Ralph Waldo Emerson once remarked that „All of my greatest ideas
were stolen by the ancients‰. The message in this first column,
the need for our graduate training programs and internships to provide
essential required training in clinical emergencies and crises has
certainly been well articulated by my illustrious predecessors (Phil
Kleespies, Bob Yufit and Dale McNeal). It does appear that our internship
programs do provide some of this essential training - thanks again
to Phil Kleespies and his students, we now have listings of many internships
that provide specific coursework and supervised clinical experience
in the assessment, management, and treatment of behavioral emergencies.
Our psychiatric colleagues, as part of their formal residency, require
their residents to have a specific number of psychiatric emergency
cases as part of their residency training. In addition, the board
certification process in psychiatry requires knowledge of (and testing
in) the handling of emergencies and crises. The leadership of Section
VII has worked diligently with CUDCP and NCSPP to initiate a dialogue
on this subject - yet in 2003 such basic training in handling emergency
situations in clinical practice is still not mandatory.
Why then has professional
psychology lagged behind our psychiatric counterparts? Discussions
with the leadership of graduate training programs in professional
psychology (i.e., NCSPP and CUDCP) have shown that these organizations
are supportive of the efforts of Section VII to advance training in
emergency psychology. However, from these same leaders we hear a familiar
litany. Namely, that training in clinical emergencies and crisis management
is like „the flag and apple pie‰ - all are in favor of
such training. But these same leaders in the field also tell us that
currently there are so many requirements for APA accreditation that
few elective units remain available in which to implement such training.
Thus, there is a natural systemic resistance to implementing any more
„required‰ modules that require specialized faculty training
and supervisory expertise.
While such systemic
roadblocks are understandable, I am reminded of a time many years
ago when I served as an expert witness for the defense side in a malpractice
action where a psychologist had a patient under her care commit suicide.
Upon direct questioning by the plaintiff attorney, I was asked what
required training was mandated for psychologists in handling patients
who were dangerous to themselves or to others. Under oath, I had to
testify that our accreditation process did not require our graduate
training programs to provide specialized coursework in assessing and
treating dangerous patients. In the dramaturgy of the adversarial
cross examination process, the plaintiff attorney loudly exclaimed
"if you psychologists can't handle people who are homicidal or
suicidal...then what good are you anyway!" Over the years, in
speaking both with members of the defense and plaintiff bar, judges
and even those lay individuals who have served on juries in malpractice
actions involving mental health care, there is wide spread surprise
and often consternation that all professional psychologists are not
required to know how to handle emergencies - that mandatory specialized
routine coursework on emergencies is not required in all of our doctoral
training. While I am not suggesting that lawsuits are the way to change
our graduate curriculum, it is interesting to note that the current
APA accreditation process is "outcome" driven (i.e., programs
must show outcome data on what they purport to train students to do).
In our own doctor
of psychology graduate program in clinical psychology between Stanford
University School of Medicine's Department of the Psychiatry and the
Pacific Graduate School (the PGSP-STANFORD Psy.D. Consortium), all
students in the fall quarter of their second year, as they begin their
practicum experience, are required to have an 11 week course in assessing,
managing, and treating clinical emergencies and crises. As president
of Section VII, I would like to hear directly from other graduate
program directors of training who require a quarter long or semester
long course on this topic (email: email@example.com). The hope would
be to accumulate syllabi, reading lists, supervisory guidelines and
so forth that could be provided on a voluntary basis to all CUDCP
and NCSPP programs. Perhaps by voluntarily encouraging such formal
training, a critical mass of doctoral programs can be achieved.
The fear of being
sued probably has more widespread and deleterious effects on clinicians
than do actual lawsuits. There is no specific set of clinical practices
that can absolutely guarantee a psychologist that she or he will be
immune from being sued (or even from a judgment for the plaintiff).
High quality well trained psychologists ethically are mandated to
practice within the scope of their training, education and experience.
Hopefully only a few years from now, the current president of Section
VII will be able to report to our members that training in clinical
emergencies and crises have now voluntarily become a routine part
of the scope of practice of clinical psychology.