It's a catch-22 known well to professional psychology graduates: Most states require new psychologists to get postdoctoral supervised clinical experience before they can get a license, but most payers won't reimburse yet-to-be-licensed psychologists for their services. The dilemma is only compounded by the fact that new, unlicensed psychologists may graduate with thousands of dollars of debt, get paid substantially less than licensed psychologists and must vie for a limited number of formalized postdoc training experiences.
APA formed a commission in 2000 to examine such difficulties. Called the Commission on Education and Training Leading to Licensure in Psychology, the group recommended that professional psychologists' training include two years of sequential, organized and supervised training, including a one-year predoctoral internship. And because today's graduate students often log more than 1,500 practicum hours before they go on internship - compared with an average of 400 back when the current licensure policy was created - the commission recommended that practicum hours be counted toward supervised experience - meaning that, under the proposed plan, postdoctoral supervision would no longer be required.
But putting those recommendations in place would require changes to licensing laws in every state - a risky endeavor, says Norine Johnson, PhD, a former APA president and co-chair of the commission. Opening up state licensure laws would give other professions a chance to change psychologists' scope of practice, jeopardize prescription privileges efforts and endanger mobility efforts that would let psychologists more easily practice in another state.
That's why APA's Council of Representatives voted in 2001 to hold off on changing APA policy and advocating state legislatures to change licensing laws - at least for now. Council is slated to review the report again in 2005, and, in the meantime, numerous groups are moving forward on some of the commission's other recommendations. The idea, says Johnson, is to build a stronger training infrastructure now so that policy changes will be easier later on.
Here's a snapshot of just three of the commission's other recommendations, and the progress that's been made:
Recommendation: The Association of State and Provincial Psychology Boards (ASPPB) reconsider its policy on when students can take its Examination for Professional Practice in Psychology (EPPP).
Rationale: Depending on the state, many students had to complete their postdoctoral hours and then sit for the EPPP - resulting in an additional wait for licensure. Allowing students to take the EPPP while in their postdoc would mean they could get licensed as soon as they complete their postdoc hours.
Progress: ASPPB's Board of Directors unanimously voted to adopt a new policy recommending that students be eligible to sit for the EPPP after they have completed their educational requirements for their doctoral degrees. However, ASPPB only makes recommendations; states and provinces actually set the policy in their jurisdiction. See the most recent "Handbook of Licensing and Certification Requirements" at www.asppb.org for each jurisdiction's regulations.
Recommendation: Enhance existing education advocacy efforts.
Rationale: Revamping state licensing laws and building funding for postdoctoral experiences requires a national network of students and psychology educators willing to contact their legislators.
Progress: APA established the Federal Education Advocacy Coordinators Network in 2002 and has stepped up efforts with Congress and federal agencies. That's resulted in several big wins, including funding for the Graduate Psychology Education Program and the Postdoctoral Education Research Training Fellowships (see www.apa.org/ed/ for information on both).
Recommendation: Define the competencies expected of graduates and design guidelines for their achievement and assessment.
Rationale: Many psychologists have different ideas about when students learn what they need to be competent practitioners, says Nadine Kaslow, PhD, of Emory University School of Medicine, who represented the Association of Psychology Postdoctoral and Internship Centers (AAPIC) on the commission. Psychology needs to iron out these differences so that advocates can prove to legislators that students with the commission's recommended training are indeed ready for licensure.
Progress: In 2002, AAPIC, APA and other groups held a conference, called the "2002 Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology," to outline these competencies. For more information, visit www.appic.org. Moreover, the Council of Chairs of Training Councils - the group of psychologists who lead national psychology training associations - has established working groups examining both postdoctoral and practicum training, says Emil Rodolfa, PhD, of the University of California, Davis, another commission member.
Although the progress may not seem fast enough to some, the time it's taking to lay the groundwork for the commission's model is significantly shorter than the last time the field implemented licensing laws, Johnson notes. That took nearly 20 years.
-D. SMITH BAILEY
The commission's report is at www.am.org/cudcp/report_of_the_commission_on_educ.htm.