MCE would have a positive effect on incompetent or unethical psychologists comes, in large part, from her background in substance abuse treatment in which,
And what is it that such results say about human nature? And more to the point, what exactly does this say about the educational philosophy underlying MPA’s mandatory continuing education for Michigan psychologists? Is mandatory continuing education the same as involuntary treatment? Is the outcome of continuing educational experiences in psychology comparable to the outcome of involuntary treatments for substance abuse? ...Is this the MPA’s educational philosophy for the Michigan psychological community? It would seem that the MPA’s educational philosophy is premised on a substance abuse treatment model with the MPA cast in the role of the empathic representative of the caring community intervening with the ignorant and educationally-impaired professional. When did the MPA stop seeing the psychologist as an ethical, conscientious and serious-minded professional? When did the MPA change its position about the professional integrity of the psychologist?
How is it that, “more education is better”? And what is it that more education is better than? Better than less education? Well, that all depends. Continuing education is not the same as mandatory continuing education. More continuing education is better; more mandatory continuing education is worse. It is compulsory, obligatory, and pre-determines what constitutes education. Both the knowledge to be learned and the educational methods, practices, and objectives of the learning process have to be pre-approved. The MPA’s philosophy of education that “more education is better” either minimizes the coercive educational philosophy of mandatory continuing education or fails to recognize its coercive nature. The judgment of the professional as to what is most meaningful to study and what might be the most effective way to learn becomes largely irrelevant; verification of meeting pre-approved requirements becomes most relevant. MPA’s call for a mandatory CE requirement produces a new bureaucratic entity, an educratic matrix that triangulates various governmental and professional bureaucracies, the process of continuing education, and the Michigan psychologist. A bureaucratic solution is proposed for an unspecified problem to achieve ambiguous results. And given the recent climate of budgetary cutbacks, it is probably safe to assume that if mandatory CE is eventually enacted as a requirement, the start-up and operational costs to underwrite the new bureaucracy will be absorbed by each psychologist through increased licensing fees.
The rather coercive educational philosophy underlying the MPA’s mandatory continuing education proposal rests on the assumption that without the benevolence of someone knowing what is best in matters of the psychologist’s education imposing His structure and direction through such standards and regulations, the individual psychologist would not be capable of creating meaningful or relevant educational experiences; would not be interested in continuing her or his education; or, could not be trusted to participate in a meaningful continuing education program. Mandatory continuing education contributes to the further erosion of the essential and defining characteristics of the profession, e.g., professional autonomy, responsibility, and integrity in the exercise of discretionary professional judgment. And in so doing, it actively participates in the de-professionalization of psychology and its transformation into a craft.
Once again, an essential question is posed to each member of our profession: At what cost do we limit our collective response to adapting to the redefinitions of our profession by policymakers, legislative action, and bureaucratic decision-making? The industrialization of the professions is an ongoing process; as a healthcare profession, psychology is continuously at risk. In the forefront of such risks at this time is the threat to professional autonomy and judgment posed by the regulation of our educational activities. To relinquish individual choice, personal responsibility, and the exercise of discretionary professional judgment regarding continuing education is to actively participate in the deprofessionalization of psychology and facilitate the process of its transformation into a craft.
Continuing education includes educating oneself about the pros and cons of mandatory continuing education and the risk-benefit ratio to the profession and practice of psychology. And then taking the responsibility of deciding what to do: to support or oppose it. And also, taking the responsibility for deciding not to decide. It is a collective silence that encourages the MPA and the Board of Psychology to make their far reaching decisions that impact the psychological community. We are not a victim class of professionals. Recently, psychologists in Arkansas took the Arkansas Board of Psychological Examiners to court over a rule proposed by the Board to expand the scope of practice of psychological examiners. Apparently, the license to practice psychology is also a license to take licensing boards to court to hold them accountable for decisions that compromise foundational principles of the profession. And it seems very significant that the legal profession in Michigan, one of the most regulated and scrutinized professions, implemented mandatory continuing legal education (MCLE) in 1989 and then discontinued it in 1994. According to a spokesperson for the State Bar of Michigan, MCLE is an issue whose time has come—and gone—in the Michigan legal community.
Discuss and debate the issues with colleagues; decide what you believe to be in the best interests of the profession and practice of psychology; and, express your opinion. Traditional codes of silence must be broken if the collective Voice of Psychology is to be heard….
(To be continued .)
Note: The full text of the MPA’s 1994 position paper: “Psychology: A Profession and a Practice at Risk” can be read on the Academy website at: www.academyprojects.org/lempa1.htm.
This essay first appeared in the October 2002 issue of the Michigan Society for Psychoanalytic Psychology newsletter, the MSPP News. It is reprinted here by permission of the author. For a copy of the references in this paper, contact the author at 248-626-6460.
Dr. Kavanaugh is a former president of the International Federation for Psychoanalytic Education, former Director of Clinical Training in psychology at the University of Detroit, and is an adjunct faculty member at the Center for Humanistic Studies. He is a former president of the Michigan Psychological Association and the current past president of the Academy for the Study of the Psychoanalytic Arts. He is in the private practice of psychoanalysis in Farmington Hills, Michigan.
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