How to Get to “No”: How Unresolved Tensions in Education Harm Professional Psychology


Corporate management books are a dime a dozen and, in my opinion, rarely worth the ten cents. Most authors of these weighty tomes seem to expend their entire intellectual capital on the title. So clever titles like “Who Moved my Iceberg,” “Our Cheese is Melting,” or “How to get to Maybe, (maybe)” are easily remembered phrases that, if the author is fortunate, are destined to become buzzwords in the aspiring master-of-the-universe set for a little while, until the next catchily phrased title pushes them out of the budding CEO’s consciousness. Never mind that it is highly unlikely that the true master-of-the-universe or high-octane CEO will have ever picked up one of these books. What they contain between the covers (usually in large typeface) is rarely of interest to such individuals, and it’s almost always interchangeable with the contents of rival management guides. Move outside your comfort zone. Seek opportunities where others have not. Pay attention to dissenting voices. Be fair. Good guys can finish first (and it’s almost always guys, by the way—these books are often decidedly, if subtly, gendered). Strong common-sense advice, but hardly the stuff that corporate empires are built on. Most of the easily digestible creampuffs of knowledge these books impart are not revelations for the reader. Rather than serving as true guideposts for future success, I suspect their real benefit is as a kind of narcissistic self-reinforcement for the executive-on-the-make. “Why, I do that all the time,” the ambitious reader might think, “which is why I should get the promotion instead of Bob in accounting.” And make no mistake about it, as much as these books are cloaked in the guise of building a better, more responsible corporate culture, at heart they are about winning, the quest for the brass ring, and the vanquishing of one’s corporate competition.

Now we in psychology, being a noble and learned if not terribly antique profession, are of course above all of this. Like all members in good standing of the academy, we compete for the supremacy of ideas rather than market share. Our success is determined solely by the contents of our CVs and the rigor of our educational foundations, right? We are, after all, the only clinical profession that requires the completion of a dissertation (or its equivalent) as a demonstration of our competence to treat patients. That has to count for something, right?

Well, maybe not. And this is a reflection of part, but certainly not all, of the problem I will shortly introduce. The tension between the requirements of the academy and requirements of the healthcare profession has never been resolved, and this is a tremendous problem for us, particularly given another path we seem to be set on following. The academic snobbery that accompanies our foundations in arts and sciences curricula has, without question, affected our development as a health service profession.

But there is plenty of snobbery to go around. We fight over who can call themselves a psychologist, and that fight is largely the fault of “by title” licensing laws mandating that only licensed psychologists can call themselves so. That error, we have to admit, comes from the practice side of the discipline, or at least the regulatory community, and puts us at odds with the rest of the profession when we insist that only actively licensed people can call themselves ‘psychologists.’ This, by the way, is an argument that would confuse our colleagues in medicine or nursing, where the degree, not the license, determines whether you are a physician or a nurse, though the license of course determines what kind of physician or nurse you can call yourself.

Don’t yawn. I know that ever since the oldest among us were graduate students these fault-lines have been a source of controversy within the profession. A more recent move, however, has called them into clear focus and requires that both the practice and academic communities move together to solve the fundamental problem of what constitutes appropriate training for a doctoral-level health service psychologist. The move I refer to, of course, is the recent push to accredit master’s programs in psychology.

Our doctoral-level education is required to be broad and general. But unlike graduate education in healthcare professions such as medicine and nursing, for whom the definition of ‘broad and general’ means an extensive foundation in both basic science and clinical practice, our definition of broad and general still stops at the foundations of academic, not professional, psychology—hence the continued insistence on the dissertation (or its equivalent) when students should be spending that time and intellectual energy on acquiring cutting edge clinical skills.

The National Register represents the professional needs of doctorally trained health service psychologists only. This is not to say that master’s level providers don’t have a role in healthcare, they do. But the difference between two years of graduate education and an average of seven for doctoral providers means something. It’s not exclusivist to say that there are fundamental differences between master’s and doctoral education in psychology. Not all of that five-year difference goes to education in academic psychology. Much of it goes to intensive training in intervention and assessment skills. What is incumbent on the profession is to demonstrate how much of that difference translates into measurable clinical skills.

Might I suggest that rather than focusing our energy on accrediting master’s level training programs in psychology that we first do the really hard work and achieve consensus at the doctoral level as to what exactly constitutes effective training for health service psychologists? The matter could not be more urgent than it is today.

Let me be clear. Accreditation of training programs in healthcare is a legitimate and necessary thing, so in principle the accreditation of master’s programs is not problematic. Whether the American Psychological Association’s Commission on Accreditation should be doing so is quite another issue. Should not such accreditation belong to another mental health profession aimed at supporting the needs of master’s level providers? Should we as a profession not be more concerned with more clearly integrating academic and training components of health service psychologists to ensure a clear understanding of training standards for licensed psychologists?

Our evolving educational standards do increasingly focus on clinical applications, as reflected in the development of profession-wide competencies as rubrics for program accreditation. But we must complete this evolution. That means we must complete the integration of academic and clinical training from the first day of graduate school until the degree is granted. Otherwise, we find ourselves exactly in the corner into which a large segment of psychology has painted itself: At the same time we’re contemplating the accreditation of master’s programs we are struggling to answer the question of what defines a doctoral-level health service psychologist. And that, as even the author of a book on corporate management could tell you, is an utterly disastrous place to be.

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