I recently had the opportunity to observe the patterns of declaring specializations in psychology, which occur in developing countries, and the political dynamics of inclusion of professionals from other countries. In countries where psychology has developed, the minimal training as a clinical psychologist required a doctorate, two years of supervised experience, passing national examinations, and vetting by the local regulatory board. Some psychologists declared specializations during this process, which required additional training and supervision, while others would complete their professional training after the doctorate was completed. Traditionally, individuals who wished to practice psychotherapy were required to complete a minimum of two years of additional training, supervised practice, personal therapy, and other requirements.
These traditions have been minimized over the years within some developed countries, but the minimal requirements for psychologists in developing countries have reduced to omission of doctoral training, and minimal clinical supervision (many times by a psychologist who is not a seasoned practitioner or adequately trained). As for personal therapy being required as part of the preparation to be a psychotherapist, this has been almost fully eliminated.
What are the dangers of reducing the standards? The psychotherapeutic technique of role-play can be learned in a weekend, but knowing and practising the technique of “deroling” is rarely used. For example, the patient and another group member act out the conflict the patient is experiencing with his lover. After the roleplay is completed, the patient and the individual playing the lover have developed a closer connection artificially. To reduce the risk of these two individuals proceeding to develop an intimacy based on this temporary role within a therapy session, the therapist would “derole” the person playing the lover by: (1) helping them symbolically shedding the role of lover, and (2) making sure that both the patient and the individual assisting are clear as to the real relationship. The therapist would then monitor to make sure that the patient has not maintained transference issues with the person playing the lover, and vice-a-verse-a.
As a health psychologist, helping a patient to stop smoking is common. A seasoned practitioner would also know that this affects the internal biochemistry and the patient’s reaction to some medications. For example, Olanzapine levels are altered by the patient’s smoking. Communication with the prescribing psychiatrist and primary care physician is essential to avoid problems. In addition, the health psychologist may be in the best position to monitor for adverse reactions brought about by smoking cessation.
As a professional, minimizing the importance of adequate training and post-degree clinical supervision is concerning. In some parts of the world, practitioners at the masters level are touting themselves as health psychologists or psychotherapists without the adequate preparation. As a medical and health psychologist, I understand the value of completing medical classes (i.e., anatomy and physiology, biochemistry, clinical neurosciences, pathophysiology, psychopharmacology, psychoneuroendocrinology, pathophysiology and others) as essential for fully understanding the scope of the field and the patient’s needs. When you add to this the limited number of seasoned professionals, who have clinical experience to provide supervision, this poses two significant dangers. The first is that the patients do not get adequate, professional care. The second is that it introduces a significantly lesser image of health and/or medical psychology to the public. Also, there is a difference between health psychology and medical psychology, as far as further specialization which requires additional training and experience. Besides the dangers this poses to the patients, it demeans the profession and undermines the perception of properly trained professionals.
Although there is a desire to provide for the increasing need for psychological services, reducing the requirements to allow for more providers is harmful. It would be much better to help clarify the gradation of training, and clinically supervised experience by guarding the titles, and providing grades of psychologist: psychological intern, psychologist associate (masters level psychologist), clinical psychologist, and the various specializations.
Even within the specialization of health psychologist, some areas of specialty require even further training and vetting. For example, in the area of treating eating disorders the psychologist must establish competence. Without this standard, results could result in the death of a patient.
Due to the limited number of psychologists in some countries, it is sometimes very difficult to find seasoned specialists. This means that specialists from outside of the country would have to be enticed to work in these lesser developed countries. This is, unfortunately, threatening to practitioners who have established themselves in a country where standards have not been established from the beginning. As international relocation has increased for work, or for other reasons, it is essential that incumbent local practitioners find ways of including specialists in clinical supervision, specialty training programs, and ways of sharing their knowledge and years of experience.
As psychologists, regardless of level of training, we need to find ways of supporting the standards of preparation, while at the same time finding ways of mentoring developing professionals, in achieving the highest level of expertise required.
Rory Fleming Richardson, Ph.D., ABMP, TEP
Dr. Richardson is a Board-Certified Medical Psychologist who is registered as a Clinical, Counselling and Health Psychologist Practitioner in the UK, licensed in Oregon (USA), vetted eating disorders specialist, and experienced Neuropsychologist who has worked with children, adolescents and adults. He has been in the field since 1975 when he obtained his certification as a Trainer/Educator/Practitioner by the American Board of Examiners in Psychodrama, Sociometry and Group Psychotherapy (ABEPSGP). He has served as an onsite examiner for the ABEPSGP, served as the Chairperson of the Oregon Board for Counselors and Therapists, and on the Education Committee of the International Association of Eating Disorders Professionals.