For our resident psychologists

[tooblue]

is merely an experiment. We are all, at this moment being delivered to some advisor somewhere in the form of a thesis paper, or as an article to a journal, or ... who knows what!

[MikeWaters]

Ironically, it may destroy psychology by decreasing its attractiveness. If you want to treat the mentally ill with meds, why not just go to med school, instead of 4 years PhD, another year of fellowship, additional psychopharm training....only to end up as the guy on the bottom rung in terms of respect, experience, and ability.

It may end up that psychology becomes nothing more than a psych version of PA. Which would effectively end psychology as a distinct clinical enterprise.

It would be a shame for psychology to pursue pill-pushing, and thereby end its focus on therapy. I guess it will be up to Licensed counselors and social workers to continue those efforts?

[danimal]

Originally Posted by OhioBlue

Thankfully, I disagree with Danimal on one point--this won't make non-prescribing psychologists irrelevant, simply because there are so many psychologists who either agree strongly with me, or who have no interest in going through the hassle to get that privilege. I don't think the numbers of psychologists pursuing this privilege will actually be all that high, at least not for a long time.

I hope you're right, OhioBlue. I worry though that it's a decision that psychologists won't be making. Managed care will make it. Psychologists who don't prescribe will end up getting reimbursed at a lower level -- it won't be cose effective enough for them. 9 out of 10 psychologists can disagree with it, they'll just end up poorer for it. It will no longer be worth getting a phd when you can get paid the same to be a social worker.

People like you, who work at counseling centers (at least I think you do) at Universities, may be better off because you don't deal with managed care. But for those who deal with managed care, I think the writing is on the wall.

[OhioBlue]

sorry, didn't read the above posts before replying with mine. I see the issue of training has already been discussed, with the post-doc hours and such.

On the notion of professions losing turf, it's been interesting for me. I started in a terminal masters program at Ohio State and, with my cohort, got licensed at the LPC level. I had no intention of stopping there with my MA, but everyone else did. When I asked for letters for PhD Counseling Psych programs, I got a few weird responses about "jumping ship" and "well all you'll get in those additional 4 years is a bunch of training in how to do research." What was funny is how all these same masters-level therapists pooh-poohed the social workers. I saw a few people who I am confident to this day are better therapists than many PhD psychologists out there, but as a general rule in 2 years of training all we really had time to do was have a bunch of technique thrown at us and learn how to avoid making big mistakes and screwing people up. There was virtually zero theory or philosophy, which is in my view the major problem with masters level therapists, not to mention only about a year or so of supervised clinical practice compared to 5+.

Fast forward to my program at BYU, where for all intents and purposes the Counseling and Clinical psychology programs existed on different planets. I'm going to unfairly generalize here, but basically the clinical folks were all about DSM, medical model, hand out CBT worksheets and call it done. I met a few who were dissatisfied with this approach and were seeking something more. I always found it interesting that in my program we had classes that would have served these people very well--and my department also could probably have benefited from more interaction with the Clinical folks, especially for those who were planning on working in hospital settings or with higher levels of pathology.

The turf wars and boundary tensions among the helping professions have always amused (at best) or really bugged (at worst) me throughout my training and experience. We're all totally insulated from each other, trying to protect our little piece of turf, looking down on all the others--yet we're all on the same team. The lay person would be hard-pressed to tell the difference in practice between a clinical and counseling psychologist. A lot of my clients don't even really know the difference between a social worker, a psychiatrist, and a psychologist. Throw in MFTs and LPCs, and you get a big mess. I don't understand why we can't acknowledge that we're working together for the same basic reasons, we each may have our niches, but the turf issues and competitiveness only serve to further cordon us all off from each other. There, that's my completely uninteresting soapbox rant about the helping professions for the day.

Next up? PhD level psychologists who are complete nutjobs and embarrassing to those of us who actually possess a bit of gray matter between the ears.

[OhioBlue]

Originally Posted by MikeWaters

Ironically, it may destroy psychology by decreasing its attractiveness. If you want to treat the mentally ill with meds, why not just go to med school, instead of 4 years PhD, another year of fellowship, additional psychopharm training....only to end up as the guy on the bottom rung in terms of respect, experience, and ability.

It may end up that psychology becomes nothing more than a psych version of PA. Which would effectively end psychology as a distinct clinical enterprise.

It would be a shame for psychology to pursue pill-pushing, and thereby end its focus on therapy. I guess it will be up to Licensed counselors and social workers to continue those efforts?

ding ding ding. Exactly.

[OhioBlue]

Originally Posted by danimal

I hope you're right, OhioBlue. I worry though that it's a decision that psychologists won't be making. Managed care will make it. Psychologists who don't prescribe will end up getting reimbursed at a lower level -- it won't be cose effective enough for them. 9 out of 10 psychologists can disagree with it, they'll just end up poorer for it. It will no longer be worth getting a phd when you can get paid the same to be a social worker.

People like you, who work at counseling centers (at least I think you do) at Universities, may be better off because you don't deal with managed care. But for those who deal with managed care, I think the writing is on the wall.

Could happen. Don't forget to factor in cultural factors though--such as a pendulum shift away from medicalizing everything--that ultimately control a lot of all of our disciplines. There's some evidence here and there that this is already beginning to happen. Also, count me among those who is holding out hope that the current managed care system is collapsing under its own weight and can't possibly continue to function the way it does, at least in regards to mental health services. Maybe I'm idealistic.

[MikeWaters]

We generally do work well together. I have always been on good terms with the psychologists I have been around.

A lot of patients distinguish psychiatrists as "oh yeah, you're the ones who prescribe medication." So you can understand how psychiatrists would be upset to see their turf diluted.

In our program we learned both psychodynamic and CBT approaches. Of all the MDs I know that do therapy, I can't think of one that does only CBT. In my experience, I thought CBT worked very well for the couple of patients I used it with. If someone is in therapy, and doesn't understand CBT, and has never practiced it, I think that is like going into battle asking "what is this big round piece of metal I'm supposed to hold in the hand opposite my sword?" Sounds like you have been around a lot more dogmatism than what I have experienced.

My personal bias is that I like treatments that have a focus and goal. Maybe that's why I liked addiction work. CBT seems to do a better job of taking the therapy into the patients life.

[danimal]

Originally Posted by MikeWaters

Ironically, it may destroy psychology by decreasing its attractiveness. If you want to treat the mentally ill with meds, why not just go to med school, instead of 4 years PhD, another year of fellowship, additional psychopharm training....only to end up as the guy on the bottom rung in terms of respect, experience, and ability.

It may end up that psychology becomes nothing more than a psych version of PA. Which would effectively end psychology as a distinct clinical enterprise.

It would be a shame for psychology to pursue pill-pushing, and thereby end its focus on therapy. I guess it will be up to Licensed counselors and social workers to continue those efforts?

I agree. Give it 30 years and what you said will be reality. Psychological testing may be the only area that distinguishes them much, although that may go to the social workers too.

[MikeWaters]

Many of the psychiatrists I know in private practice don't deal with insurance or managed care at all. Cash-only. If you want to bill your insurance, you do it on your own.

To take insurance, you have to pay someone to take care of that process, and that's at least 30k out of your pocket right there.

Managed care only works in the 15min med check model, which as I have said before, has a place. But not everyone wants to do that (both patients and MDs).

[danimal]

Originally Posted by OhioBlue

Could happen. Don't forget to factor in cultural factors though--such as a pendulum shift away from medicalizing everything--that ultimately control a lot of all of our disciplines. There's some evidence here and there that this is already beginning to happen. Also, count me among those who is holding out hope that the current managed care system is collapsing under its own weight and can't possibly continue to function the way it does, at least in regards to mental health services. Maybe I'm idealistic.

You're probably more optomistic than me. I think that counseling psych is definitely revolting to the medical model than clinical psych is. APAs huge push for prescription privileges will be hard to overcome. They have money and money talks. But I hope you're right.