Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
Continuing Education (MCE):
in the Psychological Community
[Note: This essay is continued from the essay "Mandatory Continuing Education (MCE) - Industrializing and De-professionalizing Psychology", which appeared in the October 2002 MSPP News.]
Ethics as a Participant-Observer
During the past quarter of a century, the meaning and concept of the psychologist has gradually evolved from that of a detached scientist-observer to that of a proactive participant-observer. In Colorado, for example, a group of psychologists organized the Colorado Psychologists’ Ad Hoc Committee on Record Keeping to protest a rule proposed by the state licensing board that would require that all people seen by a psychologist must be diagnosed and have their identities, reasons for consultation, and the content of each meeting recorded. The Ad Hoc Committee mailed a letter to all of Colorado’s licensed psychologists asking if they supported the following practices for the purpose of protecting privacy: (1) treating a client without assigning a diagnosis, (2) working with a client who is using a pseudonym, and (3) not recording sensitive material in the record. Twenty-seven percent of Colorado’s psychologists formally endorsed the petition; the withholding of information from the medical record was established as an acceptable standard of practice. According to Miller, “It does not take a majority vote to establish a standard of practice; a substantial minority [in this instance 27 percent] can establish that a practice is within accepted standards” in the psychological community. The licensing board’s proposed rule was successfully opposed by a significant minority of Colorado psychologists who believed that it is within the standard of practice to both omit records for privacy concerns and conduct a diagnostic evaluation only upon request (Miller, 2000). Psychologists are not a victim class of professionals that simply adapt to organizational policies, legislative actions, and administrative rules. Psychologists have become participant-observers in the healthcare-industrial matrix, the political system that shapes and defines the practice and profession of psychology.
Derived from the Latin, participare (to share or participate in), a participant is a person or group that shares in or takes part in as in participating in a conversation. And from the Latin servare (to keep safe or preserve) and the prefix ob (over or against), the psychologist as a participant-observer refers to a person or group that partners with others for the purpose of sharing in or participating in those conversations that impact the practice or profession of which (s)he is a member. This new image and role of the psychologist as a participant-observer is guided by an ethic that could be stated as follows: the psychologist has a moral and ethical obligation to watch over the profession of which (s)he is a member; to pre-serve and safeguard its essential and defining characteristics such as the exercise of individual discretionary judgment in professional activities; and, to oppose and counter those industrializing trends that impact the space in which a psychological discourse takes place (Kavanaugh, 2003, in press). It is this spirit and ethic that provided the impetus for the grass roots petition in Colorado and that underlies a similar effort in Michigan.
During the past year, the question of mandatory continuing education (CE) quite suddenly and unexpectedly came before the Michigan psychological community. The chief proponents of mandatory CE were the Michigan Psychological Association (MPA) and the state licensing board. In April of 1999, the MPA adopted a position paper supporting the establishment of mandatory CE requirements for Michigan psychologists. In March of 2000, the Michigan Board of Psychology adopted a CE proposal that requires mandatory CE requirements for license renewal. Unfortunately however, many members of the psychological community did not become aware of this conversation regarding mandatory CE until it was announced about a year ago in the MPA’s Michigan Psychologist that mandatory CE was a requirement for all Michigan psychologists. This information, it was later learned, was not accurate. A very narrow window of opportunity opened for those psychologists opposing mandatory CE to voice their opinions. The Michigan Ad Hoc Committee was formed. And a petition currently circulates in the psychological community. Sent to all Michigan psychologists, this petition provides the opportunity for individual psychologists to gather their voices with like-minded others to express their opposition to mandatory CE. The petition is in the form of an open letter to the Governor, the Department of Consumer and Industry Services, the Licensing Board and the Michigan Legislature. The response from the psychological community has been overwhelming!!!
Michigan psychologists are joining in the conversation that redefines their continuing education--even if their participation in the conversation was uninvited by the MPA or the licensing board. In a relatively brief period of time, a significant minority of Michigan psychologists has signified its opposition to the imposition of new and mandatory standards for continuing education. Petitions continue to arrive daily along with offers from colleagues volunteering to testify at hearings, meet with legislators, and write letters to their representatives. And, there has been a tremendous outpouring of financial contributions to underwrite the costs associated with this grass roots effort. In signing the petition, Michigan psychologists give voice to their belief that mandatory CE contributes to the further erosion of their professional status, autonomy, and integrity. Indeed, enactment of the mandatory CE requirement would drastically curtail, if not remove, the exercise of discretionary judgment from matters of continuing education. Mandatory CE would resituate the authority and decision-making power in various bureaucratic entities to pre-determine and pre-approve the amount and kind of information to be learned. Bureaucratization continues as the institutionalized adversary of the psychologist’s individual discretionary judgment and to the further industrialization and de-professionalization of psychology. And there is something more. Largely unacknowledged ethical dimensions and questions underlie the proposal and requirements for mandatory CE. These ethical dimensions contextualize many of the reasons listed on the petition for opposing a mandatory CE requirement. Are significant ethical questions not raised, for example, when a voluntary association representing between 11 and 14 percent of Michigan psychologists lobbies for requirements that would govern the other 86 to 89 percent of the profession? From where does the moral authority derive to speak as the Voice of Psychology in Michigan when none of the other 86-89 percent have been consulted in this matter? (petition statement #1)
Ethical Discussions in the Psychological Community
In Philosophy of Education (1998), Nel Noddings speaks of an ethic of care that insists that ethical discussions must take place with those impacted by conversations that effect their lives, professional or otherwise. In many respects, such an ethic of care forms the basis for many of the everyday interactions between healthcare professionals and the clients with whom they meet; informed consent, living wills, and the right to refuse treatment are unquestioningly part of everyday healthcare practice. Clients’ right to share in conversations that impact their healthcare has replaced the healthcare professional deciding what is best for the client. Collaboration in decision-making has replaced the benevolent paternalism of yesteryear in which, all too often, the healthcare professional acted in loco parentis. And given Nodding’s ethic of care, what is the role of a psychological organization in relationship to the larger community of psychologists? What is the moral obligation to invite and include the rest of the psychological community in those conversations that impact them?
An organizational policy that impacts members of the entire psychological community is held to a higher ethical standard than if that policy impacted only the members of the organization. Ethical discussions about mandatory CE ought to have taken place with members of the larger psychological community impacted by the mandatory CE requirement. Continuous discussions of the merits and implications of a mandatory CE policy ought to have taken place over an extended period of time, during which time there ought to have been the opportunity for internal interpretive debates by the MPA members. And also, there ought to have been the opportunity for discussion and debate with critics external to the MPA ideology and tradition. The implications of a mandatory CE policy ought to have been considered and examined by the entire psychological community through argument, comment, and debate; ongoing discussion continuously defines, refines, and revises the policy. The alternative is, in this instance, for an organization representing just 11 to 14 percent of Michigan psychologists to function in loco parentis for the for the other 86 to 89 percent, an ethic of organizational conduct that derives from a much earlier historical and cultural context.
Do four explicit references to MPA’s interest in or support of mandatory CE in the Michigan Psychologist over a twenty year period of time (1979-1999) constitute keeping the approximately 800 current members of the MPA informed? Does informing constitute discussing and debating? Has MPA’s credibility with its own members been re-established? Ultimately, only MPA members can answer these and other such questions. They are largely irrelevant, however, for the approximately 5,200 other members of the psychological community. The more immediate and pressing question before the larger community is: What is the future of mandatory CE? The opportunity was not provided them for either extended internal or external discussion, debate, and discourse. The petition from the Michigan Ad Hoc Committee provides an invitation and opportunity--belated, though it might be--to join in the conversation about mandatory CE.
The ought underlying ethical discussions arises out of a sense of awareness and respect for the world of differences in theoretical conceptualizations in our contemporary psychological community. Many of these conceptualizations rest on different philosophical premises, have different understandings of the human condition, and pursue different therapeutic objectives e.g., dynamic, humanistic, behavioral, gestalt, cognitive control, philosophical, and analytical orientations to name just a few. And there is a world of differences in our educational models, philosophies, theories, objectives, and methods. The conceptual diversity that characterizes contemporary psychology demands and deserves equal respect for the diversity in the methods, models, and philosophies of continuing one’s education. The MPA embraces this diversity in principle, if not in practice, when it acknowledges that:
As suggested by Noddings, the moral obligation to have ethical discussions with others impacted by MCE arises out of an ethic that is itself a principle. This principle translates into organizational decision-making and conduct that would always consider this diversity of theoretical conceptualization and pedagogical practices in the psychological community; include colleagues in those conversations that impact their professional lives; and, advance psychology in ways that establish, maintain, and enhance the essential and defining characteristics of the profession. This ethic of care goes far beyond simply acting out of a sense of duty, obligation, or a utilitarian principle of ethics; it extends to a caring about the profession, colleagues, and the public served. And what is the value of such conceptual and pedagogical diversity for the citizens of Michigan? Perhaps, it has been said best and most succinctly in the following way:
To continue the advances in psychology, there has to be the preservation and safeguarding of the psychologist’s freedom to think, conceptualize, educate, and practice as a professional. And the freedom to choose the methods of continuing education that are most useful to him or her to continue this diversity in principle and practice (petition statement #5). The freedom to exercise discretionary professional judgment in matters of continuing education is removed when, under the MCE proposal, state-required education would be based on standards imposed by the American Psychological Association (APA). Significant questions of ethics, power, and conflicts of interest arise when the ideology of the APA is advanced as the standard to determine what is to constitute continuing education. Many Michigan psychologists work according to theories very different from those represented by the APA, and therefore object to being required to earn credits “approved” by APA sponsors in order to preserve their license to practice (petition statement #6).
communicate respect for colleagues who conceptualize, practice, and
continue their education according to diverse traditions; speak to the
nature of our responsibility to one another as professionals and
colleagues; and, reflect an underlying ethic of caring about the
profession and practice of psychology. The question of ethics and
ethical discussions await the Michigan psychological community. In the
meantime, join with your colleagues in the conversation about mandatory
CE. Let your voice be heard!
This essay first appeared in the February 2003 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 MPA 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.
Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
Contents Legal Ethical Professional Contact Us Bibliography Round Table
Academy Home Academy Programs
ACADEMY FOR THE STUDY OF THE PSYCHOANALYTIC ARTS