Your degree and your license are likely keeping your clients from feeling better more quickly. The educational system is making you jump through hoops that shouldn’t necessarily be there, teaching you things that don’t necessarily benefit clients, and holding you accountable to things that aren’t necessarily inclusive of today’s clients.
There is a chasm between the graduate education programs and the services that mental health professionals deliver to their patients in all types of settings. Coaches, online tutorials, and even those of us here at The Modern Therapist’s Survival Guide are all making careers out of teaching what isn’t being taught in graduate school. So, if so many people are talking about it, why isn’t anything being done about it?
Before we can do something about it, we first need to examine why we are in this predicament in the first place. There are several different influences that impact what is taught in classrooms. Legislation and regulation dictate the type of coursework needed to fulfill a degree’s requirements. Licensing boards are responsible for creating the content of licensing tests. School administrators interpret the statutes and regulations from both the legislature as well as the accrediting body of the school to determine course content, which may or may not be adequately passed along to faculty. Faculty are left in charge of delivering materials that are mandated, but the choice of delivery and materials may be outdated. Schools that require trainee placements often offer little coordination with field supervisors, whose focus may be more on running the day-to-day operations of the agency rather than providing therapist education and development. Adding to all of this, the associations for each therapist license type advocate for and push for the legislation to reflect the individual services provided by the particular license type which can create turf wars between license types even when the day-to-day operations of the job are essentially the same.
If that’s not confusing and frustrating enough, there’s even more nuance to it. Oftentimes, the individuals who are tasked to provide input to such organizations tend to be more experienced clinicians. We previously discussed how therapists may be losing skills over time, but this does not account for the trend that licensed therapists are not required to learn anything after licensure. While continuing education requirements ensure that people need to sit in front of a lecture periodically, there isn’t much that is required in terms of competency of those skills. The gradual effect of this trend is that the people making decisions are basing those decisions on what they were taught in graduate school.
As an example of how this plays out, an occupational analysis committee is tasked with providing the learning objectives for a state level licensing test. The discussions around the table are about what a therapist should have to know from their graduate studies and pre-degree experience. Discussions can turn to what people are practicing rather than what people need to know for independent practice. The graduate programs who utilize the exam as a metric for course content then pushes the implementation of these objectives into the curriculum for their programs. Students are taught the materials, become members of their professional association, and influence the associations to ensure that standards are provided to ensure that this material is taught again to provide a robust educational method. The leaders of the association, typically senior members, agree that this needs to be taught and influence future legislative education in this manner.
In addition, faculty at universities are often known by reputation for their research, which may or may not translate to the teachings in the classroom. Big name researchers tend to look at psychotherapy techniques within the vacuum of a research setting and are not tasked with the aspects of delivering treatment in the real world: patient payments, running a practice, missed appointments, and generally having a life. The further from these real world issues that the research takes place, whether by time since practicing or layers between research implementation to everyday use, the less practical ability they are able to demonstrate in the classroom as to how the techniques work in the real world. Associate and adjunct professors are often seen as less credible by students due to their standing within the university, but they are also the most likely to have the most recent experiential use of therapy techniques in today’s settings.
This isn’t to say that all tenured faculty are out of touch, but that the field is beholden to slow changes from those that are far removed from the day-to-day implementation of the practice that clients are requesting and issues they face in today’s changing world. The separation between these systems, and encouraged by advocates to keep these systems in place, encourages a mistrust in therapists.
The answers to addressing to these problems aren’t easy. Legal regulations must undergo a change through the legislative process. Professional associations aren’t likely to give up the standing that their respective licenses hold. Licensing boards aren’t going to make things easier because of the optics of “loosening” requirements could potentially be interpreted as not protecting consumer safety.
The disconnect between these different silos require the individual clinicians to seek out what works, come together to put pressure on the professional organizations and legislatures, and create systematic change that addresses one of the biggest challenges of our field: we are doing it this way because we’ve always done it this way.
*Editor’s disclosure: Curt and Katie serve on the Board of Directors for the California Association of Marriage and Family Therapists, Curt has served as a Subject Matter Expert for the California Board of Behavioral Sciences and is an adjunct professor at Pepperdine University. The opinions expressed in this article are those of Curt & Katie and do not reflect statements or positions of any other organizations or affiliations.