The cat is out of the bag.
After many
months, I've finally been pushed to finish this article on questionable
credentialing in hypnosis and "psychotherapy." A reporter from a major
magazine wrote to "Dr. Zoe D. Katze" for input on an article she was
writing on hypnosis for childbirthing. She had stumbled across Dr. Zoe's
name on the American Association of Professional Hypnotherapists'
website. I had to tell her the truth.
Dr. Zoe
D. Katze, Ph.D., C.Ht., DAPA, is a cat. In fact, she is my cat.
Those familiar with basic German have probably already enjoyed a laugh.
"Zoe Die Katze" literally translates to "Zoe the cat."
Dr. Katze's
credentials look impressive. She is certified by three major
hypnotherapy associations, having met their "strict training
requirements" and having had her background thoroughly reviewed. She
holds a Diplomate in psychotherapy from an association that claims to
promote the highest standards among psychotherapists.
I was
motivated to credential my cat by two circumstances. First, I have
become increasingly heedful of all the questionable credentials out
there, and I've grown tired of sounding defensive to therapist-shopping
clients who confront me with something along the order of: "I found
somebody with all these certifications and diplomas and he/she charges
half of what you charge."
The last
straw (and my moment of inspiration) came during an internet search for
a colleague. I accidentally came upon the website of another
"psychotherapist" who listed a doctoral degree from an infamous diploma
mill. Along with his degrees, he listed a veritable alphabet soup of
impressive-looking letters after his name, corresponding to various
"board certifications" and his status as a "Diplomat [sic] and Fellow"
of the "largest professional hypnosis association in the world."
I decided to
credential my cat.
This was a
surprisingly easy thing to do. First, since so many financial
transactions are conducted by credit card, I had to get Zoe some credit.
No problem; I just added her as an "authorized user" of one of my own
credit cards. (The credit card agent asked for Zoe's social security
number, but then cheerfully relented when I told him it would take me
some time to search for it.)
The
rest was equally as easy. In the nefarious world of quasi-credentialing
and diploma scams, money talks. Or at least it meows. All I had to do
was get Zoe her first credential, which I did by filling out an
"application for certification" on a lay hypnosis association's website.
I charged her application fee, and within a few weeks, Zoe had her first
piece of paper. Since most lay hypnosis associations have a reciprocity
agreement respecting each others' certifications, it was a snap to
obtain additional (and very impressive sounding) certificates.
Zoe is (or
was, since I doubt I will pay certification maintenance fees) certified
by the National Guild of Hypnotists, the American Board of Hypnotherapy,
and the International Medical & Dental Hypnotherapy Association. She is
a Professional Member of the American Association of Professional
Hypnotherapists.
I next
decided to go for the gold: Board Certification. Since Diplomate status
is generally recognized as signifying the highest level of competence in
a medical or clinical art, I decided to apply for Zoe's Diplomate status
in an organization with which (I must admit) I was once associated. The
American Psychotherapy Association was founded several years ago by
individuals associated with the American College of Forensic Examiners
"to advance the profession of psychotherapy." (The ACFE is itself
struggling to achieve some degree of legitimacy and respect, and was the
subject of at least one highly critical article in a national journal
published by the American Bar Association.)
I resigned
from the Advisory Board of the American Psychotherapy Association after
I sensed that they were talking the talk about integrity in
credentialing, but not walking the walk. As far as I'm concerned Zoe D.
Katze put the icing on this misbaked cake. I initially applied for Zoe's
Diploma online. To their credit, the APA wrote back requesting a resume
or curriculum vitae before they would certify her. (The lay hypnosis
associations did not even ask for that much.) I quickly whipped one up,
and it's a doozy complete with some subtle and not-so-subtle clues as to
Zoe's "real" identity. (My personal favorite: her Consultant position at
the bogus "Tacayllaermi Friends School" in New Castle, DE. Play with the
backward spelling of "Tacayllaermi" and you'll see what I mean.)
I also gave
Zoe a Doctorate in Counseling Psychology and a M.S. in Clinical
Hypnotherapy from well-known mail order universities. To my knowledge,
there are no regionally accredited graduate degrees in Clinical
Hypnotherapy.
Of course,
if APA wanted to, they could have requested copies of the certifications
listed in her c.v., and I could have provided them. No such request was
made. Not for certificates, not for transcripts from the universities
she supposedly attended, and not for any licenses to practice
psychology, social work, or counseling. The APA does not seem to find
these necessary to elevate a person (or a cat) to the lofty status of "Diplomate."
Needless to say, no examination (not even by a vet) was required.
And in a few
weeks, Zoe received a gorgeous, very impressive-looking certificate
attesting to her having met "rigid requirements" resulting in her
"designation as a Diplomate." According to Zoe's acceptance letter from
the APA, Diplomate status "is limited to a select group of professionals
who, by virtue of their extensive training and expertise, have
demonstrated their outstanding abilities in regard to their specialty."
Not bad for
a cat who's not even purebred.
What do
credentials mean, really? In most health professions, the basic
credential is a license. Psychotherapy and hypnotherapy are activities
that are difficult to regulate. With few possible
exceptions--psychological testing may be the only one--they do not
require an ability to utilize a clearly-defined or unique technology
(like surgery) or a tangible asset (like pharmaceuticals). Instead, they
rely primarily or exclusively on communication and human interaction.
Ultimately, then, we are up against a seemingly impossible proposition:
How does one "license" a form of human interaction? Licensing boards
have taken on this improbable task, but they typically do not attempt to
define or enforce any set of behaviors except upon those who submit to
licensing. Of course, there are strong incentives to being licensed,
like the ability to qualify for insurance reimbursement or for certain
agency, healthcare service or government positions. But by and large one
can get by without a license to practice, especially if one has other
sources of income. Some unlicensed practitioners have succeeded quite
handsomely, thank you; unlicensed therapist-cum-author John Gray is one
of the prime examples, neurolinguistic programmer and motivational
speaker Anthony Robbins is another.
And
for the thousands of private practice "counselors" and "therapists" who
are engaged in what is essentially a small part-time business or even a
hobby (they do not need this income to survive), licensing is largely
superfluous and--with its rigid experience requirements, laborious
application and examination procedures, and continuing education
requirements--perhaps even an irritant.
In
psychology and mental health, research on whether licensing actually
assures competence has yielded inconclusive results. Nevertheless,
licensing and certification are minimally capable of doing two things:
(1) guaranteeing that an individual possesses a journeyman's fund of
basic information (at least at the time of the examination) and shares a
somewhat common educational/training experience; (2) providing a system
of accountability to the public.
Compared
with the conservative, rigidly regulated and highly structured world of
medicine, psychotherapy is the wild west of credentialing. When a
physician claims board certification, her patients can be reasonably
assured that their doctor has completed a fairly uniform course of
training and has passed a tough examination. In mental health,
credentialing is a far more varied and amorphous affair. Until
relatively recently, "board certification" meant one was either
Diplomated by the American Board of Professional Psychology (ABPP) or,
if a social worker, by the American Board of Examiners in Clinical
Social Work. There were also a small number of proficiency
certifications available (e.g., rehabilitation counseling, career
counseling) to those who completed substantial training requirements
(and usually an examination) in that area.
But,
in my opinion, something happened in the 1980s and '90s that led
directly to the proliferation of credentialing (and pseudocredentialing)
in mental health. First, the advent of managed care, coinciding with the
proliferation of graduate school programs in mental health (especially
at the masters degree level), led to uncontrolled growth in the supply
of practitioners while demand became increasingly restricted. As a
result, many mental health practitioners began to scramble for a means
(any means) to distinguish themselves, to be perceived as above the
common horde, to be singled out.
Second, the
last 20 years have seen a proliferation of specialties and "techniques,"
some valid, others a bit dubious, and still others the peculiar
invention of their creators. In some cases, like trauma treatment,
neuropsychology and forensic psychology, specialties were essentially
invented where none existed before, due primarily to advances in the
science as well as the practice of psychology. However, other more
arguably dubious credentials also came into existence, leading to the
development of "certified specialists" from "energy therapist" to "alien
abduction therapist" to "past life regression therapist."
How
confusing this must be to clients and consumers of our services. And how
frustrating this is to the legitimate clinician who might be left
feeling "credential challenged" or even intimidated by the therapist who
advertises him/herself with multiple impressive-sounding credentials.
Would
additional laws help? In my opinion, probably not. In fact, l can not
think of a legal or legislative solution that would positively impact
credentialing without creating even worse problems. Unlike medicine,
which often involves immediate life and death issues, mental health
clinicians typically treat more subtle and (with the exception of a
relatively small percentage of critical emergencies) less immediately
dangerous situations. As a result, the public and our lawmakers are less
likely to worry about the inflated or even implausible claims made by
some therapists. In addition, we clinicians have traditionally operated
under a kind of libertarian tradition. By and large we loathe
guidelines, treatment manuals, or any external agent claiming to be able
to judge or measure our competence. Nor do we want anything beyond broad
and inclusive suggestions when it comes to external agents telling us
what constitutes "good" vs. "bad" therapy. And for good reason. Human
behavior and the "mind" are just more complicated than, say, the liver
or a broken bone. What is "good" and "bad" for the psyche is not as
easily defined as what is good for the liver or bad for the fibula. We
psychotherapists continue to argue and debate these issues, and I for
one value our disagreements. I hope we never come to completely
understand the mind and what is "right" for it. (If we ever did, we
would be a short skip and a jump away from a form of
psychologically-sanctioned fascism that would make Orwell's 1984 seem
like a hippie utopia.) Those who claim to know the absolute truth about
the human psyche are more likely to be psycho-demagogues and therapy
cult leaders than benevolent role models.
So it
seems that, with the possible exception of the most outrageous forms of
"certified therapies," we are doomed to tolerate an extremely broad
array of credentialing bodies, from the legitimate to the questionable
to those that are outright shams. It is up to each of us to examine our
own motivations for obtaining credentials (both legitimate and dubious),
to police ourselves and our own professions, and to do our best to
educate the public.
Still,
one has to ask: What value can a credential hold when it can be so
easily obtained for a common household pet? I expect the unmasking of
Dr. Zoe D. Katze, Diplomate in Psychotherapy and Certified
Hypnotherapist, will make some people very, very angry. I hope they will
find it within the purview of their anger to demand serious changes in
the credentialing process employed by these associations.
Limiting a
credential to homo sapiens would be a good start.
