The landscape of higher education is definitely shifting (e.g., higher tuition costs, increase reliance on adjuncts for teaching). Along with these shifts, we have seen the rise and influence of accrediting bodies in the execution of mental health graduate programs. Indeed, there are a number of professions training graduate students to conduct psychotherapy, such as psychologists, professional counselors, social workers, marriage and family therapists, addiction counselors, school counselors, and psychiatry, to name a few. Accompanying these professions are their accreditation boards/commissions overseeing the standards of each profession. Additionally, there are licensing boards ensuring professionals have met the necessary and sufficient requirements to obtain a license to practice. I believe accreditation can be a positive force in the training of mental health providers. However, there is also a shadow to this process, which, if not attended to and challenged, can create undo divisiveness among professionals who, on many levels, have a common goal.
Regarding the Society for the Advancement of Psychotherapy (SAP), I believe we would be wise to open our hearts and minds to possibly building bridges, forging new initiatives, and honoring the unique perspectives among professions training students in psychotherapy. For those who engage in psychotherapy, conduct research on psychotherapy, and train/supervise those who are providing psychotherapy, we have a common mission—regardless of professional identity (e.g., professional counselor, psychologist, social worker). For instance, there are no clear and consistent findings demonstrating one profession has better psychotherapy outcomes, compared to others (e.g., Anderson, Crowley, Himawan, Holmberg, & Uhlin, 2015; Okiishi et al., 2006). This is not to say there are not differences among the professions; there can be both within- and between-group differences. However, there have not been clear and consistent differences in psychotherapy outcomes, and there are slim differences in the core definitions between professionals. For example, the definitional foundations of what constitutes a professional counselor from a counseling psychologist are notably similar. They both share a focus on vocational work, multiculturalism, social justice, counseling, supervision, and development. I would argue that other professions also share in these identities. Clearly, there are similarities and differences within and between our professions. Yet, if those similarities and differences are honored and respected, that process can be a source of richness, growth, and development.
Why a Training Resolution?
Before describing the training resolution, it would be useful to provide some background for why I decided to get involved in this endeavor. First, I believe professionals should be judged according to their professional acumen, not a degree. For instance, Dr. A. T. Beck was trained as a psychiatrist. It would be hard to imagine that any training program would not hire him to train the next generation of mental health professionals. However, due to the mandates in some accreditation rules/policies, this could not happen. Some of the most foremost scholars and theorists in all of our fields would not be considered for core faculty positions in some programs due to their terminal degree—regardless of what they have accomplished, or whether the programs themselves utilize information from those theorists to train their students.
Second, my hope is to bring down the walls between the professions. If we do not unify among those who provide psychotherapy, then there will be further fractioning, which will leave each profession advocating for its own special interests. Many fields are moving toward a competency-based approach for training (Falender et al., 2004). Yet, competence is not a static state. As psychotherapists, we need to continue demonstrating effectiveness, and failure to do so for any professional should be addressed. Let us stop conflating education level, experience, competence, and effectiveness. If research findings have not provided a clear and consistent relationship between these factors, we need to take a step back to consider what truly constitutes expertise in psychotherapy (Anderson et al., 2015; Goldberg et al., 2016). Consider the following example to illustrate the difficulty in answering this question: Do Socratic questions have a differential impact when delivered by a psychologist versus a social worker? This seems a fool’s errand, but could be a logical examination of psychotherapy, if we wanted to demonstrate differences among our professions. What would we gain by this approach? Simply, when it comes to doing the same task (e.g., psychotherapy), why should different professions be privileged or disadvantaged based on the degree conferred? Especially, when there is no consistent or meaningful evidence demonstrating an advantage of one profession over another in this domain. Are we not supposed to use empirical evidence to guide our decisions? Or is that only when the evidence fits our ideological pursuits? There needs to be a new way to understand therapist expertise, especially across disciplines.
There has been a growing division between American Psychological Association (APA) and American Counseling Association (ACA). To overly simplify matters (due to space), over the decades, APA commonly has asserted the profession of psychology is within the domain of psychologists (assuming doctoral level professionals in psychology; APA, 2016). ACA declared the profession of counseling is within the domain of professional counselors (assuming master’s level professional counselors and doctoral level professional counselors; see CACREP, 2015). Note the difference in the terms of psychology and counseling. I am not sure we will ever fully disentangle these concepts. However, if we try to do so, it will likely draw bigger lines between colleagues and professions in ways that are both unnecessary and divisive.
I have taught in both psychology and counseling programs and there is much overlap. For instance, the foundational theories for the practice of psychotherapy are consistent between programs and the empirical studies supporting practice are from the same literature pool. In my opinion, APA (as an organization) has never truly embraced our master’s level colleagues, even though many of its members spend countless hours training master’s level professional counselors and other master’s level mental health practitioners. In many ways, APA may have cast the first (of many) stones in this situation. At the same time, ACA is not innocent in this regard either. For instance, ACA as an organization supports CACREP (Council for Accreditation of Counseling and Related Educational Programs) accreditation as the only accreditation body to train professional counselors (even though there is another viable accreditation body for professional counselors). To this day, the Society for the Advancement of Psychotherapy (SAP) does not have a specific domain for professional counselors, or any other master’s level practitioner conducting psychotherapy. We, too, have room to grow.
To provide a brief background on the main issues behind this resolution, let me start with the CACREP accreditation policies. CACREP is a driving force in the accreditation of master’s level programs training professional counselors. In ACA’s latest accreditation policies, there is strict language declaring core faculty must have a doctoral degree in Counselor Education and Supervision (CACREP, 2015). Accordingly, this policy would exclude counseling psychologists, clinical psychologists, social workers, psychiatrists, etc., from being hired as a core faculty in a CACREP accredited program. There is also a grand-person clause exempting core faculty who taught in counseling programs prior to 2013 (CACREP, 2015).
The faculty qualifications for core faculty are even more problematic for our international colleagues, who may not have the degree of Counselor Education and Supervision in their respective countries. They, too, would be ineligible for hire into a CACREP accredited program as a core faculty member, sending a clear message to the international community regarding its status in ACA and CACREP. Consistent with my position above regarding my psychiatrist colleague, CACREP policies do not seem to have much empirical backing or flexibility for exceptions. For instance, there are some master’s programs in clinical mental health preparing students to be licensed professional counselors, and those students consistently score above the national average and above the average for CACREP programs on the National Counselor Exam (NCE), which is utilized for licensure (similar to the EPPP for psychologists). For some of these programs, none of the core faculty graduated from a Counselor Education and Supervision program. However, they are obviously providing quality preparation for their students’ professional futures on this metric (as well as many other program outcome metrics).
The situation gets more complex. CACREP members have been supporting efforts to change licensure laws to have only those individuals who graduate from a CACREP program be eligible for licensure as a professional counselor. These efforts have been successful in some states (e.g., Ohio, Kentucky). Accordingly, in combination, if CACREP-only licensure laws for professional counselors are enacted, then colleges and universities will need to have CACREP master’s level programs—and core faculty positions in those academic programs are restricted to only those who graduate with a doctoral degree in Counselor Education and Supervision (with the exception of the grand-person clause).
The Training Resolution Initiative
Given my comments above about how I believe we have moved away from a more evidence-based and personalized view of expertise, I decided to act upon SAP members, as their Training and Education representative (2012-2015). Consequently, I authored a resolution so we, SAP (Division 29), can clarify our beliefs about training master’s level professionals (see below).
The SAP Board voted to approve this resolution (see below). Additionally, the Boards of Divisions/Societies 17, 22, 35, 43, and 49 have also endorsed this resolution. There are other divisions/societies currently reviewing this initiative.
This is a first step in the conversation. Training future psychotherapists is an important topic. At the same time, I believe we also need to support our colleagues in their independent practices. In regard to professional counselors, we train them to be licensed professional counselors who can practice independently. We should support those efforts in a more active and supportive manner.
Here is an initial list of efforts I believe APA and its divisions/societies should embrace:
- Develop relationships with master’s level professionals from other disciplines (e.g., professional counselors, social workers, marriage and family therapists).
- Develop strategies for recruitment of master’s level professionals (i.e., outreach for identifying individuals who would like to join APA and/or its divisions/societies), based on their needs and alignment with the division/society’s mission. (Note, some colleagues may not want anything to do with APA or its divisions/societies, which is completely understandable). If we are to welcome new colleagues to the table, it may be useful to have a specific domain within divisions/societies to have a true home for our colleagues. For instance, SAP does allow master’s level professionals to join our division.
- APA and its divisions/societies need to publically endorse psychotherapy practice at the master’s level. We train master‘s level practitioners to provide services independently, and this resolution supports our efforts to this end. However, it is hypocritical to support efforts to train master’s level professionals to practice independently, and then not support their independent practice of psychotherapy. This must change, providing an opportunity to build bridges.
In closing, I hope my efforts are not misconstrued. Do I like what CACREP is trying to do with CACREP-only language for licensure laws, and the support they received from ACA? Absolutely not. At the same time, I am not a member of those communities. If CACREP and ACA governance want to continue down this current path, with member support, that is their right. At the same time, we (especially SAP) can be an alternative, as we share in a common mission—psychotherapy. I am not trying to change ACA or CACREP. I am trying to encourage APA and its divisions/societies to be inclusive of our master’s level colleagues. We have an opportunity to be a home for many professional counselors and master’s level practitioners who do psychotherapy. Many of these individuals do not stand united with those who preach divisiveness. We have our own work to do at APA. We can do better, and we need to do better.