Outcome of the Commission on Education and Training Leading to Licensure in Psychology: Impact and Implications for Students and New Psychologists

Carol Williams-Nickelson, PsyD
Associate Executive Director, APAGS

If you had the chance to do it all over again, would you choose psychology as a career? Diminishing practice options for licensed psychologists, vastly divergent modern day education and training environments, extreme variability in the style, quality and availability of supervision, expanding post-doctoral requirements, licensure and mobility constraints, and finding that it is increasingly difficult - sometimes impossible - to prepare for and secure gainful post-doctoral employment in health services areas, has left some students and new psychologists answering “no” to this question. This answer concerns the profession, APA and APAGS.

A variety of variables and impediments are contributing to these problems. For example, many students report inadequate preparation and training for an evolving health care system, a lack of career guidance and business planning from their academic institutions, and the unwillingness of health care payors to reimburse providers who do not have full independent psychology licensure status, or who have not been in practice for several years. A lack of licensure reciprocity between states, coupled with an unwieldy range of licensure requirements unique to each state, complicates an already dire situation for future psychologists. Additionally, there is mounting concern over the debt that students are incurring for their graduate education.

The Formation of the Commission

Many boards and committees have attempted to address these problems over the years, but their independent recommendations and interventions have been only modestly effective. As a result, at its February 2000 meeting, the APA Council of Representatives (Council) approved the establishment of a 30 member, presidentially-appointed, cross-constituency Commission on Education and Training Leading to Licensure in Psychology. The Commission was asked to report back to the Board of Directors within one year with recommendations for modifications in education, training, examination, and supervision requirements leading to licensure in psychology, particularly as they relate to the current and future marketplace for psychological services. The Commission's review of the education, training, and licensure process was to include an examination of the content of training in relation to the twin goals of quality of education and training and its relevance to the changing marketplace and emerging specialties. Council requested that the Commission's report include specific mechanisms for achieving its recommendations.

Patrick DeLeon, PhD, JD, APA President at the time the Commission was proposed and formed, appointed current APA President, Norine G. Johnson, PhD, as the Commission's chair. APA Board of Directors members, Ronald F. Levant, EdD, and Ruth Ullmann Paige, PhD, served as co-chairs. Nominations for commissioners were solicited from the organizations and governance constituencies specified by Council. One commissioner was selected to represent APAGS and another to represent the APAGS Task Force on New Professionals' Issues. (APAGS also sent a non-voting liaison to the meeting.) Each commissioner was granted one vote in decisions of the Commission. Commissioners were expected to consider issues in light of the concerns of the constituencies they represented, but they were not required to seek authorization of their nominating organizations for each vote, as the Commission itself was an independent group. Based upon their expertise in the field, commissioners were asked to vote their minds on the issues discussed by the Commission. As such, the recommendations of the Commission carry the weight of a group of respected leaders representing many constituencies in psychology. However, decisions of the Commission are not considered binding on the nominating organizations. Meetings of the Commission were held May 19-21 and September 8-10, 2000. While iterations of the Commission's work continue to be carried out, the Commission was time-limited, officially ending with the Commission recommendations and report provided to Council at their February 2001 meeting.

Charge to the Commission

The Commission was charged with reviewing the current state of education and training in professional psychology for the purpose of determining at what point basic readiness for independent practice is achieved. Given that licensure is intended to be a proxy for basic practice readiness, as a starting point for discussion the Commission used the Model Act for State Licensure of Psychologists (Model Act) and the current APA policy that provides recommendations regarding education and training leading to licensure. The Commission was aware that its recommendations were intended to inform policymakers and that only the APA Council of Representatives can make changes to APA policy. More explicitly stated, the Commission was also aware, and students should know, that APA can develop standards and policies, but APA does not create or enforce legislation and regulatory statutes. APA can, however, inform and influence state and national policy, but this requires the involvement of students and psychologists in state and federal legislative advocacy efforts.

The issues prompting the establishment of the Commission, as well as the implementation and policy change recommendations that developed out of the Commission, are extremely complex with multiple and overlapping implications. It is important to note that the Commission was not established simply to suggest and justify the elimination of a post-doctoral training requirement or to quickly resolve the increasing debt loads and financial dilemmas of students. While these two issues were certainly acknowledged and considered by the Commission, they were not the main impetus or primary focus of the Commission's work. Rather, the Commission was more interested in examining issues of quality, relevance, competency, preparedness and opportunities for adequately compensated entry level practice for licensed psychologists.

Informing Council about the Commission's Impact on Students and New Professionals

A written and verbal report on the Commission was provided to Council at their February 2001 meeting. I was allotted a few minutes to discuss the Commission's impact on students and new professionals. As you may already know, student affiliates represent nearly 1/3rd of APA's membership and 1 in 7 full members are new professionals. As you can probably imagine, I had a fairly awesome responsibility in trying to convey the sentiments of these two vital constituencies during this brief presentation. I gave it my best shot and what follows is the essence of what I shared.

From the perspectives of students and new professionals, the establishment of the Commission was a welcome, appreciated and long overdue gesture that was a good first step in collectively and comprehensively acknowledging the many changes (especially over the last decade) in graduate education, preparation and attainment of licensure, and the job market. The formation and work of the Commission sent a strong and important message of support, interest, and hope to students and new professionals, who were feeling increasingly frustrated, dismissed, disheartened, and defeated about the disconnect between their training and the realities of modern day practice. Hearing students and new professionals, who were once enthusiastic and optimistic about psychology, express fear, anger and resignation about their futures, has been concerning and very sad.

Some have have been discouraged because they view the APA as increasingly irrelevant to their needs and too-often unresponsive to their pleas - and often cite these as reasons for their decision not to renew their membership, or refrain from transferring from a student affiliate to a full member. Current policies and programs that were once very rational and appropriate are becoming increasingly obsolete for today's students and new professionals.

Over the years, psychology has attracted very talented graduate students. In order to continue to attract the “best and the brightest,” which is a goal I have heard expressed by a number of groups, we need to demonstrate that psychology is responsive, flexible, concerned and invested in students, new professionals, and their futures. Current economic realities are likely to push these “best and brightest” towards other disciplines, especially if-as a profession - we continue to cling to outdated policy that may only be providing a false sense of stability. Fearing change seems to prevent us from taking action, and by doing this, we may run the risk of disengaging and ultimately losing the “best and the brightest.”

I believe that psychology as a whole, and Council leaders, value and care about students, new professionals, their experiences, and the future of the field - which is why Council created the Commission in the first place. APAGS is eager to work with Council and other psychology leaders to strategically plan and implement changes that will re-ignite the excitement in students and new professionals that has recently faltered.

What are the major problem areas and primary concerns for students and new professionals in regard to training, education and licensure? Here is just a small sample of the issues students and new psychologists have shared with me:

• Graduates do not want formal post-doctoral training to be required. New professionals have a difficult time finding both informal and formal post-docs, and report that while the post-docs listed in the APPIC directory are a start, the number available are insufficient.
• Master's practitioners seem to have more maneuverability than those newly awarded with doctoral degrees. Many of our graduate students, and new professionals, obtain licenses in other - Master's level - disciplines, in order to earn a living.
• There is a lack of job opportunities, if not licensed.
• Or, only exceptionally low paying jobs - sometimes exploitative - are available.
• When applying for internship, students interpret that there is a focus on the number of hours, rather than a focus on the quality of training experiences and related competencies.
• Our students and new professionals have far more training compared to other advance-degree disciplines.

Why does the Commission offer hope and have the potential to re-ignite interest and commitment to psychology? In other words, Why is this different from past attempts to address the problems? Students and new psychologists know that this is the first time a cross-constituency coordinated vision and plan is being cultivated. They know that efforts in the past have been made, but they have been splintered, and as a consequence, only mildly effective.

What do students and new professionals want to see happen or not happen as a result of the Commission? Swift resolution of all the difficulties students and new psychologists face is unrealistic. They do not expect a quick-fix, nor do they want to see anything happen that is temporary or detrimental to psychology. What they do want to see is continued systematic, comprehensive, cooperative and carefully orchestrated implementation to address the myriad of problems that have culminated. Council members were left with the message that students and new psychologist's hope that the momentum and interest in change, spurred by the Commission, will continue - which will ultimately restore full optimism in students and new professionals, while protecting the integrity of the field. And, APAGS needs Council's support to make this happen.

Commission Process and Outcome: Report Highlights

Relevant sections of the Commission's report to Council are included below. Council asked for APAGS and other groups to circulate the Commission's recommendations, suggested policy statement and implementation issues among their members for feedback. After feedback is received and consolidated for Council, a decision will be made about changing APA policy and beginning to strategically plan for integrated implementation. It is important to note that groups have already started to address some of the concerns of students and new professionals, since a change in APA policy is not necessary to begin such a process.

The Commission asserted that professional training, whether at the practicum, internship, or postdoctoral level, needs to be organized, sequential, and well supervised with ongoing evaluation of competence in a breadth of professional areas. The Commission's review of the current state of education and training in professional psychology highlighted the changes in predoctoral supervised professional training that have occurred over the last fifty years, and especially within the past decade.

The Commission specifically and explicitly stated that two years of organized, sequential, supervised, professional training experience (in addition to completion of the doctorate) is necessary and sufficient for entry-level professional practice. The Commission affirmed a one-year, formal, predoctoral internship as a necessary component in the sequence of education and training, and recommended that this be added as an explicit aspect of APA policies regarding licensure. Students currently receive a substantially increased amount of supervised professional training in practica prior to internship. Provided that this pre-internship practicum experience is organized, sequential, and well supervised, the Commission believed that this experience met the need for a second year of training in addition to the internship. However, the additional year could also be obtained after the predoctoral internship and the granting of the degree, through postdoctoral experience. Thus, the Commission did not recommend decreasing supervised experience for licensure; they recommended increased flexibility in the timing of these experiences. The Commission believed that this flexibility would strengthen the profession because it better matches current training models and also will encourage accountability among training programs for providing organized and sequential training, regardless of whether it is predoctoral or postdoctoral.

The Commission was committed to the importance of APA accreditation of both doctoral and internship programs, yet wanted to ensure that opportunities remain available for new and innovative programs to develop, as well as for postdoctoral respecialization.

The Commission concluded that the current training of many doctoral psychologists provides them with sufficient experience to be competent for entry-level practice upon completion of the internship and doctoral degree (In other words, when they have completed two years of organized, sequential, supervised professional training experience predoctorally). At the same time, the Commission strongly affirmed the value of organized, sequential, supervised postdoctoral experiences for those who wish to receive further training. Obviously, psychologists who do not receive two years of such training predoctorally should have the option of receiving it postdoctorally. In addition, for those psychologists who have received two years of training predoctorally, the Commission saw organized postdoctoral training programs, postdoctoral consultation, and postdoctoral supervision as an important mechanism for the development of advanced competency and expertise for professional practice.

The Commission was aware that implementing changes in APA policy and in licensing laws and regulations would require a significant commitment of time and both human and financial capital, in addition to a significant shared commitment among the various communities within organized psychology. The Commission was also aware that changes in APA policy do not automatically translate into changes in legislation and regulation. Further, decisions about implementation (and the impact of efforts to implement policy changes) will need to be considered in the context of legislative priorities in a given state, but also in the context of other priorities and initiatives underway within organized psychology.

Process

At the end of its first meeting, the Commission voted on a draft statement that proposed altering the education and training recommendations for licensure in the Model Act. Between meetings, commissioners reviewed the draft statement carefully with their constituency groups, and through a series of working groups, outlined its implications for each stage of the education and training process. An Implementation Working Group focused solely on the legal and political challenges of implementing the draft statement recommendations in actual state licensure acts.

Commissioners reviewed the implications of the draft statement compiled by the working groups during the second meeting of the Commission. Discussion of these implications led to revision of the Commission's statement. The Commission voted and approved the statement below. A second series of working groups convened to develop recommendations and implementation strategies for each constituency group that would be responsible for implementing various recommendations. The commissioners felt strongly that the implementation recommendations are interdependent. They did not feel that APA policy could simply be changed without parallel supporting action as outlined in the recommendations. The Implementation Working Group reconvened to develop a list of implementation issues and implications that should be examined if APA considers a policy change.

Statement of the Commission

The Commission on Education and Training Leading to Licensure in Psychology recommends that psychologists be eligible to sit for licensure upon completion of the following education and training:

1. A doctoral degree from an APA- or CPA-accredited program in psychology.¹ Where accreditation in the program's substantive area is not available, the program will be required to be designated as a doctoral program in psychology by the Association of State and Provincial Psychology Boards or the National Register of Health Providers in Psychology.

2. The equivalent of two years of organized, sequential, supervised professional experience, one year of which is an APA- or CPA-accredited predoctoral internship, or one that meets APPIC membership criteria, or, for school psychologists, a predoctoral internship based in a school setting which meets CDSPP Doctoral Level Internship Guidelines.² The other year of experience also may be completed prior to receiving the doctoral degree.

An aspect of this training is the ongoing assessment of competence in a breadth of professional areas. Postdoctoral education and training is an important part of the continuing professional development and credentialing process for professional psychologists.

Abbreviated Commission Recommendations

Policy Change

• APA to adopt as policy the Commission recommendation that psychology graduates be eligible to sit for licensure as specified in the statement approved by the Commission.
• APA to work with relevant groups to pursue changes in state licensing laws when appropriate.
• Define competencies (e.g., research, practice, human diversity, etc.) expected of graduates of doctoral programs in professional psychology over the next decade and design developmentally-informed education and training guidelines for their achievement and assessment, to include:
  • Guidelines on practicum training related to definitions and minimum requirements (including the possibility of a cap), quality of training sites and supervision, curriculum and competency objectives at different stages of training, trainee performance assessment, and relationship between doctoral program and practicum sites, beginning first with analyzing information available on competencies from accredited doctoral and internship programs and national groups representing professional psychology education; and
  • Guidelines for communication between graduate programs and internship sites related to articulation of student competencies expected of each by the other, the assessment of those competencies prior to, during, and at the end of internship training, and working with problem students.
  • APA to recommend that the Committee on Accreditation reexamine and consider revising Domain B (Program Philosophy, Objectives, and Training Plan) of the Accreditation Guidelines and Principles with regard to competency objectives, curriculum plan, and guidelines for practicum and internship training.

• APA to recommend that the Association of State and Provincial Psychology Boards (ASPPB) reexamine and consider policy on the timing of the national Examination for Professional Practice in Psychology (EPPP) for licensure in psychology to assure appropriate timeliness of administration in the sequence of doctoral education and training.

Infrastructure Development

• Establish an infrastructure to support a national forum on issues of education and their link to the future of psychology. Leaders of the education constituencies to convene regularly to discuss critical issues of change in education, our discipline, and our society relevant to the teaching of psychology and preparing the next generation of psychologists.
• Enlist the support of current practitioners and educators to integrate suggested changes into their state and federal advocacy agendas, as well as their program curriculum.
• Develop ongoing mechanisms for future conversations and priority discussions between practice and education constituencies to work towards integration of practice and education initiatives, as well as agreeing on the advocacy priorities for professional education and training as they relate to career development and marketplace needs for practitioners.
• Develop and expand information systems for prospective students and the public about outcomes of professional education and training, to include information on program goals and professional competencies for which training is offered, information on program admissions, attrition, time to degree, student debt, internship placements, licensure outcomes of graduates (and reference to public information on licensure requirements by jurisdiction), and job placement following graduation.

Implementation Elements

The proposed policy changes from the Commission are destined to remain historical artifacts unless issues of implementation are seriously addressed. The Implementation Working Group of the Commission believes that for APA to entertain the possibility of movement from proposed policy to large-scale implementation of psychology license statutory change, it must, by definition, agree to address the changes outlined by the Commission. This will also require major financial, intellectual and personnel resources of the APA. Changes must also coincide with similar priority setting and resource commitment by groups outside of APA, such as State and Provincial Psychological Associations (SPPAs), educational institutions, the Committee on Accreditation (CoA), state Political Action Committees (PACs), and the Association of State and Provincial Psychology Boards (ASPPB), among others.

The Commission proposed a preliminary template for organizing the necessary support, data, money and advocacy to move from policy to implementation through licensing law and regulatory change, in addition to modifications in accreditation standards. The implementation plan addressed a variety of complicated and interrelated issues. Although the task seems daunting, similar processes have been implemented and successful in the past, and this process can as well if it is determined to be in the best interests of the profession.

If APAGS members would like to contribute comments or reactions to the Commission for Council's eventual review, please contact me , or you may contact any member of the APAGS Committee. We are very interested in your thoughts and strive to represent your interests, and the discipline's interests, effectively.

Footnotes

¹ Individuals with doctoral degrees in psychology who wish to respecialize may complete the education and training requirements described in this document postdoctorally. Return to text

² By 2010, all internships shall be APA- or CPA- accredited.
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