Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
Liberty and License
This Letter to the Editor was written in response to Cynthia McLoughlin's article On Mandatory Continuing Education and was published in the newsletter of the Michigan Society for Psychoanalytic Psychology in October 2000. It is reprinted here by permission of the author.
This letter is written in response to the education I received upon reading Cynthia McLoughlin’s informative and disturbing report on mandatory continuing education. I will not be receiving CE credit for taking the time to read and respond to the article but I rejoice in the knowledge that the MSPP News is not (yet?) edited with APA guidelines for what is appropriate or educational in its determination of what news is fit (or unfit) to print.
Personally and professionally, I am distressed by the notion that the Michigan Board of Psychology agreed unanimously with the notion that a licensed psychologist should be continually educated in a manner ultimately determined by third parties (APA and its sponsor representatives) lest he/she lose the license to practice. It seems to me that this is just the latest example supporting the notion that the very idea of having a "license" is increasingly oxymoronic. That is because, as licensing boards (as well as other institutionalized bureaucracies, national committees and various special interest groups) increasingly work toward defining normative standards of diagnosis and treatment procedures, psychologists paradoxically have less and less "license" to make independent, autonomous, professional discretionary judgments. Whether it pertains to mandatory rules for reporting (which itself prohibit a practitioner from listening to associations as anything other than veridical and "real" accounts of actual behavior) guidelines being drawn up as we speak about what is ethical or unethical for all practitioners and those who consult with them, or guidelines (read instructions) being developed by committees and task forces for implementing appropriate treatment procedures for certain diagnostic categories of individuals (which disallows the possibility of conceptualizing an individual in other than reductionistically medical, biological terms and may very well one day forbid the practice of "talking therapy" for certain individuals with specific constellations of symptoms) our freedom and license to practice as we deem professionally, individually and ethically appropriate is being increasingly limited. In numerous ways psychologists no longer have the license to practice outside of the contextualizing metaphor of medical health care, which reduces the individual to a constellation of symptoms, diseases and deficiencies, be they behavioral, biochemical or environmental.
I happen to be someone who believes in continuing education. Regardless of who the individual I am working with in the clinical setting may be, my goal is to be open to learning…constantly. In addition to this daily work, I have engaged in other forms of continuing education. I have consulted with colleagues and have provided consultation to others. I have enrolled in seminars and classes and have taught them. I have attended conferences and I have presented papers at conferences. I have organized conferences as well. For all of these activities, true continuing education has necessitated the ability to think freely, to choose freely, and to interrogate the status quo. Such an interrogation, to my mind, is an essential aspect of psychoanalysis, always lying at the heart of the process. In contrast, "continuing education" as defined and determined by forces outside of myself, aimed at enforcing the status quo (read policies and principles of the APA) is antithetical to true education and to my version of psychoanalysis. If continuing education comes to pass in Michigan, I have little doubt that, eventually, such guidelines will necessarily in one way or another contextualize all manner of professional activity mentioned above.
Dr. McLoughlin quotes Dr. Linder-Crow, the director of APA’s Office of Continuing Professional Education, as saying, "The focus now needs to be on developing quality programs with more emphasis on practice-oriented skills." But who is to define what these skills are, and what practice they would pertain to? This is not a rhetorical question. If for example, it has been determined by some combination of committees such as the Utilization Review and Accreditation Committee, the National Committee for Quality Assurance, the National College for Professional Psychology, or the APA’s Board of Professional Affairs Task force that individuals diagnosed with anxiety disorders are most effectively (cost efficiently?) treated with cognitive behavioral treatment, then it is that determination which will delineate exactly what "skills" are necessitated. Consequently, that which counts as "education" will no longer be up to the individual to determine for his/her self. To put it more succinctly, in order to maintain a license we will need to be losing our license (to think and practice freely) and continuing education will mean the disallowing of alternative roads to exploration and learning.
Initially I viewed the idea of mandatory continuing education as a contradiction in terms. But perhaps not. With the push toward continuing education, we as a profession are witness to the re-definition of education. Maybe it is indeed the case that psychologists must now be "educated" about APA guidelines and rules and ethics and standards of care. Sadly we are indeed getting a dose of continuing education on what our profession is becoming and how increasing regulation and standardization are the norm.
If Michigan’s licensing rules are brought "into step" with those of other states, and programs offering CE credit are "evaluated by uniform national standards" (June 2000 MSPP News, page 4) this reflects a kind of thinking in which respect for the uniqueness of the individual—be that an individual patient, clinician, student, teacher, seminar, conference etc.—is overlooked in favor of the generalizable and normative.
Among the most chilling of the ideas Dr.
McLoughlin shares with us in her research is the notion that it is argued that
interactions at CE sponsored conferences might serve to keep "otherwise
isolated practitioners in step with the professional mainstream and may serve to
open up blind-spots that would otherwise go unnoticed" (page 4)
(italics mine). The implication to me is that individuals who might choose to
educate themselves differently, to work differently and to think differently
would be presumed to be "blind" to that which is deemed
"appropriate" and "correct." Ominously this signals, in
turn, the warning that organized psychology and its licensing boards are no
longer willing to be "blind" to those of us who do choose to practice
differently. Fortunately for us, over the summer the Engler administration chose
to veto the Michigan Board of Psychology’s recommendation. Relieved we can be,
for now, but we should not be blind ourselves to the significance of this
initiative on the part of our Michigan board, which joins the chorus of voices
all over the country threatening, ironically, to transform our professional
license from something originally aimed at granting us professional freedom into
the very thing that might prevent its practice.
|ARTICLE: On Mandatory Continuing Education|
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