Science, applications, and regulation

Abstract

About the time that Japan was opening its doors to Western societies (1868 Meiji Restoration), those Western societies were establishing psychology as a scientific and laboratory-based discipline (1879 Wundt's Laboratory). Two Japanese scholars, Yujiro Motora and Matataro Matsumoto, obtained their PhD degrees in America in the 1880s, and G. Stanley Hall and Y. Motora published a joint paper in the first volume of the American Journal of Psychology in 1887. Other psychologists received Western training, for example, Tsuruko Haraguchi who earned her PhD degree at Columbia University under Thorndike in 1912, and Takashi Hayashi who studied with Pavlov in 1932. These points illustrate that Japanese and Western psychology have been intertwined from the outset of scientific psychology. From among these early leaders, Matsumoto went on to found psychological laboratories in Japan starting in 1903. He also founded the Japanese Psychological Association in 1927 – the 80th anniversary of which we celebrate this year. It is a special honor for me to participate in this celebration and to bring to the Japanese Psychological Association the congratulations of the International Union of Psychological Science (IUPsyS). The Japanese Psychological Association, like other early psychological organizations, such as the American Psychological Association, was founded to advance the discipline of psychology as a science. Yet, both are today challenged by the need to use psychology to advance human welfare and the desires of its members to do so. As scientific psychology developed, laboratory research showed clearly that the mind and behavior were lawful products of experience. Laboratory facts were quickly used in other contexts. For example, changes in productivity in factories could be related to environmental changes. Successes in schools could be related to how teachers rewarded students. Indeed, Pavlov's early discovery that special environmental challenges, for example, making discriminations hard or signals unreliable could induce “experimental neuroses” in both dogs and children, gave impetus to this view. This parallelism, which is foundational for any modeling process, is illustrated in Figure 1, which sketches the work of Shenger-Krestinikova and of Krasnogorski that was carried out in Pavlov's laboratory. Outline of research in Pavlov's laboratory on the discovery of experimental neuroses and the process of modeling. The ease and lawful reliability with which “experimental neuroses” could be induced in animals and humans was a significant insight. This view is fundamental to psychology as a science. This insight suggested to many that we might experimentally model disordered and dysfunctional behaviors and then search for cures within the framework of the discovered principles of psychology. One powerful instance of this is in the research of Joseph Wolpe, which is outlined in Figure 2. Outline of Wolpe's science process for developing systematic desensitization therapy for phobias. Building on the earlier work of Masserman, Wolpe used cats to research conditioned fears and the amelioration of those fears. He obtained success by first inducing a relaxed state by feeding them and then phased in extinction. This was the foundation of the therapeutic technique of systematic desensitization – and all other exposure-type therapies. This is but one instance. Although the origins of modern psychology are as a scientific discipline, applications of psychology were also important from the earliest years, starting with the psychological clinic at the University of Pennsylvania (1897). Early psychologists (Binet, Yerkes and Wechsler) also developed an assessment of individual abilities as a tool for classifying individuals. Yet, the major transition to a predominantly applied discipline can be traced back to the late 1940s. As the foundational scientific knowledge increased across the full scope of the discipline, so to did the potential for more and wider applications of psychology to guide child development, to improve education, to increase productivity and successes, to ameliorate stress and mental illness, to promote health behaviors, and to aid graceful aging. This transition from primarily a basic science to a discipline and profession of science-based application has continued to accelerate in recent decades until, in many parts of the world, the science base has almost been lost, resulting in new professionals being trained in skills the scientific basis of which they do not really understand. As professionals involved in providing practical applications of psychology have become the predominate aspect of psychology, psychology has entered into circles of other helping professions, several of which are recognized (and regulated) by governments. These other, regulated helping professions are often considered by the general public to be high status, for example, medical doctors. Among the features of such regulation is licensure and, thus, many psychologists believe that national licensure of psychologists will bring more recognition and higher status to the field of psychology. This may – or may not – be true. But, alas, with recognition and licensure come sweeping regulations and changes for all in the field: students at all levels, faculties, universities and curricula, national organizations, and government bureaucracies. It is important to assess the likely nature of the changes, the potential benefits, and the potential costs. I can only point to possibilities that you will need to explore. These possibilities come to me from observations of practices and events in other nations. As Japanese psychological societies contemplate national licensure, they can look to the experiences of other nations. However, looking at the other national experiences and learning from them is quite different from using any one as a model. Each national effort must be recognized as culturally situated. What occurs is one country need not necessarily occur in another. What is successful in one country may be problematic for another. I plan to discuss some models, including that of the USA and of some other Western countries. I chose Western countries because of the links between them and Japan in terms of governments, medicine, and psychology. I will discuss foundations, action, and important consequences for the whole psychological enterprise and the discipline when one or more specialties within psychology seek licensure. There appear to be 40 member organizations of the Japanese Union of Psychological Associations. As I understand the situation in Japan, many of these national societies or boards – such as the Japanese Psychological Association and the Japanese Certification Board for Clinical Psychology – provide some form of certification to the graduates of some programs in specialized applications of psychology to selected populations of students, patients, or others. However, there is not yet governmental national level legal licensure of psychologists for practices. I also understand that there is substantial interest in Japan about establishing national licensing as various subdisciplines of psychology strive to address societal needs (Sakano, 2004). One aspirational answer to the question of “Why seek licensure?” is (from a recent paper authored in Japan) “so that professional psychologists will have increased economic stronghold in Japan and rank equally with other nationally licensed professions” (Tanaka-Matsumi & Otsui, 2004; p. 204). After having invested in training, psychologists want to be recognized as the professionals they are, be more competitive in the marketplace, and protect their incomes. Indeed, it is often the belief and the hope that licensure will bring respect and economic gain that motivates seeking licensure. If reference to other licensed professions in the United States can be taken as any guide at all, this may be a false hope! Both chiropractors and practical nurses are commonly licensed, but neither is well remunerated nor are they held in especially high regard. Public respect clearly springs from bases other than licensure per se. We can speculate on what these bases are and seek to develop them. At least one basis is having established empirically supported interventions that the public is informed about. Most psychologists have civic goals, as well. They want those who wish to call themselves “psychologists” to be graduates of quality programs and to have been well trained in psychology. This motivation typically leads to “accreditation” of training programs and “certification” of individuals. Legal recognition of “accreditation” limits competition through enrollment capacity limits, while legal recognition of “certification” results in “protection of title”. How institutions and competence are defined and assessed is a special challenge to the recognizing organization. Either or both of these steps may contribute to defining the profession's scope of practice on a permissive basis. Accreditation and certification are commonly the initial steps towards instituting licensure, and Japan has made some progress in this. However, further licensure may be a necessity if psychologists are going to have privileges to practice their specialties in hospital settings or in the community in parity with other providers of services – and even that may not be enough (e.g., Holloway, 2004). Government licensure is a governmental response to a perceived need to protect the public. It is essentially a “consumer protection” action (Vaughn, 2006; Wilson, 1982). The purpose of licensure is to insure that those who are offering services can deliver the services to some benefit and without public harm. Licensure is a designation that should engender public trust. However, such trust is neither automatic nor necessarily warranted unless the profession fits into the zeitgeist. For example, licensing astrologers in the USA would not increase public respect nor public trust because the public at large does not believe in the foundations of astrology, but rather mostly sees it as “entertainment.” Nonetheless, it is the general case that government regulation and licensure of psychologists reflects that the discipline in that country has reached a level of development, sophistication, and usefulness in addressing societal needs to warrant recognition. It is in fact the International Union of Psychological Science policy that “The International Union of Psychological Science supports legislative recognition, or the equivalent, of Psychology as an autonomous profession based on established standards of education and training anchored in scientific psychology”. The Union stands ready to support applications to legal regulatory bodies that recognize professions in countries that have established standards of education and training anchored in scientific psychology. Objections to licensure of psychologists arise from a range of society forces. Commonly, objections come from other professions – such as medicine – as well as from those who would not meet licensure criteria, but infringe on the psychologists’ scope of practice. These professions may argue that there is nothing special in psychology that they cannot do. However, reference to an established list of knowledge bases and skills at interventions in which psychologists have been trained and the others have not – that is, the psychologists’ scope(s) of practice – can be used to make clear that psychology is a profession uniquely able to make contributions to human welfare and well-being. The government protects the public by ensuring that the named person meets specific standards. Historically, this was through setting specific educational and training requirements. In recent years, this has become more focused on the attainment of designated competencies. As part of licensure, the government typically ensures that proper training exists, ensures that the training requirements were met, ensures that the person has adequate knowledge for the specific license, ensures that the person has specific skills and competencies, and ensures knowledge of ethical practices. The licensure process is commonly based on both educational standards and separate examination standards (Association of State and Provincial Psychology Boards, 2006). Government insistence on licensure may also spring from a need to protect government and private insurance programs from expenditures on ineffective interventions. By licensing psychological practitioners and paying only them for specific services, government ensures value for money – assuming that psychological interventions are of known efficacy. This last point brings up a whole other important area of concern for the discipline and it is the issue of empirically supported or evidence-based interventions. This issue has in the USA been one of heated and extended debate with regard to what constitutes proper empiric evidence supporting an intervention. Certainly randomized controlled trials are one source of evidence, but not the only acceptable source. What is clear is that in the absence of a catalog of empirically supported interventions, there is little government interest in licensing “scope of practice” in psychology. Indeed, in most countries that do have legal licensure, what is regulated is the use of the “title” and not the “scope of practices”! Protection of title is most commonly at the behest of the profession rather than reflecting a governmental need. This fact does not mean that protection of title lacks value for the public; protection of title does insure that the practitioner has specific qualifications. The difference between licensing the “title” versus licensing the “scope of practice” is critically important for the field and for those seeking licensure for psychologists. Only licensing the “scope of practice” insures against other professionals (or even non-professionals) from offering services identical to the psychologist so long as they do not call themselves psychologists. As I noted, in most countries “scope of practice” for psychologists is not protected by license. Where anything about scope of practice is mentioned at all, it is to limit the psychologists’ activities. As an example, the licensing law of the State of Minnesota in the USA says that a licensed psychologist may practice independently (meaning without supervision), must practice within the licensee's stated competencies, must adhere to the provisions of the Psychology Practice Act, and is subject to penalty for violation of any of these. Note specifically that these provisions limit the psychologist, but do not limit others who are not licensed (e.g., pastoral counselors)! That is, the psychologists’ scope of practice is not protected. It is “scope of practice,” however, that is licensed in the medical professions around the world. No matter what you call yourself, you cannot go out and do surgery without a license. This contrast between psychology and medicine is an important instruction regarding the type of licensing law psychologists ought to seek. However, as noted, it cannot happen without empirically supported interventions as the armamentarium of the trained psychologist. Without these, there is no “scope of practice” to license. I do not want to be negative; psychologists do have a substantial list of effective interventions, but we have not always taken the necessary efforts to provide the full evidentiary base required. These points are summarized in Figure 3. What is to be protected by licensure? Psychology is a diverse discipline. We have child psychologists, developmental psychologists, educational psychologists, career counseling psychologists, family psychologists, clinical psychologists, gerontological psychologists, health psychologists, industrial-organizational psychologists, sports psychologists, social psychologists, assessment psychologists, forensic psychologists, economic psychologists, and even traffic psychologists. And, let us not forget all those professors of psychology. What is to be licensed? Each and all of these offer services to the public. Does one seek a general license to practice psychology (“licensed psychologist”) like the “general medical practitioner” license for physicians? Or, does one seek to license each specialty (“licensed clinical psychologist,”“licensed gerontological psychologist”)? If one licenses each specialty, then when does a clinical psychologist's practice spill over into a developmental psychologist's practice or a health psychologist's practice? Or vice versa? The challenge of defining boundaries is not trivial for the discipline or for the specialties. In some Scandinavian countries, the government recognizes “psychologists” who have completed a specific regimen of training, and they are broadly authorized to practice any area of psychology. The national association may offer additional certification for a specialty practice. In the USA, there are somewhat different licensing practices in each and every state (N = 50). Some states only restrict the use of the title of psychologist. Some states have a single title, but the individual's license may delimit the areas of practices in which the individual may engage (say, industrial-organizational psychology rather than clinical psychology); other states have specific titles for some claimed area of practice. Typically, the seeking of licensure has been driven more by those in clinical psychology than those in other areas. An important consequence of this is that the model licensing laws developed often attend more to the specific needs in clinical psychology than other licensable areas. Writing a licensing law that applies only to clinical psychology can later create special challenges for these other licensable areas that might be avoided from the outset by thinking through the licensing goals and processes that might apply to all areas. One example of such a challenge might be in terms of including a specific legal requirement for licensing that includes a requirement for an experience that would be irrelevant or unavailable to other specialties; an example of such a requirement might be for an “accredited internship” experience that might not yet exist in all specialties. This has happened in some countries, and it reflects more a failure to see the consequences for colleagues rather than an intention to challenge colleagues (Tippins, 2006). Nonetheless, it is to be avoided. Any country contemplating new licensing laws needs to think through fully the ramifications of the different “naming” strategies and the consequent opportunities, restrictions, and limitations a strategy implies for the qualified psychologist. But know at the outset, if you choose to have lots of specialties, each to be separately licensed, and each having very different training requirements, this will complicate the licensing law process and it has the potential to divide the discipline, set psychologist against psychologist, and engender feuds over where the boundaries are between areas of psychology. Combinations of general government licensing and association specific certification may be a partial resolution, but it is not a perfect solution. In addition, are psychologists that are to be trained for a licensed profession going to be required to receive their training from licensed psychologists and only licensed psychologists (and if so – must they be licensed or certified in a given specialty)? This decision at the licensing law level will necessarily impact the college and university faculty composition. Additionally, will the licensing law specify how much training and how many courses in the specialty? This, too, will impact on the curriculum and the composition of the faculty needed to deliver the curriculum. Will the universities cooperate by changing their faculty compositions? With limited budgets, requiring more courses in one area necessarily means fewer courses in another area. Do you want the licensing law that serves one sub-area of the discipline to shape the training of the whole discipline? If one perceives oneself or one's university as engaged in training practitioners to serve the public, it would be very natural to train psychologists in the widest array of effective skills. Unfortunately, as one requires greater breadth and depth in applications that may benefit the public, there is less time and energy for training in the basic science that underlies the interventions and in the scientific understanding of the phenomenon itself that, if grasped, could lead to new interventions. Different countries have different training strategies. Some Asian countries only train in psychology to the “Bachelor's degree” level (some require even less training). In the Scandinavian countries, students get 6 years of training totally focused on psychology. The students are exposed to conceptual foundations, principles, and to applications – although the depth in these is necessarily somewhat limited because they cover the full scope of the field. Training for the Canadian PsyD degree has a similar broad structure. An emerging model framework is being developed within the European Federation of Psychological Associations (EFPA). This model appears to have much in common with the current Scandinavian model, but assumes 5 years of academic training plus 1 year supervised applied practice for the EuroPsy degree/recognition. It is assumed (but not required) that individuals will go on to further specialized training. In each case, the training is deemed adequate for independent practice, it is generally not deemed adequate to sustain the graduate as an independent researcher; for this a doctoral degree is required. A narrower, alternative model is found in the USA, and is called the Boulder Scientist-Practitioner model. After an undergraduate degree with one-third of the time devoted to psychology broadly conceived and the balance in supporting areas, the student receives 4-6 years of additional graduate training psychology with only limited exposure to the full range of psychology. Rather, the focus is on one specialty area (clinical, counseling, educational, or other), but with substantial depth there, including completion of a significant research program typically resulting in a PhD degree. This training is expected to be sufficient to sustain the student as either an independent practitioner or as an independent researcher in the area, or both. This Boulder Scientist-Practitioner model was consensually derived in the USA in approximately 1949 (Raimy, 1950) and continues to be much discussed in the literature. The Boulder Scientist-Practitioner model was introduced to Japan in 1996 (Imada, 1996). It is worth noting that while the American Psychological Association subscribes to the Boulder Model and to the view that the PhD degree is the degree required for independent practice, other national organizations in the USA – and some states’ licensing boards – subscribe to the view that a Master's level degree is sufficient training for some forms of delimited independent practice. Some governmental units even have multiple levels of licensure recognizing different levels of training (e.g., Foxhall & Daw, 2001). It is not my function here to certify which model is better or which level of training is the appropriate level. It depends on the context in which the individual will function and the national goals the discipline has for their graduates. However, it is clear that the different training strategies yield different types of psychologists with different types of competencies. One consideration in choosing a model, however, may be that a more limited training focused on techniques limits the individual to those techniques, while training in the scientific understanding of phenomena and concepts guiding interventions allows for more flexible, creative, and adaptive responses when faced with complex multiple factor situations. Moreover, the greater level of training required for licensure lends greater stature to the professionals – and to their trainers! Some countries, of course, may not yet have the infrastructure to offer graduate-level training, but that is not the case in Japan. A review of discussions across nations suggests to IUPsyS that the future expectations for licensed independently practicing psychologists are likely to be for a level of training that is going to be the equivalent of at least the Master's degree levels (EFPA). Accreditation, certification, and licensure all serve valuable purposes for the public, the discipline, and the psychologist. There are also costs in terms of the regulation of training, and of practice activities as noted in Table 1. In addition, the process of seeking licensure places demands on the discipline to define itself, to catalog psychology's knowledge-bases and skill-bases, to evaluate what training psychology now offers and what should be offered, to develop criteria for educational practices, to develop criteria for mastery of knowledge and skills, and to develop methods for assessing these things at both the institutional and individual competence levels. These are major tasks that require a high level of organization best accomplished within formal organizational structures. The associations should work closely together to develop a model licensing law(s) to facilitate government enactment that will serve the public, the profession, and the discipline. As these things come to fruition, regulations will follow and bureaucracies will enforce the regulations – and any limitations implied. Sometimes in drawing up regulations for one facet of psychology, there is a risk of impeding another. For the benefit of unity of the profession, within-discipline contrariety needs to be avoided. In seeking forms of “recognitions” for psychologists, one needs to be concerned not only with the specialty to be recognized, but also with the impact on the whole discipline and all psychologists. Associations and training institutions should recognize that requiring higher levels of training for licensure of independent practice of psychology conveys not only higher status to the licensee, but also to the trainers as well. In addition, the licensee trained to the higher level is more likely to find successful applications in complex cases and be more flexible in adopting newer scientific findings to the presenting cases. An argument for higher levels of training as embedded in the Boulder model is that there can be no continuing development of practical applications of psychology without continuing development of strong foundations in basic science related to the applications. To train practitioners to a lower level than that required for the science is to inadvertently create barriers to applied questions fostering new scientific inquiry. It is best to think of the science of psychology and the practice of psychology across the spectrum as reinforcing each other and informing each other. Both are needed as partners for a healthy discipline. A careful cost-benefit analysis of these multiple issues appropriate to the national and cultural context is warranted.