Questioning House Bill H203: 2007

House Bill H203

HOUSE . . . . . . . No. 203

By Ms. Balser of Newton, petition of Ruth B. Balser and others to protect psychotherapy patients. Consumer Protection and Professional Licensure.

In the Year Two Thousand and Seven.

AN ACT TO PROTECT PSYCHOTHERAPY PATIENTS.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

The Commonwealth of Massachusetts
Ruth B. Balser
Susan C. Fargo
John W. Scibak
Ellen Story
Douglas W. Petersen
PETITION OF:
William N. Brownsberger
Mary E. Grant
Barbara A. L’Italien
Steven A. Tolman
James R. Miceli

SECTION 1. Chapter 112 of the General Laws, as appearing in the 2004 Official Edition, is hereby amended in section 65A by inserting after the first sentence the following new paragraph:— The division of professional licensure may, after a consent agreement between the parties or after an opportunity for an adjudicatory hearing held pursuant to chapter 30A, assess and collect a civil administrative penalty not to exceed $1,000 for the first violation and a civil administrative penalty not to exceed $2,500 for a second or subsequent violation, upon a person who, without holding the required license or fulfilling supervised experience for licensure under the qualified supervision of a licensee, holds himself out to the public as a psychotherapist or represents that the service he is offering is psychotherapy in violation of section sixty-five F.
SECTION 2. Said chapter 112 is hereby amended by adding the following new section:— 65F. No person shall hold himself out to the public as a psychotherapist or represent that the service he is offering is psychotherapy, unless

(a) he is currently licensed as a physician, psychologist, social worker, psychiatric nurse mental health clinical specialist, marriage and family therapist, or mental health counselor and is practicing within the scope of practice of such license or

(b) he is a student, intern or person fulfilling supervised experience for licensure in the above professions under the qualified supervision of a licensee.

This section shall not apply to an activity, service or use of an official title by a person providing services for a federal, state, county or municipal agency or public or private educational institution or a clinic licensed by the commonwealth, if the person is performing services within the scope of the person’s employment. Any person who violates this section shall for the first offense be punished by a fine of not more than one thousand dollars; and for a second or subsequent offense, by a fine of not more than two thousand five hundred dollars.

2 HOUSE — No. 203 [January 2007]

How This May Affect You:

If this bill passes, these are some of the ways that it may affect you:

1. Your right to choose will be violated. Legislators have a responsibility to the public to help them maintain their right to choose.

2. The wide spectrum of training and techniques employed by many different types of psychotherapists will be limited to only what licensed providers offer, thus excluding many valuable and innovative alternatives.

3. Consumers want access to the care they are most comfortable with. Their present choice between licensed and unlicensed providers will be eliminated. The many consumers who prefer alternative treatments for their mental health issues will no longer have that option.

4. This bill will put many earnest, conscientious, experienced, well trained, and helpful psychotherapists out of business.

5. At a time when our health care system is in crisis and the public's need for mental health services is growing to the point where it can take weeks for someone in serious trouble to get an appointment and some people can't get help at all, the number of available providers will be reduced.

6. The public can be protected from fraudulent providers (both licensed and unlicensed) by means other than this bill. For example, the state of can require a central registry of licensed and unlicensed providers that is available for consumers, which could list provider credentials, areas of expertise and any past disciplinary actions taken. This would allow consumers to make informed decisions when hiring a psychotherapist.

Contact Information / What You Can Do

Here are important contacts as well as information on what you can do to stop this bill.

THE MOST IMPORTANT CONTACTS ARE THE JOINT CHAIRHOLDERS

Meeting both with the state rep and the state senator chairmans listed below is a key. Also they suggest that your send your letters -- cc to all committee members below.They also suggest that we work on a petition. And make phone calls.

For clarity, one committee is comprised of state representatives and the other committee is comprised of state senators.

JOINT COMMITTEE ON CONSUMER PROTECTION & PROFESSIONAL LICENSURE
Room 43
State House
Boston, MA 02133
Telephone: (617) 722-2030

It shall be the duty of the committee on Consumer Protection and Professional Licensure to consider all matters concerning consumer credit, consumer protection, the issuance of licenses for the sale of alcoholic beverages the registration of various trades or professions, and such other matters as may be referred.

State Senators appointed to the committee:
Michael Morrissey of Norfolk and Plymouth - Chair (DEM)
State House
Room 413-D
Boston, MA 02133
Telephone: (617) 722-1494
Fax: (617) 722-1055

Mark C. Montigny of Second Bristol and Plymouth - Vice-Chair (DEM)
State House
Room 511-A
Boston, MA 02133
Tel: (617) 722-1440
FAX: (617) 722-1068

also
District Office
888 Purchase St.
New Bedford, MA 02740
Tel (508) 984-1474
Fax (508) 984-1590

Brian A. Joyce of Norfolk, Bristol and Plymouth (DEM)
State House
Room 413-A
Boston, MA 02133
Telephone: (617) 722-1643

Benjamin B. Downing of Berkshire, Hampshire and Franklin (DEM)
Room 413F
Boston, MA 02133
Tel: (617) 722-1625
Fax: (617) 722-1523

also
District Office
20 Bank Row, Room 202
Pittsfield, MA 02101
Tel (413) 442-4008
Fax (413) 442-4077

Scott P. Brown of Norfolk, Bristol and Middlesex. (REP)
State House
Room 520
Boston, MA 02133
Telephone: (617) 722-1555
Fax: (617) 722-1054

State Representatives appointed to the committee:

Michael J. Rodrigues of Westport - Chair (DEM)
State House
Room 43
Boston, MA 02133
Telephone: (617) 722-2030
Fax: (617) 722-2215

also
District Office
151 State Rd.
Westport, MA 02790
Tel (508) 646-0650
Fax (508) 646-0656

Kay Khan of Newton - Vice-Chair (DEM)
State House
Room 22
Boston, MA 02133
Telephone: (617) 722-2140
Fax: (617) 722-2339

also
District Office
18 St. Mary's Street
Newton, MA 02462
Tel (617) 527-1451
Fax (617) 965-4162

Louis L. Kafka of Stoughton (DEM)
State House
Room 237
Boston, MA 02133
Telephone: (617) 722-2305
Fax: (617) 722-2598

also
95 Erin Rd.
Stoughton, MA 02072

William M. Straus of Mattapoisett (DEM)
State House
Room 34
Boston, MA 02133
Telephone: (617) 722-2320

Charles A. Murphy of Burlington (DEM)
State House
Room 136
Boston, MA 02133
Telephone: (617) 722-2396
Fax: (617) 722-2774

also
19 Sears St.
Burlington, MA 01803

Michael F. Kane of Holyoke (DEM)
State House
Room 473B
Boston, MA 02133
Telephone: (617) 722-2263

also
110 Cherry St.
Holyoke, MA 01040
Tel (413) 540-9842
Fax (413) 540-9843

Joyce A. Spiliotis of Peabody (DEM)
State House
Room 236
Boston, MA 02133
Telephone: (617) 722-2430

also
85 Gardner St.
Peabody, MA 01960
(978) 531-3269

Brian P. Wallace of Boston (DEM)
State House
Room 472
Boston, MA 02133
Telephone: (617) 722-2013

Thomas J. Calter of Kingston (DEM)
State House
Room 237
Boston, MA 02133
Telephone: (617) 722-2425

Donald F. Humason Jr. of Westfield (REP)
State House
Room 542
Boston, MA 02133
Telephone: (617) 722-2803
Fax: (617) 722-2390

also
64 Noble St.
Westfield, MA 01085
(413) 568-1366

Richard J. Ross of Wrentham (REP)
State House
Room 237
Boston, MA 02133
Telephone: (617) 722-2305
Fax: (617) 722-2598

Index of Legislative Representation by City and Town
http://www.mass.gov/legis/citytown.htm

185th General Court of The Commonwealth of Massachusetts
http://www.mass.gov/legis/legis.htm

Guidelines On Writing To Your Representative

Writing your representative
FYI Info on how to address your Letters.

Going to write your State Legislator? Good idea. Make it a good letter.People who think members their State Legislature pay little or no attention to constituent mail, are plain wrong. Concise, well thought out personal letters are one of the most effective ways Americans have of influencing law-makers. But, they get hundreds of letters and emails every day. Whether you choose to use the Postal Service or email, here are some tips that will help your letter have impact:

The most impact, in order of importance, are a face to face meeting, a postal letter and lastly email. If you meet with them face to face have something written to leave with them.

Think Locally
It's usually best to send letters to the Representatives or Senators from your local or closeley surrounding District. Your vote helps elect them -- or not -- and that fact alone carries a lot of weight. It also helps personalize your letter. Sending the same "cookie-cutter" message to every member of the legisalture may grab attention but rarely much consideration.

Keep It Simple
Your letter should address a single topic or issue. Typed, one-page letters are best. Many PACs (Political Action Committees) recommend a three-paragraph letter structured like this:

Say why you are writing and who you are. (If you want a response, you must include your name and address, even when using email.)
Provide more detail. Be factual not emotional. Provide specific rather than general information about how the topic affects you and others. If a certain bill is involved, cite the correct title or number whenever possible.
Close by requesting the action you want taken: a vote for or against a bill, or change in general policy.
The best letters are courteous, to the point, and include specific supporting examples.

To Your Representative:
The Honorable (full name)
(Room #)
Boston, MA 02133

Dear Representative:
When writing to the Chairperson of a Committee or the Speaker of the House, address them as:
Dear Mr. Chairman
Dear Madam Chairwoman
Dear Mr. Speaker
Dear Madam Speaker

The above addresses should be used in email messages, as well as those sent through the Postal Service.

Finding Their Addresses
http://www.mass.gov/legis/citytown.htm
http://www.mass.gov/legis/memmenu.htm

To Conclude
Here are some key things you should always and never do in writing to your elected representatives.
AlwaysBe courteous and respectful without "gushing."

Clearly and simply state the purpose of your letter. If it's about a certain bill, identify it correctly.
Say who you are. Anonymous letters go nowhere. Even in email, include your correct name, address, phone number and email address. If you don't include at least your name and address, you will not get a response.
State any professional credentials or personal experience you may have, especially those pertaining to the subject of your letter.
Keep your letter short -- one page is best.
Use specific examples or evidence to support your position.
State what it is you want done or recommend a course of action.
Thank the member for taking the time to read your letter.
NeverUse vulgarity, profanity, or threats. The first two are just plain rude and the third one can get you a visit from the Secret Service. Simply stated, don't let your passion get in the way of making your point,Don't fail to include your name and address, even in email letters.
Demand a response.

Identifying Legislation
Cite these legislation identifiers when writing to members:
House Bills: "H.R._____"
House Resolutions: "H.RES._____"
House Joint Resolutions: "H.J.RES._____"
Senate Bills: "S._____"
Senate Resolutions: "S.RES._____"
Senate Joint Resolutions: "S.J.RES._____"

Sponsors Of The Bill

Downloadable Petition

Here is a link to a petition which can be printed out.

http://www.equinemusic.net/H203/H203.doc

If you right click & select "Save As" you can save the file to your computer.

Online Petition

Dear Friends,

I have just read and signed the petition: "QUALITY PSYCHOTHERAPY IN MASSACHUSETTS".
Please take a moment to read about this important issue, and join me in signing the petition. It takes just 30 seconds, but can truly make a difference. We are trying to reach 1,000 signatures - please sign here:

http://www.thepetitionsite.com/takeaction/909794144

Thank you!
Rebecca

Examples of Letters

http://www.equinemusic.net/H203/letter1.doc

If you have a letter that you would allow us to post here as an example to help others write their own letters, please email to h203 @ equinemusic.net

Licensing Would Not Guarantee Quality Psychotherapy

Licensing Would Not Guarantee Quality Psychotherapy
By Dan Hogan, JD, PhD
Instructor of Psychology
Harvard Medical School
(The writer’s publication’s include“The Regulation of Psychotherapists.“)

The issue of how best to regulate psychotherapy is particularly vexing and complicated. Judy Foreman’s June 19 article cites with apparent horror the fact that Dr. Peter Gills Cambridge Psychotherapy Institute in Newton includes therapists who are neither licensed nor possess any academic credentials (Psychotherapy in Massachusetts virtually unregulated”).

In commenting on the allegations of harm caused by the institute, she presents the traditional argument of the profession that strict regulation is needed to protect the public from the danger’s of unlicensed practitioners. Such regulation would, among other things, require all therapists to hold advanced academic degrees.

In the name of such quality control, she mention that Blue Shield is limiting the number of reimbursable assistants to three. A good argument can be made, however, thitherto these restrictions actually do more harm than good.

That is the conclusion I have come to after years of intensive research on the subject, begun when I was a Research Fellow to the Department of Psychology and Social Relations at Harvard University. My analysis suggests that most licensing laws are counterproductive, . Briefly put, the argument runs as follows:

First licensing does not do what it is supposed to do. Although meant to ensure that only competent professionals are admitted to practice, little evidence exists that current entrance requirements, especially academic credentials, bear any relationship to performance. While opinions abound, the unfortunate truth is we simply do not know what makes someone a good therapist. What little we do know suggests that intangible qualities like empathy are particularly critical; but theses are nearly impossible to measure. Joseph Darla’s excellent review in “Psychological Bulletin “ examines 42 studies directly comparing relatively untrained and uncredentialed practitioners with highly skilled, doctoral level professionals. In 28 cases, the paraprofessionals performed as well as the pros, and in another 12 they actually outperformed their professional counterparts. In only two instances were the tables reversed.

This was the case over a wide variety of client populations, including a substantial number of psychiatric outpatients and hospitalized in patients. It was also true over a wide variety of out come measures that were not limited to superficial changes.

Evidence on disciplinary endorsement reveals a woefully inadequate system in which licensing boards rarely take action against licensed practitioners who are unethical or incompetent. To give but one example, several years ago, 33 states revoked no medical licenses. Does anyone really believe that physicians are that good? Even the prevention of unlicensed practices is generally spotty, often being aimed at eliminating competition, not incompetence.

Second, even if licensing laws do ensure competent practitioners, the price may not be worth it. The increased cost of services, the shortages, the misdistributions of supply lead to direct harm through the inability of he poor and other disadvantaged groups to afford or find any practitioner at all. Frequently such persons resort to injurious self help.

Quite apart form these most obvious costs, the entry requirements of licensing laws have a tendency to discriminate against the poor, the aged, women, and minorities, as well as inhibiting important innovations in the methods of organizing and delivering professional services.

Third, even if the net benefits of licensing outweigh the costs, equally beneficial but less expensive alternatives may be available. In addition, other factors than licensing may be far more influential in determining the quality of service ultimately received by the public; and it is these factors that should be looked to if sound regulation is desired.

The president of Massachusetts Blue Shield claims that limiting the number of assistants will improve the quality of services delivered. I believe that the only improvement will be in Blue Shield’s ability to control costs. That a practitioner can only do a good job supervising three assistants seems patently absurd. It depends on the nature and amount of the assistants’ work. If Blue Shield were truly interested in quality control, why did it not focus on the number of hours and the nature of supervision provided?

As for restrictive state licensing. It is my opinion, based on current research, that we would be better off with a law requiring all psychotherapists simply to register with the state. In such a system, they would not have to possess any academic degrees, but should be required to disclose their background and other relevant information for all clients. They would also lose their right to practice of found guilty of harmful or unethical activity.

Although I wish it were otherwise, the paucity of our knowledge make it inadvisable to adopt more restrictive regulatory alternatives.

Dare We Do Away With Professionalism?

Dare We Do Away With Professionalism?
By Dr. Carl Rogers

Speech presented to 1972 Assembly of American Psychological Association
Excerpted form his book A Way Of Being published in 1980

The third challenge I wish to raise, especially for clinical and social psychologists, is the radical possibility of sweeping away our procedures for professionalization. I know what heresy that idea is, what terror it strikes in the heart of the person who has struggled to become a “professional” but I have seen the moves toward certification and licensure, the attempts to exclude charlatans, from a vantage point of many years, and it is my considered judgment that they fail in their aims. I helped the APA to form the ABEPP* (as it was then known) in 1947 when I was president of the APA. I was ambivalent about the move then. I wish now that I had taken a stand against it.

I am not in any way impugning the motives, the integrity, and the efforts of those who aim toward certification and all that follows from it. I sympathize deeply. I wish there were a way to separate the qualified from the unqualified, the competent worker from the opportunist, the exploiter, and the charlatan. But let’s look at a few facts.

As soon as we set up criteria for certification-- whether for clinical psychologists, for NTL group trainers, for marriage counselors, for psychiatrists, for psychoanalysts, or as I heard the other day, for psychic healers-- the first and greatest effect is to freeze the profession in a past image. This is an inevitable result. What can you use for examinations? Obviously, the questions and tests that have been used in the past decade or two. Who is wise enough to be an examiner? Obviously, the person who has ten or twenty years of experience and who therefore started his training fifteen to twenty-five years previously. I know how hard such groups try to update their criteria, but they are always several laps behind. So the certification procedure is always rooted in the rather distant past and defines the profession in those terms.

The second drawback I state sorrowfully: there are as many certified charlatans and exploiters of people as there are uncertified. If you had a good friend badly in need of therapeutic help, and gave you the name of a therapist who was a Diplomat in Clinical Psychology, with no other information, would you send your friend to him?: Of course not. You would want to know what he is like as a person and a therapist, recognizing that there are many with diplomas on their wall who are not fit to do therapy, lead a group, or help a marriage. Certification is not equivalent to competence.

The third drawback is the urge toward professionalism builds up a rigid bureaucracy. I am not personally aware of such bureaucracy at the national level, but it certainly occurs frequently at the state level. Bureaucratic rules become a substitute for sound judgment. A person is disqualified because he has 150 hours of supervised therapy, while another is approved because he has the required 200. No attention is given to the effectiveness of either therapist, or the quality of his work, or even the quality of the supervision he received. Another person might be disqualified because his excellent psychological thesis was done in a graduate department that is not labeled ”psychology”. I won’t multiply the examples. The bureaucrat is beginning to dominate the scene in ways that are all to familiar, setting the profession back enormously.

Then there is the other side of the coin. I think of the ‘hot - line’ workers whom I have been privileged to know in recent years. Over the phone, they handle bad drug trips, incipient suicides, tangled love affairs, family discord, all kinds of personal problems. Most of these worker are college students or those just beyond this level, with minimal intensive “on-the -job” training. And I know that in may of these crisis situations they use a skill and judgment that would make a professional green with envy. They are completely “unqualified,” if we use conventional standards. But they are, by and large, both dedicated and competent.

I think also of my experience in groups, where the so-called naïve member often has an inner wisdom in dealing with difficult individuals and situations which far outclasses that of myself or of any other professional facilitator. It is a sobering experience to observe this. Or, when I think of the best leaders I know for dealing with groups of married couples. I think of a man and a woman, neither of whom has even the beginning of satisfactory paper credentials. Very well qualified people exist outside the fence of credentials.

But you may protest, “How are you going to stop the charlatan who exploit persons psychologically, often for great financial gain”? I respect this question, but I would point out that the person whose purpose is to exploit others can do so without calling himself a psychologist. Scientology (from which we might have learned some things, had we been less concerned about credentials ) now goes its merry and profitable way as a religion! It is my considered judgment that tight professional standards do not, do more than a minimal degree, shut out the exploiters and the charlatans. If we concentrated on developing and giving outstanding personal help, individuals would come to us, rather than to con artists.

We must face the fact that in dealing with human beings, a certificate does not give much assurance of real qualification. If we were less arrogant, we might also learn much from the “uncertified” individual, who is sometimes unusually adept in the area of human relationships.

I am quite aware that the position I am taking has disadvantages and involves risks. But so does the path to certification and licensure. And I have slowly come to the conclusion that if we did away with “the expert“, “the certified professional,” “ the licensed psychologist,” we might open our profession to a breeze of fresh air, a surge of creativity, such as it has not known for years.

In every area --medicine, nursing, teaching, brick laying, or carpentry--certification has tended to freeze and narrow the profession, has tied it to the past, has discouraged innovation. If we ask ourselves how the American physician acquired the image of being a dollar-seeking reactionary, a member of the tightest union in the country, opposed to all progress and change, and especially opposed to giving health care where it is most needed, there is little doubt that the American Medical Association has slowly, even though unintentionally, built that image in the public mind. Yet the primary initial purpose of the AMA was to certify and license qualified physicians and to protect the public against the quack. It hurts me to see psychology beginning to follow that same path.

The question I am humbly raising, in the face of what I am sure will be great shock and antagonism, is simply this: Can psychology find a new and better way? Is there some more creative method of bringing together those who need help and those who are truly excellent in offering helping relationships?

I do not have a final answer, but I would point to one suggestive principle, first enunciated for me by my colleague Richard Farson (personal communication, 1966): ‘’The population which has the problem possesses the best resources for dealing with the problem:” this has been shown to be true in many areas. Drug addicts, or former drug addicts, are most successful in dealing with individuals who have drug problems: similarly, ex-alcoholics help alcoholics, ex-convicts help prisoners--all of them probably more effectively than professionals. But if we certify or otherwise give these individuals superior status as helpers, their helpfulness declines. They then become “professionals” with all the exclusiveness and territoriality that mark the professional.

So, though I know it must sound horrendous. I would like to see all the energy we put into certification rules, qualifications, licensure legislation, and written and oral examinations rechanneled into assisting clinical psychologists, social psychologists, and group leaders to become so effective, so devoted to human welfare, that they would be chosen over those who are actually unqualified, whether or not they possess proper credentials.

As a supplement to guide the public, we might set up the equivalent of a Consumer Protective service. If one complaint comes in about ineffective or unethical behavior, it might well be explained away. But if many complaints come in about an individual’s services to the public, then his name should be made available to the public, with the suggestion “Let the buyer beware“.

Meanwhile, let us develop our learning processes in psychology in such new ways that we are of significantly more service to the public than the ”instant gurus,” the developers of new and untried fads, the exploiters who feed on a public obviously hungry to be dependent on someone who claims to have the answer to all human problems. When our own lasting helpfulness is clearly evident, then we will have no need for our elaborate machinery for certifying and licensing.

Psychotherapy law would restrict practice to licensed pros in Mass.

Psychotherapy law would restrict practice to licensed pros in Mass.

By Gintautas Dumcius/State House News ServiceState House News ServiceTue May 29, 2007, 04:20 PM EDT

BOSTON - A bill restricting psychotherapy to licensed professionals brought a turf war to Beacon Hill Tuesday as psychologists and psychoanalysts faced off over the restrictions and the potential shuttering of institutes and schools.

"It's really truth in advertising," said Elena Eisman, executive director of the Massachusetts Psychological Association, who testified in support of the bill.

The bill (H 203) is sponsored by Rep. Ruth Balser (D-Newton), a psychologist herself, and was drafted with the help of mental health organizations.

This morning's hearing for the bill before the Joint Committee on Consumer Protection and Professional Licensure comes just two weeks after the highly publicized trial and sentencing of an ex-stripper who posed as a licensed psychologist. The woman was given a six-month sentence, suspended for five years, for larceny, false health care claims and saying she was a psychologist.

"It's instances like that," Balser said. "In the absence of this legislation, anyone can hang out a shingle and say they do psychotherapy."

"There are many casualties when we allow people to call themselves psychotherapists who aren't licensed," Eisman said.

One such casualty: Dr. Suzan Kamm's husband-to-be. The psychotherapist to her and the husband she was planning to divorce misrepresented his credentials and improperly treated him, she said.

"My husband . . . and I were referred to a psychotherapist who misrepresented himself as being a licensed clinical psychologist and because of his lack of training, a horrific tragedy occurred. My husband committed a homicide," she said, drawing a gasp from the back of the hearing room.
Balser's bill restricts psychotherapy to physicians, psychologists, social workers, psychiatric nurses, marriage and family therapists, or mental health counselors.

Students, interns and individuals getting supervised experience for a license in the aforementioned professions would be permitted to practice, under the bill. The bill fines violators $1,000 for a first offense and $2,500 for a second or subsequent offense through the state Division of Professional Licensure.

Due to a lack of exemption for psychoanalysts, opponents of the bill say it could cause them to shut down their practices and close their institutes. Psychoanalysts are not licensed by the state.
A dozen or so students and administrators from the Boston Graduate School of Psychoanalysis and the C.G. Jung Institute appeared to testify against the bill.

"If this bill passes, it will exclude rigorously trained clinicians from practice and affect all of their patients and supervisees," said Jane Snyder, a psychoanalyst and Boston Graduate School provost. "Furthermore, passage of this bill may lead to the closure of graduate and postgraduate institutions chartered by the state of Massachusetts that train people in this field according to national established standards."

"While we agree that consumers need to be protected from defrocked psychiatrists, strippers and other unqualified persons who parade as psychotherapists, the proposed legislation inexplicably does not include psychoanalysts who are highly trained mental health professionals who also practice psychotherapy," added Pamela Donleavy, a psychoanalyst and president of the New England Society of Jungian Analysts.

Connecticut has an exemption of psychoanalysts, she said, while Vermont has a certification process. While practicing in Maine psychoanalysts have to register. In New York, psychoanalysts are licensed through a board.

Rep. Jay Kaufman (D-Lexington) said he would be submitting an amendment to the bill to include psychoanalysts.

But bill proponents say the change is unnecessary and dismiss the warnings of school and practice closings. "It's not casting any aspersions against psychoanalysts," Eisman said of the bill.
Under the bill, schools can remain open and continue to engage in psychoanalysis, but they can't call themselves psychotherapists, proponents say.

Psychoanalysts say the bill is one aspect of a battle between them and psychotherapists who do not want psychoanalysis to be an independent field.

"If this bill passes, I cannot practice here," said Siamak Movahedi, a UMass-Boston professor and chair of the sociology department, who testified against the bill.

Psychologists say the issue is less a turf battle than one over consumer protection.

Why don't current psychotherapy licensing regulations work?

Why don't current psychotherapy licensing regulations work?
A review and suggestions for change
John M. Grohol, Psy.D.
March 1998;

http://psychcentral.com/archives/licensing.htm

Licensing of professionals who provide psychotherapy services in their community is often hailed as a necessary requirement for ensuring a minimum standard of quality care and accountability that would otherwise be lacking in a professional field such as behavioral healthcare. Consider that licensing requirements for one type of behavioral healthcare professional -- psychologists -- have been around for decades in most states. The rationale is that the licensure requirements protects you, the consumer, from fraudulent professionals and maintains a certain minimum standard in the field. But how well does licensure succeed in meeting these goals?

Getting a license as a psychologist in any given state is a time-consuming, often costly task. It usually involves a minimum set of supervised hours doing therapy, at the expense of the unlicensed psychologist. If the unlicensed psychologist isn't working in some type of agency setting, this means paying another, licensed psychologist for their supervisory time. This already brings up an ethical dilemma of a dual relationship for psychologists, which is often ignored. The unlicensed psychologist is paying the supervisor for services rendered (supervision), while at the same time acting as a mentor/teacher and often times, friend. In an agency setting, the unlicensed psychologist is often an employee overseen by the same supervisor (boss/employee relationship). All of these issues make for a murky ethical situation, one where the supervisory relationship boundaries are often gray.

The second aspect of a psychologist's licensure is taking two examinations. One examination, a national test which is the same for every psychologist in every state each year, tests the unlicensed psychologist's knowledge in every area of psychology. No matter that the unlicensed psychologist already has his or her doctoral degree! Apparently all those years of schooling don't ensure any type of quality... or knowledgebase. Ideally, the assumption is this test will weed out psychologists who didn't learn anything from all of those years of schooling. The reality is that most psychologists who sit for this test purchase test preparation materials. The examination just doesn't test clinical knowledge, but all aspects of psychology. This includes areas such as industrial-organizational psychology, experimental psychology, and a host of other sub-fields not often the focus of a clinical psychologist's training or education. Most psychologists re-learn this material (or learn it for the first time) through the test preparation materials (often costing hundreds of dollars). How really useful is this test, then?

The second test is a local examination on the specific state laws governing mental health care in the state. This is the most vital aspect of licensure, because it does ensure the professional knows and understands all the legal statutes which dictate how that professional can practice psychotherapy in their state.

Since one of the main strengths of psychology is in designing and assessing the usefulness of psychological tests, one would expect the research literature to be brimming with information about the validity and reliability of licensure examinations. After all, a part of psychologists' ethical code is to ensure that psychologists know that a test they use is psychometrically sound (see the APA Ethical Principles, specifically sections 2.02-2.04 http://www.apa.org/ethics/code2002.html). So how do these licensing exams fare? Poorly, with little research which validates their usefulness. Diane Novy, Kenneth Kopel, and Paul Swank in 1996 reported that "published evidence justifying the effectiveness and fairness of oral examinations for licensure as a psychologist is sparse across jurisdictions that exercise the power to implement these examinations." David Johnson and Dan Huff (1987) discovered that for social workers, "the factor that most strongly correlated with performance on the licensing examination was undergraduate grade point average [emphasis added]. Results indicate that few people fail the licensure examination and that education and work experience have little impact on test scores..." Clinical social workers go through a similar licensing process are the most heavily used behavioral healthcare professional amongst the majority of managed care organizations today. What does it say about licensing examinations in general if the most predictive indicator of doing well on it is simply one's undergraduate GPA? Not very reassuring. Most licensing examinations in most states do not directly test a clinician's therapeutic skills in any empirically-validated, systematic, and scientific manner.

Even if the process is so flawed, does it actually do what it purports to do --protect consumers and ensure a minimum quality standard for professionals? W.E. Goodrich, Ph.D., a Colorado psychotherapist, argues that it doesn't in its current form in most states (Goodrich, 1998). Dr. Goodrich states, "Historically, the purpose of licensing (of professions, as opposed to driving cars, etc.) has been 'turf protection.' Especially in the medical and mental health fields. In fact, it goes back to the Charters and Guilds of the 15th century." Goodrich's statements seem to be supported by the research literature in this area. Although David Lambert and Thomas McGuire (1991) found that consumers wanted licensure protection, they also confirmed that psychology licensure is "a product of the self-interest of providers." Kenneth Thomas (1993) argues that "that the primary purpose of professional credentialing is not to protect the weak but to increase the power, authority, and incomes of the strong." Other behavioral healthcare professions fare little better. Steven Segal and Sung-Dong Hwang (1994) in a California study found "that although licensure occurred with greater frequency among facilities serving the most disabled population, licensure neither predicts nor has as its apparent consequence the development of higher-quality [sheltered care] facilities."

Daniel Hogan (1985) makes a strong argument with the drawbacks to current licensing laws as they exist in most states today:

It is suggested that licensing may not only fail to accomplish its intended purpose but may be counter-productive. Licensing may not improve the quality of professional services, licensing boards often fail to discipline unethical or incompetent practitioners, and actions taken against the unlicensed are more often aimed at eliminating competition, not incompetence. In addition, licensing laws may have negative side effects, including an increase in the cost of professional services, the creation of shortages and maldistributions in supply, ineffective use of paraprofessionals, and impediments to needed reforms in education, training, and services. It is concluded that equally effective alternatives may be available that are less expensive and have less negative impact, and a system of registration is advocated for all practitioners.

Goodrich (1998) reports on the effectiveness of licensing laws in Colorado:

A recent multi-year study (commissioned by the State Legislature) found that there was no evidence [emphasis added] that licensing provided any degree of consumer protection overall. In one recent year, the Board issued several times more disciplinary actions (per capita) against each of the licensed groups than against the nonlicensed group. In fact, the Licensed Psychiatrists (who the non-licensed group outnumbered by about 4 to 1) drew more total disciplinary actions -- and more serious disciplinary actions -- than the unlicensed group that year. Not just more per capita, more overall.

Licensing examinations don't appear to be all that useful, based upon the sparse research available, and licensure in its current form doesn't appear to protect anybody other than the professionals who are already licensed from "outsiders". So what can be done to improve this situation? Getting rid of licensing isn't the answer; reforming it is, however.

Goodrich (1998) suggests a sensible, four-step outline based upon his experiences with the Colorado model. These steps include:

Recognition and appropriate regulation of nonlicensed psychotherapists.

Consolidation of the regulatory and disciplinary functions into a single multidisciplinary "grievance board" consisting of representatives of each form of Licensed Psychotherapists (LMFT, LPC, LPsychologist, LCSW, etc.), nonlicensed psychotherapists, and general-public "consumer representatives". An exception might be made for psychiatrists, who would be answerable to the relevant Medical Board for their actions (as physicians).

A consistent set of functional and ethical regulations for all forms of psychotherapists.

A central registry for all types of psychotherapists.

These steps seem very reasonable in light of the fragmentation of the current psychotherapy field, with no less than a half-dozen different professions providing forms of psychotherapeutic services in most states. Why should one profession be held to a higher or lesser standard than another profession, when both are doing the same thing -- psychotherapy? It simply doesn't make sense. It provides a byzantine structure consumers must navigate through to bring a grievance against each different type of mental health professional. A central registry and consolidated regulatory board overseeing all psychotherapy professions appears to directly benefit the consumer -- which is, after all, the original purpose of licensing laws in the first place.
Goodrich (1998) also suggests further changes which again would mainly benefit the consumer, reducing the confusion of trying to understand the differences between behavioral healthcare professions:

Elimination of categorical licensure (except for psychiatrists) for such groups as psychologists, clinical social workers, marriage and family counselors, and the like. Categorical recognition can be handled on a discipline-based Certification process, for purposes of third-party evaluation and interstate/international recognition.

Competency-based licensure for certain specific functions, such as psychometry, forensic psychology, legally-binding diagnosis, etc. without categorical qualifications. For example, "Psychologist" certification (or lack thereof) would have no bearing on Psychometry Licensure...which would be based on demonstrated ability to properly conduct and interpret major categories of psychometric tests.

Optional competency-based Certification for specific categories of therapeutic practice, independent of the discipline-based certification in 1) above. These would include techniques, such as hypnotherapy, NLP, EMDR, etc., and functional areas such as grief resolution, trauma/PTSD, addiction/compulsion, substance abuse, severe dysfunction (such as schizophrenia or schizoaffective disorder), etc.

Goodrich (1998) summarizes his suggested changes this way, "The overall effect would be to provide consumers with a wide variety of choices and reasonable ways to make those choices, and create an effective and relatively 'nondenominational' mechanism for regulation and discipline of psychotherapists (and therefore some degree of protection for consumers and affected others), while limiting the scope and effect of organizational 'turf wars.'" Only time would tell whether Goodrich is right or not as to the likely effect of the implementation of his proposals. But the proposals are more consumer-oriented than current licensure regulations, and less protective of any specific behavioral healthcare profession. This suggests that bad professionals, no matter what their degree, could be held more easily to answer for their unethical or illegal behaviors in psychotherapy than currently possible under most states' arcane systems of licensure.

Goodrich's call for states to adopt more open, inclusive licensing laws such as those currently found in Colorado is unlikely to gain much support in the short-term. National professional organizations don't like the idea of partnering and unification with other professions. In fact, they often are antagonistic toward one another, in the increasingly competitive psychotherapy marketplace. For example, the American Psychiatric Association withdrew in late 1997 from a partnership with the American Psychological Association to publish a new journal entitled Treatment out of fear that the psychological association would use the journal as support for helping psychologists gain prescription privileges (impinging on psychiatrist's domain). If professions can't even agree to publish a scientific journal together, it is unlikely they will join hands to help fix the licensing practices found in most states and help consumers. In fact, the American Psychological Association lobbied for over a decade to get the types of restrictive licensing laws currently in place in most states. They would likely view the elimination of categorical licensing as something to fight against, despite the lack of research evidence which supports their point of view (see, for instance, Garfield & Bergin's [1994] review of the literature which still shows little strong empirical evidence supporting that differences in degree make any significant difference in client outcomes).

Currently licensing of psychotherapy is a delusion most behavioral healthcare professionals quickly and easily learn to buy into at an early point in their therapy careers. It ensures the continuity of the profession and gives an illusion of consumer protection, while offering very little actual protection to consumers in most states. Bringing a complaint against a psychologist is likely to be a completely different process than bringing a complaint against a psychiatric nurse or a clinical social worker, although all three can provide essentially the same psychotherapeutic services. Consumers have to muddle through a maze of different bureaucracies currently, each with their own unique set of arcane rules, regulations, and forms to fill out. Worse yet, each profession has their own set of ethical guidelines, confusing the consumer even more about what is a legitimate professional activity and what is actionable.

Simplifying licensing regulations, providing a registration system for unlicensed psychotherapists, developing one set of cohesive, sensible ethical guidelines, and consolidating all regulatory and disciplinary functions in one board makes a lot of sense for consumers. As a voter, you have the power to call your state representative in your legislature to ask them to look into the current system and make these changes. Licensure should work to protect you, as it was always intended to do. Help make it so.

References
Garfield, S.L. & Bergin, A.E. (1994). Handbook of psychotherapy and behavior change (Fourth edition). John Wiley & Sons: New York. Goodrich, W.E. (February, 1998). Personal communication.
Hogan, Daniel B. (1983). The effectiveness of licensing: History, evidence, and recommendations. Law & Human Behavior, 7, 117-138.
Johnson, David A.; Huff, Dan. (1987). Licensing exams: How valid are they? Social Work, 32, 159-161.
Lambert, David A.; McGuire, Thomas G. (1991). Determinants of stringency of psychologist licensure. Special Issue: Law, psychiatry, and mental health policy. International Journal of Law & Psychiatry, 14, 315-329.
Novy, Diane M.; Kopel, Kenneth F.; Swank, Paul R. (1996). Psychometrics of oral examinations for psychology licensure: The Texas examination as an example. Professional Psychology: Research & Practice, 27, 415-417.
Segal, Steven P.; Hwang, Sung-Dong. (1994). Licensure of sheltered-care facilities: Does it assure quality? Social Work, 39, 124-131.
Thomas, Kenneth R. (1993). Professional credentialing: A doomsday machine without a failsafe. Rehabilitation Counseling Bulletin, 37, 187-193.

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