November 23, 2005

Governor Jennifer Granholm

P.O. Box 30013

Lansing, Michigan 48909

Dear Governor Granholm,

I am writing to you as a constituent, a clinical psychologist, and President of the Academy for the Study of the Psychoanalytic Arts. In case you are unfamiliar with the Academy, we are largely, though not exclusively, an organization of practicing psychologists, who regularly meet with one another, sponsor conferences and operate an extensive website with contributions from professionals from many countries. Our members frequently write articles in local newspapers as well as professional newsletters and journals. Represented within the Academy are practitioners of different orientations and approaches to psychotherapy practice. We are deeply committed to the flourishing of clinical psychology as a profession and to being able to offer current and prospective consumers of our services the highest quality services possible. It is in this spirit that I am writing to you now. On behalf of the Board of our organization, I am asking that you place the name of our organization alongside the approximately 2,000 signatures of psychologists who have already voiced their strong opposition to including the discipline of psychology in the pilot study for “continuing competency” and to contact us as soon as possible to arrange a meeting with members of your staff to discuss our concerns. We are aware that members of your administration and officers in the Department of Community Health have been advised by other psychologists of numerous problems associated with the inclusion of psychology in this project. Most recently, your staff was contacted in September by the Ad Hoc Committee on Mandatory Continuing Education. We are in agreement with that position and would like, now, to elaborate on concerns that apply, particularly, to our members.

We have yet to be shown that a public need exists for this regulation. Our own research reveals that there is no data in existence to demonstrate a positive correlation between the imposition of such measures in psychology (MCE as well as continuing competency requirements) and the reduction of complaints, valid or otherwise, brought against practicing psychologists. Indeed, there is an abundance of evidence indicating that competency is already ensured via the extensive education fully licensed psychologists receive, which includes but is not limited to practicum, internships, supervision, a national licensing exam, mandatory postdoctoral supervision, and years of supervised post-graduate experience. Additionally, there is every reason to believe that disciplinary measures and ethical guidelines maintained, updated and implemented by the Michigan Licensing Board, adequately handle the relatively few complaints brought against members of the profession.

The lack of a demonstrable need to implement a new program quite naturally raises the objection that to do so presents an unnecessary financial and time burden on professionals. The money that will be spent, which includes the money likely to be spent on regulation, record keeping, and possible test administration seems wasteful to us. Quite frankly, it also seems unconscionable, given the fact that such monies could be spent instead on providing direct mental health services to those in need within our state. Consequently, it seems to us that the continuing competency requirements are an unnecessary and wasteful drain on the time and resources of psychologists and, ultimately, the consumer, since the cost of fulfilling such requirements would in time, be passed along in part or in whole, to the consumer. As the public is alerted to this questionable expenditure of money at a time when the citizens of Michigan are very much feeling the pinch of a stressed economy, it is our prediction that this expenditure will be judged as a wasteful bureaucratic exercise, especially as there is no evidence whatsoever that such exercises improve public safety.

Beyond the issues just noted, there are additional considerations that concern us even more greatly than our being required to participate in exercises satisfying no verifiable need or purpose. To put it succinctly, we feel this is a dangerous move for our profession and for those consumers of our services. Let me explain.

Psychology cannot and should not be placed in the same category as other health care professions such as respiratory therapy, veterinary medicine, and physical therapy.

Unlike health care professions in which the body and its biological functions are changed or manipulated and, per force, put the body at some risk of physical impairment and/or death, talk therapy poses no risk of physical harm to its clients. Consequently, the necessity of safeguarding the safety of clients is very different than it is for professionals such as respiratory therapists whose “mistakes” could have a profound impact on the health and safety of the consumer. The other health care professions to be included in the study are quite different from psychology in this respect. For them, it could indeed be argued that the correct application of a proven methodology  is not only something that is possible as a goal, but that it is desirable and necessary, as a means or protecting the safety and well being of its recipients.

In contrast to the other health professions that utilize prescribed, pre-determined protocols to be administered to patients, the practice of psychology, especially within a psychotherapy setting, is very much a creative, constantly evolving, and individually based experience between two people. Consequently, the exchange between therapist and client cannot be standardized or anticipated in advance. Because of the particularity of the therapist/client relationship and the diversity of preferences that consumers express with regard to the goals of psychotherapy and the means by which they choose to attain these goals, there is no agreed upon set of uniform procedures that can be deemed superior to others. Numerous theoretical orientations and therapies derive from quite different theories, all of which have long histories of demonstrated usefulness. For example, while some psychologists apply behavioral regimens to their clients to help rid them of particular problems, others offer more open-ended exploratory talk therapy that seeks to obtain a fuller picture and understanding of the context in which certain problematic behaviors and/or psychological concerns may have developed. Different consumers seek out different forms of treatment, and appreciate having these options at their disposal. And, indeed, consumers sometimes move between these perspectives as they seek to address what concerns them across the span of their lives.

The fact that clinical psychology is multifaceted and theoretically diverse is a longstanding strength in the field and one that is greatly appreciated by the consumer. At the present time, psychology has the luxury of being able to offer valuable and diverse options for individual clients interested in having a wide array of choices available to them. We at the Academy are quite concerned that including our discipline in its competency requirement program would threaten this diversity. Allow me to explain.

In her meeting with the Michigan Society for Psychoanalytic Psychology, Ms. Brim herself noted that the specific form of competency definitions and requirements  would be informed by “standards of care” extant within the profession. As you may or may not be aware, these “standards of care” are very much the subject of strenuous and committed intellectual debate that is vigorously going on at the local as well as the national level. It must be appreciated too, that entrepreneurial forces that interpret and make very selective use of the narrowly drawn “results” of research studies are using them primarily in the service of increasing profits. It is well known within the field, that health insurance companies create pressure, for business reasons as opposed to clinical care reasons, for treatments to be short and standardized, and that industry forces the adoption of these practices as “standards of care.” There is increasing evidence, alarming and deeply discouraging to our members’ sense of purpose and commitment to care, that conclusions deriving from narrow business agendas are already determining  definitions of “standards of practice” within the field, and that definitions of competency will be developed in tandem.

We believe that such restraint of free choice is not the intended purpose of this regulation. However, we also believe that once it becomes the law, such regulations will inevitably contribute to this phenomenon. While it may very well be the  intent of the Department of Community Health and the Bureau of Health Professions in particular, to respect the specific and diverse ways in which competency requirements could be devised, it is unlikely, over time, that  adequate protections for such diversity would realistically be able to be maintained. While we also have every reason to believe that the current members of the Psychology Licensing Board would be respectful of the diversity extant in the field, we must all be mindful of the fact that regulations codified in law, far outlive the particular persons filling these positions.

Finally, we are concerned that for a field such as psychology to be included in a competency requirement program leaves many individuals open to legal risk. For one thing, as I imagine you are aware, the literature on competency demonstrates that for competence to be a useful construct, its definitions and evaluations need to be very specific to each individual context to which they apply. Given the tremendous diversity in the field, it is simply impossible to develop any meaningful measure of competency that would apply to all psychologists. If the pilot study is codified into law before it is thoughtfully researched, and if it is administered in a manner that falls short of the highest methodological rigor, it leaves the administrators of such programs and requirements vulnerable to legal challenges. To date, systematic analysis of various ways of implementing such a system has not been done, and it is unlikely to be done in the near future.

For all of the abovementioned reasons, we urge you to return to your earlier plan to exclude psychology from the pilot study on competency requirements. We suggest that psychology be excluded for the present in order to take advantage of the opportunity to learn from the experiences of the other professions included in the pilot project, professions in which the application of competency requirements is more straightforward and where there is more unified agreement within the professions, about the advisability of participating in such an endeavor. Once regulations are in place, it is highly unlikely that they will be removed easily. As there are already 2,000 psychologists who have expressed their opposition to these new regulations, it would seem to be in the best interest of all involved to address these concerns now, so that the issues involved can be thoughtfully addressed.

I appreciate your taking the time to consider these matters. Members of the Academy Board would like to meet with your staff to discuss this issue. Please contact me at your earliest convenience so that a meeting can be arranged.

Sincerely yours,

Linda J. Young, PhD

President, Academy for the Study of the Psychoanalytic Arts