|
The Michigan Society for Psychoanalytic Psychology |
| MSPP News |
Volume 10, Number 2 |
|
On Mandatory Continuing Education Cynthia McLoughlin, Ph.D. In March 2000, the Michigan Board of Psychology (commonly known as the licensing board) unanimously passed a proposal for mandatory continuing education. The proposal is now under consideration by the Engler administration. This article was written with the goal of informing readers about the proposal and about arguments for and against the adoption of mandatory continuing education (CE). BACKGROUND The trend toward mandatory continuing education legislation for psychologists began in the post-Vietnam, post-Watergate
environment of the late 1970s. At that time, there was a widespread demand for public scrutiny of and accountability from
many institutions that had once enjoyed a privacy based on deference. The professions were among these institutions. A 1976
article in Business Week (quoted in the 1994 APA "Study of Mandatory Continuing Education") summed up the reasons for
the increased regulation of the professions:
Historically, CE for health care professionals was instituted with the idea that medical knowledge changes so rapidly that it is
necessary to protect the public by requiring practitioners to show proof that they are keeping up in some way with cutting-edge
technology and skills. CE for clinical psychologists was modeled after similar requirements for pharmacists, physicians, nurses, THE MICHIGAN PROPOSAL In April 1999, the Michigan Psychological Association
(MPA) wrote a position paper supporting the establishment of CE
requirements for Michigan psychologists. It says that 43 (83 percent) of the states have already adopted some form of CE
requirement for licensure. Requirements range from 10 to 50 CE credit hours per year with an average of 18.9 hours. Proponents of CE requirements for licensure advance a number of reasons for the necessity and desirability of such
requirements. They argue that CE protects the public from psychologists who do little or nothing to maintain their knowledge
and skills after gaining licensure. Loretta Polish, Ph.D., Chair of the MPA Licensing Committee observes, "The primary
complaint brought against individual psychologists in Michigan is incompetence. Psychologists are people, and like all people, THE IMPACT OF CONTINUING EDUCATION REQUIREMENTS Surprisingly, given the widespread and growing use of mandatory CE for members of the health-care professions, there has
been almost no research on the effectiveness of such programs in accomplishing their stated aims. Dr. Linder-Crow explains,
"It’s a bit of a dilemma. There is no information available on the impact of CE for psychologists" (for example, on the kinds or
number of complaints brought against psychologists in states that have mandatory CE versus those that do not). "The APA
Insurance Trust gives discounts to psychologists who participate in CE, but they don’t have the stats to back it up.... It’s very
hard to measure the effectiveness of CE in psychology. If you did find an improvement, it would be difficult to distinguish how
much was due to content and how much to the experience of interacting with colleagues that is part of CE
programs…What most people end up saying is that it has to be helpful to have CE. It has to be better than not doing it."
ARGUMENTS ADVANCED BY CRITICS Criticisms of CE come from a variety of perspectives. One argument made is that, while CE may be necessary for medical
professionals, it is not applicable to psychology because cutting edge technology and skills are not of the essence of what most
psychologists need to know in order to do their work competently. What, these critics ask, is the body of knowledge that
psychologists as a group need to keep up on? Unlike medicine, clinical work in psychology covers a broad range of
theory and technique, and it would be impossible to "keep up" on all of it. In practice, few
psychologists use more than one or two modalities, and familiarity with new skills or techniques is not a primary goal for many clinicians. Continuing Education requirements are constantly evolving. While Michigan is just moving to require mandatory CE, other
states have had such requirements for decades. One trend has been away from the enormous amount of paperwork involved in
requiring all licensees to produce proof that they are meeting the requirements. To save administrative time and money, many
states have moved toward an enforcement method based on sampling. Like the IRS, these licensing boards enforce compliance
through the threat that anyone could be audited rather than the requirement that each psychologist show proof of compliance. Letters to the MSPP News Editor in Response to This Article The following Letters to the Editor were written in response to Dr. Cynthia McLoughlin's article "On Mandatory Continuing Education": Liberty and License by Linda J. Young Ph.D. "The" Voice of Michigan Psychologists? by Patrick B. Kavanaugh Ph.D. "Appropriate Curriculum" by Terri I. Egan Ph.D. Defining Not Empirical as Not Psychology by Terri I. Egan Ph.D. (This Letter to the Editor written in response to Dr. Cynthia McLoughlin's article "On Mandatory Continuing Education" is reprinted here with permission, from the newsletter of the Michigan Society for Psychoanalytic Psychology, October 2000). 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. "The" Voice of Michigan Psychologists? (This Letter to the Editor written in response to Dr. Cynthia McLoughlin's article "On Mandatory Continuing Education" is reprinted here with permission, f Continuing education is certainly an integral and ongoing aspect of everyday professional life. What bodies of knowledges, however, constitute continuing education for the feminists? The object relationists? The existentialists? The behaviorists? The cognitive therapists? The phenomenologists? And what educational model, philosophy, and methods are most meaningful in each individual’s continuing education? The proposal submitted to the licensing board seemed to be premised on a logical-positivist’s view of knowledge, ethics, and education, a point of view increasingly recognized as but one perspective amongst many. The rather narrow and traditional positivist perspective does not appreciate, much less represent, the many different theoretical assumptions, purposes, and objectives that characterize the more contemporary theories of psychology and psychotherapy emerging in the psychological community of the 21st century. In a recent President’s Column, the current president of the American Psychological Association (APA) speaks to A New View of the CE Landscape, in which he encourages psychologists to break with tradition in planning for new models of CE (American Psychologist, June 2000). As he succinctly states, "CE should provide the forum where new, and even controversial, ideas are shared, debated and challenged as a way of encouraging the natural evolution of the profession." We might welcome the recent decision by the governor’s administration to not implement the Michigan CE proposal. This unexpected decision provides an opportunity for us to rethink our traditional notions of the sources and forms of knowledge. And to rethink our traditional educational assumptions, methods, and objectives, including the largely unquestioned presumption of mandatory CE. If the MPA wishes to speak as the voice of psychology in Michigan, then it might consider sponsoring a series of conferences organized for the purpose of questioning, challenging, and debating such issues by the different psychological organizations in the state. It seems to me that to simply mandate an educational philosophy, model, and body of knowledge that is contrary to the principled beliefs, values, logic, and knowledges of one’s colleagues raises serious questions of institutional(ized) power and ethics in the psychological community. As a former member and president of the MPA, I would hope that any future CE proposals advanced by the MPA would represent the educational interests, philosophy, and models of all Michigan psychologists. Indeed, as suggested by the current president of the APA, the MPA has a unique opportunity to challenge our received assumptions about psychological knowledge and education; question and break with the institutionalized traditions of the past; and in so doing, proactively participate in the changing nature of our profession. "Appropriate Curriculum"(This Letter to the Editor written in response to Dr. Cynthia McLoughlin's article "On Mandatory Continuing Education" is reprinted here with permission, from the newsletter of the Michigan Society for Psychoanalytic Psychology, October 2000). Thank you for your background research and discussion of arguments advanced by proponents and critics of Mandatory Continuing Education (CE) requirements for psychologists. With regard to its impact on psychoanalysts and psychoanalytic psychologists and, I would like to mention an article I recently read in the APA Monitor (Vol. 30, Number 11, December 1999) entitled, "APA No Longer Approves CE Sponsorship for Thought Field Therapy." This article reports that the Continuing Professional Education Committee (CPEC) "defines appropriate curriculum content for CE credit." The CPEC reports to the APA Board of Directors through its Board of Educational Affairs. If instruction in any particular area of clinical practices "does not meet its definition of appropriate continuing education curriculum for psychologists," approval for programs featuring such instruction becomes denied by the CPEC. While I hold no position with regard to Thought Field Therapy, the point is that this article in the APA newsletter illuminates an important implication of the power of regulatory processes to define for us what is, and what is not "appropriate" for psychologists to be presenting and studying. Continuing down this educational path apparently leads to significant influences upon one’s freedom to practice in accord with one’s way of thinking, thus committing us to a re-shaping the very meaning of "professional." As an MSPP member I question what impact mandatory CE could have on our Society’s freedom to develop and present programs of interest to ourselves and to our community. The term "psychology," and by extension "psychologist," has become a specifically, legally, scientifically, and medically defined term, the meanings and usage of which derive from (and are grounded in) an objective, concretized, behaviorally observable, and reductive way of thinking about people, their thoughts and feelings, and about the way they live their lives. As a Society of people interested in psychoanalytic ways of thinking, many of us choose not to work from within this medically modeled psychology framework. Certain APA initiatives are actively promoting the notion that all "psychological" intervention be grounded in empirically validated outcome studies. To the degree that such initiatives shape education, practice, and regulatory policy, how likely is it that the CPEC will consider different, non-medically premised, subjectively derived, contextually based ways of thinking and practicing as that which would "meet its definition of appropriate continuing education curriculum for psychologists"? If it does not, then what happens at that point in time when our license renewal depends on evidence of educational requirements that keep us "up to date" with that which is "other than" the way that we think and work? I disagree with Joanne Linder-Crowe’s suggestion that "the time to argue the issue has come and gone." The recent denial by the Department of Consumer and Industry Services (CIS) of the Michigan Board of Psychology’s request to establish mandatory CE for psychologists in Michigan provides us with time (precious little) to speak. At the 9/10/00 MSPP meeting presentations by members of the State of Michigan Board of Psychology, it became clear that while the CIS has denied the Board of Psychology the power to establish mandatory CE in this state, other groups are already appealing directly to the Director of the CIS "to move it forward" for all Michigan health care professions. What this means is that mandatory status for CE in Michigan is moving forward NOW. Do we really want to open the door to being told that the "APA No Longer Approves CE Sponsorship" for psychoanalytic studies per some construal of "appropriateness?" Once bureaucracy–government or otherwise–mandates the manner in which we continue to educate ourselves how long will it be before what happened to "Thought Field" therapists happens to psychoanalytic psychologists? If CE becomes mandatory for psychologists practicing in Michigan, then will license renewal eventually depend not only upon the accumulation of CE credit hours in, but also practicing in accord with, "appropriate content," as determined by whoever defines that content? Does the contour of the Mandatory Continuing Education landscape contain enough flexibility to be receptive to the freedom to study and practice within multiple theoretical and philosophical perspectives and paradigms? Does it contain room for the "diverse educational backgrounds" and "all significant viewpoints in psychoanalysis" (MSPP 2000 Membership Directory, p. 1) that represent our interdisciplinary society? I think it important that we find out.
Defining Not Empirical as Not Psychology? (This Letter to the Editor was written in response to Dr. Cynthia McLoughlin's article "On Mandatory Continuing Education" is reprinted here with permission, from the newsletter of the Michigan Society for Psychoanalytic Psychology, February 2001).In the October issue of the News, I wrote a letter raising questions about how decisions made by the APA about Continuing Education (CE) credits could impact the work of psychoanalytic psychologists. I expressed concern that a CE requirement for licensure would likely be accompanied by standards for “appropriate content” of CE programs and that such standards might eventually translate into a mandate to practice in accord with some organizational definition of “appropriate content.” Shortly after my letter was published, the National Psychologist (Vol. 9, No. 5) published an article entitled, "Quandary develops about Thought Field Therapy (TFT) after Arizona psychologist is reprimanded." This article reports that, within one year of the APA’s decision to discontinue accepting CE credits for courses or workshops offering TFT, the Arizona licensing board disciplined a psychologist "for using these long-tested therapies." According to this article, the Arizona Board held that if a therapy method: (1) is not accompanied by research evidence that defines it as a "viable approach to psychological healing," and (2) makes claims for treating various problems in living "without empirical basis," that methodology no longer meets accepted APA practice standards, and its practice "cannot be called psychology." Interviewees for this article are cited as being "quite surprised" to hear that a colleague had been sanctioned for practicing a type of therapy the APA no longer recognizes as "appropriate content" for CE credit. Given the reported rationale for this decision, the possibility that psychoanalytic study and practice (or some forms thereof) could also become re-defined by the APA as "not psychology" immediately emerges. At a recent professional meeting a discussion of pros and cons of offering CE credits prompted the response that there is no reason for concern about the APA denying approval for CE credits offered by psychoanalytic organizations. The reason given was that, unlike TFT, psychoanalysis has a strong scientific foundation, and therefore persons practicing psychoanalysis in accord with its scientific standards do not risk similar reprimand. This response assumes that there is only one version of psychoanalysis and that its claims to knowledge are grounded in empirical science. Even the briefest survey of psychoanalytic literature yields a much broader picture in which psychoanalysis is viewed not only as science, but also as a hermeneutic, semiotic, and linguistic discourse, as well as other conceptual frameworks. These well-established ways of viewing psychoanalysis are not necessarily amenable to being tested through the methods of empirical research. Are they therefore subject to being branded as “not psychology”? If CE becomes mandatory in Michigan, what would be the standards according to which “appropriate content” would be determined? Would the licensing board make use of APA standards? And if APA (or other) standards were adopted and enforced how long would it be before the practice of all other methods of psychotherapy become defined as non-standard, subjecting the practitioner to a fate similar to that of our Arizona colleague? This question begets new and related questions, such as:
|