The Medical Model

The medical model has long been the dominant model of our time for providing health services.  It has the most power, the most money, and the largest following.  Essentially it has these core components: a disorder, a scientific explanation for that disorder, a mechanism of change, healing actions, and specificity.  The disorder is whatever the problem or complaint is that puts the patient in need of services.  The scientific explanation is the etiology of that problem according to relevant research or theory.  The mechanism of change is whatever strategy will be used to solve the problem.  Healing actions are the specific interventions applied to the patient.  Specificity is the inference that the healing actions are what cures the patient.  These comprise the core of the medical model.

In the realm of medicine the strategy used is applying medical knowledge, and the healing actions are the actual treatments given, but in psychology the strategy is the theoretical approach of a given counselor, and the healing actions are the specific interventions used.  In medicine the interventions are physiochemical, but in psychology the interventions are psychological.  Both have incidental, or placebo, effects that are psychological.  This poses somewhat of a problem for psychology as both the specific interventions and the incidental effects are psychological.  Perhaps the medical model is not the best framework for psychology.

Nevertheless, psychology has adopted the medical model, which means it has had to fight for turf in the medical arena.  In the 1990s psychopharmacology started to assert that its treatments were more effective and more proven.  In response, psychology had to prove the effectiveness of its own treatments, which led to manualized treatments and contributed greatly to the thrust now known as evidence-based practice.

In the medical model everything must be proven, and since psychology has professionally fallen into this model, it leads to specific treatments having to be documented and then proven through research, as if they were a new drug being tested.

Certification Above and Beyond: Options for Overachievers

Some of you have received a license to practice as a psychologist in your state of choice, and you are not satisfied.  You want another credential to back up your training.  It turns out you have the grand opportunity of getting another credential, primarily through three organizations.  The first is the ASPPB (the progenitors of the EPPP).  The second is the National Register of Health Service Providers (NR).  The third is the American Board of Professional Psychology (ABPP).  Now I know the rest of you are thinking, "Oh, but I was completely satisfied when I got licensed.  What could induce me to go to the trouble of obtaining another credential when I just spent the past seven to ten years getting my doctoral degree and getting licensed?!"  That is a great question.

The ASPPB, NR, and ABPP each offer their own credential, with their own qualifying process, and of course, the accompanying fees.  Each of these beneficent organizations additionally offers you the opportunity to start banking your credentials with them before you graduate with your doctoral degree.  Maybe you haven't heard of credential banking: sending all of your credentials and qualifying documentation to one of these organizations, having them verify each credential and archive it in a file for you.  Later when you apply for licensure in one or multiple states, you can have that organization send all your qualifying credentials directly to the licensing board of your choice.  This would save you the hassle of collecting all the official documentation and having it sent to a licensing board yourself, each time you apply for licensure in a new state.  As for the credential that is offered by each organization, and obtained by meeting specific requirements, it is like that organization's seal of approval.  The hope is that some states will recognize the credential as satisfactory and grant you a license without needing to see all your original documentation, and many states do recognize some or all of these credentials.  In some cases a state licensing board may still require you to take a jurisprudence exam or waive only some of the requirements for licensure.

I am too bored at the moment to go into the specific requirements for each credential, but rest assured that whether you seek a credential or just a credential bank you will always have to pay an annual fee to maintain your credentials with one of these organizations.  Really, this is an enterprise that stems from the original monster of different requirements for licensure in each state and the increased mobility of today's world.  If all states had the same requirements for licensure, then all states could be part of one big agreement of reciprocity, and instead of resending credentials to each new state you would only have to show them a current license and take that state's jurisprudence exam.  How simple that would be!  Not to mention much cheaper!

Mobility remains the number one struggle in licensure.  Let's say you originally get licensed in a state with very few requirements for supervised hours.  After practicing for 15 years, you decide to move to Florida, which requires 4000 hours of supervised experience.  You didn't have an accredited internship and only had 1500 hours of postdoctoral supervision.  Even though you have been practicing for 15 years, you still won't be able to get licensed in Florida until you make up the rest of your supervised hours.  And who is going to supervise you?  Another psychologist, possibly one who has only been practicing for five years.  Does this make sense?

Hoops to Licensure Cont.

As promised...
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Also known as the Examination for Professional Practice in Psychology, the EPPP is required for licensure in all states and provinces.  It is a computerized written examination designed to test 8 major content areas (each comprising 8-15% of the entire exam) that are seen by the Association of State and Provincial Psychology Boards (ASPPB) as "foundational to the competent practice of psychology."  The exam has 225 multiple choice questions with four answers each and no penalty for incorrect answers.  As of Aug 2011, only 175 of those questions will contribute to your score (previously 200 of those items were scored).  The rest are pretest items for validity testing.  The scores for this test are scaled from 200-800 just like all the other major scholastic tests of life, i.e. the SAT and GRE.  In most jurisdictions a score of 500 or more is passing, and that is also the ASPPB recommended passing score.

But wait there's more!  In addition to passing the EPPP, all states require a certain amount of supervised experience.  Frankly, I'm still quite confused about how many states allow for some of these hours to be before your doctoral degree is conferred.  In general, I am under the impression that most states only allow you to count hours after you have received your doctorate, which would mean not counting any of your hundreds of practicum hours during graduate school, nor your thousand or more hours during internship.  The general standard for supervised experience seems to be around 1500 to 2000, though some jurisdictions may require up to 4000-6000 hours.  However, things in this arena may be changing, as the Commission on Education and Training Leading to Licensure recently recommended two years of experience (equivalent to around 2000 hours) as sufficient preparation for licensure, allowing for one or possibly both of those years to be before receiving a doctoral degree.

Furthermore, many states require additional exams.  The possibilities include an oral exam, a jurisprudence exam, and ethics or other exams.  These vary widely by jurisdiction, and anyone seeking licensure would be well advised to look up the specific requirements per state of choice.

After all of these requirements have been successfully navigated, you will apply for licensure in a given state.  This process entails filling out an application and having credentials and transcripts and records of hours all sent to the licensing board of said state, as well as an application fee, of course.  Then you will be a Psychologist.  Not a clinical psychologist or a counseling psychologist or an industrial organizational psychologist, everyone gets the same title: Psychologist.
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Coming soon: Certification Above and Beyond: Options for Overachievers

Hoops to Licensure

The only reason I'm writing right now is because I have accountability, and I have not written anything academic yet, nor have I written anything at all in several days.  I haven't read many sources yet, but I have read a few, so here goes...a rough, rough draft putting together some thoughts from my readings so far.
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Licensure as a psychologist is about jumping through a series of hoops, in order.  According to one source, the proportion of time that it takes to become licensed as a psychologist, compared to the median amount of money a psychologist makes, is significantly less than other professions, being a doctor for example.  So the hoops must completed in order, and there may be some slight variations based on your state of residence or choice.  First, you must apply to and enroll in an APA accredited program.  Check, that's the only thing on the list that I've accomplished so far.  Next, you must complete your doctoral degree.  Read, you must pass a number of classes, accumulate debt as a graduate student, spend hundreds of hours in practicum training, and write a dissertation.  Not only that, but in completion of your doctoral degree you must apply for internship sites and go through the match process to determine where you will be located for a year of your existence, likely uprooting you from the support networks you formed in graduate school and potentially causing relationship strife with any significant others (at least that's what I've heard).  After a successful supervised internship year at an APA accredited site, if you have finished your dissertation, then your doctoral degree will be conferred upon you.  Next hoop: the EPPP.  Also known as the...
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to be continued, I've met my 15 min quota for the night ;)