ARTICLES ON PROFESSIONAL  ISSUES

  EST, MCE, MCC: The Abbreviating of Psychology  Linda J. Young

"As I see it, the abbreviations in the title of this opinion piece are working to define and delimit the status quo in such a way that options and freedoms currently enjoyed and taken for granted are being significantly curtailed. Some of these forces are subtle, others less so. I fear that once in place within our political and professional landscape, they will have a half-life that far exceeds what can be easily envisioned now, and that our professional lives as clinicians will be foreshortened and abbreviated in all kinds of ways."

Codes of Silence and Whispers of Discontent: A Perspective on Mandatory Continuing Education    Patrick B. Kavanaugh 

"Different philosophical assumptions lead to very different answers to the question, What constitutes continuing education?  And also, to very different political objectives. For example, our more contemporary psychologies speak from a new and different science that understands life as lived in a non-linear, uncertain, and unpredictable matrix. As it represents the legislative interests of all Michigan psychologists on issues of practice and regulation, will the MPA be advancing an ongoing program of education to the public, the courts, the legislature, and the Board of Psychology that for hermeneutic-humanist-existential psychologists, and perhaps for some others as well, human behavior cannot be predicted or controlled? "

Continuing Education  Ed Zuckerman 

"We, I believe, must, as scientists (at least as consumers of empirical evidence), acknowledge the meaning of the present lack of evidence about the benefits of CE. We must acknowledge, if we are to have integrity, that we give, take, and require CE units on faith alone. It may, in fact, be even worse. We may do it despite the evidence."

Death Knell for Clinical Psychologists as Psychotherapists   Karen Shore

“It is…important to any new authoritarian power to control the education of the young, so that new generations learn only what the regime wants them to learn, and no one has any memory of any other way to think. The managed care industry applies the same principles—not through banishment, incarceration and murder, of course, but through forcing the opposition out of work, intimidating a majority into submission, and taking over the education of the new generation of mental health clinicians.” 

Don't Let Them Take Your Mind and Spirit: On Being Called a Provider   Karen Shore

“The use of the word ‘provider’ leads others to see all those who give care as ‘interchangeable parts.’ It becomes easier to think that any ‘provider’ can deliver any ‘product’ or perform any ‘service.’ One will be less apt in the future to ask for a social worker, a psychologist, a psychiatrist. One will ask for a ‘provider’ and will be assigned a ‘provider,’ with the covert implication that each ‘provider’ is equivalent to and interchangeable with every other ‘provider.'"

Exchange of Letters on Mandatory Continuing Education  and the MPA   Patrick B. Kavanaugh, &  Marvin Hyman; Daniel H. Swerdlow-Freed; Bert Karon

The first letter, and the reply received from Michigan Psychological Association (MPA) which follows it, were submitted to the editor of the newsletter of the the Michigan Society for Psychoanalytic Psychology by Drs. Hyman and Kavanaugh, both former presidents of the MPA, to be published for the purpose of informing MSPP readers. Drs. Hyman and Kavanaugh are currently preparing a position paper to encourage debate on the pedagogical issues involved in making continuing education (which, they argue is, in the best sense of the term, universally accepted as an essential element of professional life) mandatory. The response from Dr. Karon first appeared on the Michigan Psychological Association’s e-mail discussion list (“listserv”). 

Fighting to Eliminate the External Management of Care: What Does Character Have To Do With it?   Karen Shore

"Managed Care not only deprives people of needed care and sometimes kills them.  It restricts the freedom and agency of patients and clinicians, intrudes into patient’s privacy, and prevents clinicians from protecting their patients’ privacy.  It also has tried hard and sometimes succeeded in squeezing clinicians empty, trying to force out their humanistic, empathic sensibilities, to remove their basic philosophies and beliefs from their clinical souls and replace them with a belief in their own simplistic, superficial, rote, mechanical forms of treatment."

Ideas Concerning Mandatory Continuing Education for Psychoanalytic Psychology - The Good, the Bad, and the Ugly   Barry Dauphin

The expressed concern is about the Public Trust.  Yet when it is pointed out that those who are presumed to be laggards might very well do crossword puzzles through workshops (which parenthetically might be of greater educational value than some approved workshops), the response is usually something like--well we know we might not be actually protecting the public but that is not as relevant.  Some people might learn something and by mandating this education, the public will know that psychologists are required to do this and are concerned about it.  To which one might respond: so you want the Public Trust by creating laws that don’t solve the problem you have yet to show is a problem; that any of the public who actually bothers to think about the issue likely comes to the conclusion that psychologists can’t be trusted to educate themselves and must instead be required to verify their presence at a location where there are corroborating witnesses and sign an affidavit.  You have the right to remain silent.

Implications of National Standards for Psychoanalytic Education   Etta G. Saxe

"... [A] motion was made and passed to support the Consortium’s developing a letter to be sent to State Legislatures about standards for the licensing of psychoanalysts.  The standards being developed by the Consortium would serve as the recommended standards for such licensing--in effect,  opening the door  for rules requiring attendance at an accredited institute as criteria for licensure."

Literature on Psychoanalytic Work with "Psychotic" Persons

"One of the ways in which the scope of our field seems to be narrowing is in the kinds of persons for whom psychoanalysis or psychotherapy (as opposed to psychotropic drugs) is deemed “appropriate.” Reading the mainstream literature, one might be left with the impression that there is little interest, these days, in psychoanalytic work with more disturbed persons. Here is a list of books and articles (some recent, some classic) on the topic that shows such interest is alive and well in some quarters."

Mandatory Continuing Education     Sandra Kerka

"The issue of mandatory continuing education (MCE) for professionals is controversial because at its heart are questions about the nature of professions and of adult education. Being a professional implies commitment to continuing one's education and the ability to pursue practice-enhancing learning. So there would seem to be no need for mandates. However, due to advances in knowledge and technology, as well as public demands for accountability and consumer protection, the number of states requiring continuing education for many professions has significantly increased in the last 10 years."

Mandatory Continuing Education: Does it Really Protect Society from Incompetent Professionals?    Patricia McPartland

"There is no question that, if the public is to receive the best quality of care, health care professionals need to continue to learn. However, as Houle states, 'participation in organized activities is only one mode of continuing learning and not necessarily the most effective or appropriate under all circumstances.'...The ideal situation would be, as Darkenwald and Merriam suggest, mandating 'competent performance through periodic evaluations and to deny relicensing to those who fail to demonstrate continued proficiency.'...Periodic evaluations may be more effective than mandatory continuing education programs, but health care professionals are apt to resist them vigorously. Mandating continuing education is a feasible alternative, being relatively easy to administer and acceptable to most professionals. Yet, shortcomings have gone unnoticed."

Michigan Mandatory CE Efforts Confront Roadblock   From the National Psychologist

The prospect that Michigan continues as a state without required continuing education would mollify Patrick Kavanaugh, Ph.D., and Marvin Hyman, Ph.D., both former presidents of the Michigan Psychological Assn. (MPA) and widely-known psychoanalysts. They were so upset by what they thought was the surreptitious tactic of MPA in lobbying for the legislation that they fired off  letters of protest  to trade newspapers and pertinent individuals in the field. Two of their principal contentions were that MPA represents only 16% of Michigan psychologists—not all of them practitioners—and that the association lobbied for the legislation without the knowledge or support of its own members. 

MSPP President's Column on MCE    Etta G. Saxe

"Since it is my view that psychoanalysis teaches us the value of associative, non-linear thinking, then psychoanalysis, like many other subjects, is best studied with minimal restrictions...That is why MSPP writes its brochures the way it does - - as an invitation to come and listen to the speaker’s thoughts/ideas if these seem interesting to you... Do I think that such learning will afford as good a “protection of the public” as other formats (the reason given for MCE)? You bet I do, as professionally responsible self-direction is built right into the education and that protects the public. Such self-directed, self-responsible experiences are likely to encourage seeking further collegial consultation, in a timely way, at one’s own initiative when questions arise in one’s work. In my view, such consultation offers one of the finest protections of the public!"

The Narrowing Scope of Psychoanalysis    Patrick B. Kavanaugh

“Psychology and psychoanalysis have developed in the United States as empirically based health care professions concerned with repairing and normalizing pathological structures, states of mind, behaviors, and ways of thinking…. The scope of psychoanalysis increasingly narrows as the analytic practitioner and educator are subsumed by the changing rules and regulations of the health care professions.” 

The Neurosciences, Prescription Privileges, and A Little Bit of Sugar Still Don’t Make The Medicine Go Down    Patrick B. Kavanaugh

"Research in the neurosciences during the ‘80’s and ‘90’s produced the current generation of anti-psychotic drugs, the more-improved atypicals such as Clozaril, Risperdal, and Geodon ...  There is a growing body of literature in the scientific community, however, that unequivocally asserts that the research underlying the atypicals is scientifically and medically unacceptable; that the nature of the triangulated dialogue between our psychological institutions, the neurosciences, and the pharmaceuticals has been economically—and ethically—corrupted; and, that the role of the atypicals in the treatment of severe mental illness is a form of medical fraud.  ... Why have outcomes for Americans with schizophrenia actually worsened over the past twenty-five years, the dialogue of psychology with the neurosciences notwithstanding?  ... "

A New Initiative for Psychoanalysis   Marvin Hyman

“How long can we continue to perceive ourselves and act as if we are a sub-specialty, neglected and maligned, of psychology, psychiatry, social work, or nursing? Is this our only hope of survival? Perhaps we can begin to consider the heretical notion that there are other professions than the four just listed upon which we can model our profession: e.g., law, accountancy, architecture, art, even perhaps, religion. None of these, for the most part, rely on third party payers for its definition and legitimacy.” 

On the Consortium's Proposed National Standards for Psychoanalytic Education   Cynthia McLoughlin

“Yet another set of opponents of the proposal argue that psychoanalysis ‘ought to learn from history rather than repeating it’ … They argue that national standards do more harm than good because they ignore important and valuable differences in educational philosophy and theoretical orientation, making educational programs more uniform, but not necessarily any better.”

On Mandatory Continuing Education   Cynthia McLoughlin

“The vast majority of psychologists who are required to do so earn their CE credits by attending ‘approved’ conferences. Critics ask whether it is wise to place any group in charge of deciding what constitutes acceptable continuing education for their colleagues. They argue that this trend has the potential to stifle diversity and lead to a deadening of debate that may be harmful to the long-term interests of the field of psychology.” 

On Psychoanalytic Education, National Standards, and Mandatory Continuing Education   Patrick B. Kavanaugh

(Essay arguing the need for diversity in and individualization of psychoanalytic education)

“Questions of ethics, power and economics arise when state licensing boards and ethics committees refuse to acknowledge systems of ethics and ways of conceptualizing human being outside of the health-care ideology and matrix. Psychoanalysis is one of the most significant voices in our technocratic culture to maintain the importance of the complexity and uniqueness of individuality. It seems to me that its institutional forms and pedagogical philosophies must reflect and encourage this respect for the idiothetic nature of the education and training experiences of those who aspire to knowing, translating and speaking the uniqueness and complexity of its discourse.” 

Open Letter to Colleagues on Mandatory Continuing Education    Etta G. Saxe

"As a profession and as individual professionals we have the right, and in my opinion the obligation, to participate in [the process of making decisions about administrative rules governing MCE for psychologists] and not simply stand by and allow a few people to speak for us and likely then design a program that is based either on simple ease of management, what everybody else is doing, or the limited interests of a sub-group of professional psychologists in Michigan. I believe our responsibilities to the public also require that we participate in designing the most suitable and educationally meritorious program which enhances our sense of individual responsibility for our work as well as our knowledge and skill."

Policing Professionals  Marvin Hyman

"In times past, society viewed professions as social organizations defined by possession of a body of knowledge and skill, obtained through education, training, and experience, and by the intention to use that knowledge for the societal good rather than for personal gain. In return for the contribution the profession made to the society it was accorded certain privileges, among them the right to define its own standards of ethics and morality, the right to establish standards of education, training, and experience, and the right to govern and regulate the members of the profession."

Professional Issues of the Cultural Paradigm Shift: A New AHP Energy Center   Chip Baggett

"Unfortunately, openness to such diversity is not generally welcomed in the professional field of applied psychology, specifically as related to psychotherapy and related mental health services, which are still dominated by the medical model rooted in old paradigmatic thought. The political and financial institutions that control licensure, standards of ethics, and third-party payments, are rooted in the old paradigm and continue to hold exclusive rights to define and regulate professional practice. This limits practitioners and clients to certain constraints that many find unhelpful, if not counterproductive, to the healing process. At a time when, in clinical practice, much emphasis is being placed on managed care and symptom relief, many healing professionals are being forced to comply with mainstream thought and practices, even though their own experience and wisdom impel them to address broader and deeper issues [and practices] of consciousness and healing. A serious rethinking of clinical theory, skills, and ethics is called for."

Proposal for an Archive for the Preservation of Psychotherapy    Bernard McDowell

"In some cases, using the principle of  “respectable minority”, the courts have upheld the treatment methods of just a handful of practitioners.  In a much longer article cited below, I outlined the context for the value of a democratically maintained archive to protect appropriate therapy from corporate power.  Now, I propose a very modest beginning ... I would like to invite a dialogue of psychotherapists towards taking our collective responsibility to legally define therapy via petitions or an Archive--rather than leave it to corporate boardrooms. I suggest that with widespread cooperation, it would be extremely difficult for courts to outright dismiss a large group of professionals’ signed statements in favor of certain practices, especially if collated and registered in an on-line archive.  Imagine if 35 states had signed petitions like the one in Colorado ."  

Protecting Privacy With the Absence of Records    Ivan J. Miller

"Is it within the standard of practice to protect privacy by treating a client without assigning a diagnosis? - By working with a client who is using a pseudonym? - Or by not recording sensitive material in the record?  In Colorado, 519 Psychologists have established that a substantial number of psychologists believe that it is within the standard of practice to both omit records for privacy concerns and only conducting a diagnostic evaluation upon request."

Psychology: A Profession and Practice at Risk   Michigan Psychological Association (Position Paper)

“At what cost do we limit our collective response to that of adaptation to the redefinitions of our profession and practice by policymakers and legislative actions?... To limit our collective efforts to a reflexive adaptation to policy and legislative redefinitions of the profession of psychology is to participate in the gradual dilution of professional functioning and responsibility, the erosion of a psychological way of understanding and working with people, and in the eventual demise of the profession of psychology.”  

Recommended Principles and Practices for the Provision of Humanistic Psychosocial Services: Alternative to Mandated Treatment Guidelines    Task Force for the Development of Practice Recommendations For the Provision of Humanistic Psychosocial Services

"Most versions of  'empirically supported treatments' (EST) guidelines are based on traditional natural science criteria, modified to appeal to business and governmental agencies which think in medical model terms. The criteria rank the randomized controlled clinical trial (RCT) at the top of a purported validity hierarchy of methods for evaluating psychotherapy. In addition, to be considered by supporters of the EST movement as an 'empirically supported treatment' a given therapy must have been validated in studies in which the therapy is manualized, and where the therapy is studied as a treatment for a particular problem or disorder. . . . Such criteria are biased towards certain types of therapies, and lists of empirically supported treatments have tended to exclude therapies which emphasize personal discovery and relationship, including many psychodynamic, feminist, constructivist, narrative, and family systems approaches, as well as humanistic therapies."

Reinventing the Growth Psychology Agenda: Towards a Therapeutic Counter- Culture  Maureen O'Hara

“Psychotherapists have little to lose and a tremendous amount to gain if they reject outright the industrialization of the field, speak out about its unethical and dehumanizing practices, and lay out their own alternative growth-focused agenda outside the health care system altogether.” 

Scenarios for Psychoanalytic Practice   Marvin Hyman

“I believe that it is a distinct possibility that psychoanalysts will not only be prohibited from practicing within any system of health care that may be developed; they also will be prohibited from practicing outside of any system because of guidelines, standards, rules, regulations, and malpractice considerations that are being developed. Indeed, many of these are already in place.” 

Straight Time and Adult Brand Education   John Ohliger

"The current panoply of degrees, credentials, and continuing education units based on required courses saves the time of the administrators of the economic system while stealing the time of everyone else. For instance, employers don't need to make informed judgments in hiring or promotion. They can rely more on requiring certain pieces of paper from educational institutions or from in-house programs instead of depending on interaction with potential employees or supervisors."

Summary of Continuing Education Program   Excerpted from the APA Division of Psychoanalysis ( 39) Continuing Education Handbook

"One continuing education credit is given for each hour of learning time. Breaks and meals must not be figured in as learning time. The following language must be used in its entirety: "CE credits ___ (enter number to be granted) Division 39 is approved by the American Psychological Association to offer continuing education credits for psychologists. Division 39 maintains responsibility for the program"....All participants must sign in at the beginning of the activity, attend the whole activity, and submit a participant satisfaction questionnaire and a learning assessment at the close.  For courses and longer activities, participants must attend a minimum of 80% of the activity to receive credit. Participants who complete these requirements should be given a certificate of attendance that documents the continuing education credits awarded, the name of the activity and instructor, and the date(s) of the activity. The local chapter continuing education coordinator should sign the certificate of attendance."

Thoughts on the Psychoanalytic Consortium: Are We the Ghosts of Christmas Past?   Etta G. Saxe

(Letter to the Editor of the Psychologist-Psychoanalyst, newsletter of the Division of Psychoanalysis of the American Psychological Association)

“If the consortium continues in the direction in which it is going the acceptance of the standards for Institute's will once again narrow the scope of who is a psychoanalyst to those who find it most desirable acquire their education in an Institute setting. While Dr. Wallerstein assured me that this would serve to keep ‘anyone’” from calling themselves psychoanalysts, I think we need to remember that it was not long ago that the Dr. Wallersteins of the world considered many of our group to be such “anyone's.’” 

Un-Branding "Standard Brand Adult Education"  for Continuing Professional Education   Gloria E. Cruice

(Letter to the Editor of the MSPP  News, newsletter of the Michigan Society for Psychoanalytic Psychology, in reply to John Ohliger's article entitled  "Straight Time and Adult Brand Education")

"Ohliger also implies an insidious ideological trend that I believe is even more threatening to the intellectual climate in our culture than the unrelenting adherence to the positivistic, temporally linear versions of education and learning characterized by modernistic thought. I am referring to the erosion of individual responsibility in educational pursuits, particularly post-degree learning, that follows from institutionalized, “standard brand” education and educational requirements mandated by the state. Such versions of education seriously undermine freedom, so highly valued in our society, because upholding freedom requires individual vigilance, awareness, and responsibility. Education narrowly defined as conforming to standards and institutionalizing knowledge not only discourages free thinking and creativity, it also stifles responsible decision-making and, I submit, is antithetical to learning."

Update on Mandatory Continuing Education   Cynthia McLoughlin

"The Public Health Code currently allows the Board of Psychology (the Licensing Board) to impose MCE requirements only if it has the support of the Department of Consumer and Industry Services (CIS) (the state administrative body that, among many other things, includes the Board of Psychology). CIS officials are appointed by the Governor. Tom Martin, the director of the Office of Legislative and Policy Affairs for the CIS says that there will be no new MCE requirements under this administration. He noted that Governor Engler has opposed MCE on principle—not only for psychologists, but for all other professions as well. “We don’t believe mandatory CE, the way it’s used in this state and in other states, is particularly helpful in assuring competence or protecting the public, so we’re not going to do it. "

Wake Up Call for Humanistic Warriors  Maureen O'Hara

“Whether we like it or not, if humanistic practice is to survive, we must once more engage in the paradigm wars that forged our discipline and revisit questions of our world views, methodologies, ethics, and ultimate aims.” 

Who Controls Quality Control?  Corporate Expropriation and Professional Abandonment of the Healing Arts   Bernard McDowell

"[HMOs begin]… to define orthodox medicine by sheer domination of most of the medical decisions for vast numbers of people.  Certainly, therapists and doctors, not on their panel, may continue to hang their shingles, but will more often be practicing unorthodox medicine by default.  These questions aren’t hypothetical.  As already demonstrated, some insurers do promote certain types of therapy, have contractually prevented doctors from discussing alternatives with clients, do maintain a lion’s share of the market in some areas, and do maintain close associations with other HMO’s through groups like the NCQA to standardize their agenda.  Whole approaches to psychotherapy and medicine are imperiled."