It’s not everyday you wake up and find your profession in midst of a holy war.
Yet that seems to be what’s happening in the profession of clinical psychology. A new journal article to be published next month by Timothy B. Baker, Richard M. McFall, and Varda Shoham (2009) suggests that psychology is falling apart. Specifically, the researchers argue that graduate training programs for psychologists studying to become psychotherapists has taken a wrong turn and needs to be turned around before it’s too late.
So what steps could be taken to fix the apparent problem? Funny you should ask, because not only do the authors have a prescription, they actually started implementing their prescription more than a year ago.
Is Psychology Like Medicine?
Baker et al.’s argument largely relies on comparing psychology to medicine. After all, they both help people get better. To me, though, such a comparison belies some psychologists’ inferiority complex — always wanting to be “real” doctors, garnering the same kind of respect as “real” doctors do.
The crux of the argument hinges on whether it’s a fair comparison — is psychology like medicine? If so, then perhaps there’s some merit in looking at the medical model for its training. If not, then looking at how medicine trains doctors — while an interesting intellectual exercise — is engaging in a logical fallacy.
The human body is a complicated piece of plumbing and electrical work all put together in one messy piece of organic material. But it’s solid, real. You take a scalpel to the skin and you know exactly how much pressure to apply to make an incision. We now know to scrub our hands before surgery to prevent infection from organisms that live on our hands.
We still basically have no idea how the brain works, however. We can’t flowchart working through someone’s imagination, or an emotional reaction to a traumatic event. Sure, we can treat these things, but is it the same as what we know about and how we treat the human body?
It would seem to be a far more fair and an “apples to apples” comparison to not look at how doctors train in medicine (since very few doctors do anything like psychotherapy), but rather look at how other professions train their students to become psychotherapists. After all, you wouldn’t look toward an electrician’s training to understand how to train a good programmer (although both share many commonalities, such as good problem solving skills and the ability to design complex systems).
Despite the fact that other professions provide more psychotherapy than psychologists do, these researchers apparently believe that other professions don’t have much to offer psychology’s training programs. “Master’s level” training is just assumed to be inferior by definition.
If Psychology is Like Medicine, Is Medicine Creating Good Science Practitioners?
Let’s say that the researchers’ comparison is somehow valid. Is medical training really the “gold standard,” creating good doctors who keep up on the research and their medical training throughout their career? Do most doctors use evidence-based procedures in their profession?
The answers are not at all clear. Medical science advances at such a great rate (there are over 5,000 biomedical journals in publication and over 400,000 research citations added to MEDLINE every year), it would be irrational to suggest that most medical doctors keep up with the research. If they did, the medical profession wouldn’t only just now be getting around to practitioners actually following evidence-based medicine guidelines. If the medical model of training was one worth modeling, why has it taken 60 or more years for doctors to actually start doing what the research tells them what works?
Research suggests that many physicians don’t practice what their training supposedly preaches anyway. Buchbinder et al. (2009), for instance, found that in a study of 3,381 general practitioners who actually have a special interest in back pain, the physicians held pain management beliefs contrary to the best available evidence.
Hay et al. (2008) noted in a different survey of physicians that, “Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and evidence-based medicine summarizing electronic clinical resources rather than refer directly to the evidence-based medicine literature.” Sounds familiar, doesn’t it? The medical literature is littered with similar examples. Medicine is not exactly doing an exemplary job of training scientist-practitioners after all — they study one thing, and practice another.
Even if we take it that some physicians do keep up with the research, is that inherently a good thing? With research that’s been ghostwritten by pharmaceutical companies and clinical trials that bear no relationship to reality, it’s legitimate to ask — What research can we trust and generalize from? Most research studies have been designed and conducted in such a manner as to minimize other factors that may influence the results. But because of this, most real-life patients don’t resemble the people used in most research studies. There’s no way to know whether a particular research study is going to stand up to the test of time.
A Solution to the Imaginary Problem
A straw man argument is when one side creates a position that distorts or exaggerates the other side. I’d argue that, sadly, this is exactly what Baker and his colleagues have done.
Psychology isn’t failing to churn out good therapists so much as it’s failing to churn out psychologists that meet the authors’ own arbitrary definition of what constitutes a “good clinician” — those with a rigorous background in research. Would you expect any different argument from three Ph.D. academic researchers?
77 comments
As a patient, and hopefully future PsyD, I have to say that most of what I read on here, aside from the article itself (which was very well written and had a healthy sense of skepticism) is a little alarming.
I agree with Dr. Sam and some others here who find the disconnect between the academic mentality and the actual human.
One thing that I find startling as a patient is the lack of compassion from some of the practitioners I have met. It means a great deal, as a patient to have someone acknowledge one’s pain.
Although I understand the importance of research, I have to agree that too many researchers forget the difference between humans and lab rats.
I will as a clinician, never forget that the person in front of me has a spirit that is ill. That is trying to heal and that my job is to help in that process.
Melodramatic as that may sound to you staunch academics, so be it. That’s where I will choose to work from.
Lastly, to skillsnotpills, your comment of the social work field was harsh and untrue. I know many social workers who have great insight into the human experience and are great healers. No, they don’t have the training that you think premium, but what they lack in what you consider top-notch training, they make up in innate intuition. Something I have seen lacking in many a ivy league trained hacks.
“Although I understand the importance of research, I have to agree that too many researchers forget the difference between humans and lab rats.”
While Human Beings are unique in the sense that they have abstract reasoning and complex language, the fact is we are animals. That isn’t to say that makes us unvaluable, but we are animals and a product of evolution. This is a fact.
Plus, Cognitive Science and Social Psychology has reveal a great deal about Human Beings as I stated before.
I also find it funny that many people seem to think of Scientists as being cold and austere, yet have not provided any evidence for this. Just anecdotal evidence which isn’t reliable for the reasons as I stated above.
“One thing that I find startling as a patient is the lack of compassion from some of the practitioners I have met. It means a great deal, as a patient to have someone acknowledge one’s pain.”
I have also met many Clinicians who relied on their intuition and clinical judgement but weren’t understanding and empathetic to my mental illness which is Social Anxiety Disorder. I’m sorry, but just because a therapist relies on intuition doesn’t mean that they are understanding and empathetic. Also, Scientist do dwell on Cognitive Processes as the field of Cognitive Psychology shows.
Pt. # 5678,
That was a perceptive contribution. I liked it!
I would like to direct you to what I consider a great way to explain what you and I are trying to describe. David Hawkins, a psychiatrist, broke down how you can know where people are at in their lives in terms of “enlightenment.” The model explains well why people are stuck in certain levels. It also explains why some persons are live in emotional darkness along with their belief systems. There are toxic levels and inspiring/empowering levels. The model explains why some persons make you feel exhausted when you are with them and others energize you.
It is interesting that Hawkins quantifies how persons who are “academic” are stuck in a rationalistic level where they do not understand what the power of healing is behind unconditional love. One reason is because they have to control their world and love is scary. To go into the realm of uncondtional love one must be willing to admit that one’s intellect might be flawed or imperfect and linear. Love is not linear and you must surrender your ego to enter there. Hence many academics can only refer to unconditional love but do not live it. That is why they make lousy therapists/healers.
I found a good link that explains well Hawkin’s model in a cursory way. He has written extensively on the matter. I recommend his first book on Power Versus Force as a great eye-opener.
Here is the link and I wish you amazing success as you pursue becoming one of the great healers of our time:
http://celestinechua.com/blog/2009/02/map-of-consciousness/
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
Pt. # 5678,
Sorry for the typo. I meant,”That was a great contribution. I liked it!”
A Clinician can rely on Science and use empathy to their clients. In fact, it is very much emphasized in CBT. For instance, in the book “Anxiety Disorders and Phobias: A Cognitive Perspective” by Drs. Beck, Emery, and Greenberg, you will find that a guideline for using Socratic Questionings in therapy states “The questions should be timed to foster rapport and problem-solving.”
After reading and re-reading some of the “history”, description of, and mission of PCSAS, it is clear that the issue supersedes just a conflict of interest.
The mention of only Ph.D. programs on their website, and their explanation of why there needs to be reform (a shift from University based programs to free standing for-profit programs, large classes, etc etc) is a direct attack on Psy.D. programs. I doubt very much any of the Board of Directors have a Psy.D.
It is clear that their main beef is the lack of emphasis placed on research in “these programs” (my quotes). However, it seems that they make greatly overgeneralized statements about Psy.D. programs and research, as many programs incorporate research/experimental training and emphasize the importance of research in clinical training and practice. These are the practitioner -scholar model programs.
My feeling is that these individuals feel threatened in some way since there is nothing preventing someone with a Psy.D. from working in academia or conducting research. Somehow, they are upset about this.
The Vail Conference made it perfectly clear that PhD programs did not adequately prepare individuals for clinical work as programs up to that point where to much based on research. In fact, if I remember correctly, the Vail Conference and emphasis on shifting to another model was headed by PhDs who felt ill prepared for direct clinical care.
As upsetting as such a reform might be to us PsyDs (in the words of Rodney Dangerfield, ‘No Respect!’), in the end I’m not too worried. The gold standard of accreditation for psychology is the American Psychological Association. If you attend an APA accredited graduate program, you are golden.
I feel that in order for these folks to push their propaganda and get ahead, they are going to have to directly challenge APA in redefining what constitutes a “good” clinical program – somehow, I don’t see them succeeding.
However, its probably safe to assume that somewhere, some program or programs will embrace this push for reform.
It will be interesting to see which ones actually apply.
Dr. Wayne,
I share your views. I also have wondered whether there is a subtle bias and discrimination towards Psy.D.’s from Ph.D. academicians at institutions offering Ph.D. level Clinical Psychology programs. One thing I have noticed is that Psy.D.’s tend to get relegated to oversee only or primarily clinical practicums/residencies instead of being permitted to teach standard graduate curricula. I also do not see many Psy.D.’s being given chairmanships of Psychology departments at these schools. I do think there are some schools that do not have this bias but they are smaller ones, private, and not so close-minded.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
Dr Wayne – Indeed, reading the paper itself is an exercise in watching authors try and implicate an entire set of dozens of degree programs with broad-stroke generalizations, all the while saying “while there are exceptions…” Well, if there are “exceptions,” why not delineate what specific programs — regardless of degree — are subpar (in their eyes) and design their new credential around that. Instead, you have many paragraphs about the evils of Psy.D. programs.
And I say “evils” tongue in cheek, since the largest evil of these programs is that they are not as research-oriented as most of their Ph.D. brethren. Which is, of course, by design.
Seems like some academics want us to go back to the 1960s, when there were very few psychologists being trained, and it was indeed a very elite profession. Now that it’s been opened up to more individuals (who the researchers basically call dumber), they are crying to try and reinstate the standards of 40 years ago. Good luck with that, I say.
The barn door’s been open and there’s no putting the horses back in.
My comment was lost and I hope it won’t appear later as it sometimes does.
I was thinking about a favorite researcher, Bessel van der Kolk, and who is well known in trauma research. He has tons of integrity, and is very caring as well.
He told, (at a lecture I attended) that the problem with his research is that he cannot do what he needs to do because of Government regulations/limitations, and I really empathize with his frustrations. (They are ridiculous!)
Van der Kolk used to be popular with the ‘elite’, and by that I mean the field of Psychiatry and Psychology that goes by the ‘Bible of psychoanalytic therapy and thinking’.
But he no longer is because he searches for truth more than popularity, and he has found that many other types of therapy are of great benefit in the treatment of trauma, including such as ‘Massage Therapy’.
Talking about a compassionate researcher and scientist!!!
As a mental health patient who has been in treatment for over a decade, I would love to see the revival of psychiatrist-therapists, educated and trained to practice from the psychoanalytic, psychodynamic, CBT, and/or eclectic approaches.
After nearly decade of treatment, I have come to be extremely thankful and appreciative of my “T-Doc”, Dr. S., who I was lucky to have found after all these years. Now I see what I’ve been missing. My regret is not finding this type of clinical practitioner sooner, as neither general practioners nor psychiatrists have recommended this type of treatment to me. I did not know they existed.
I also appreciate the thoughtful comment from patient and future clinician Pt. # 5678 (8:07 pm on October 5th, 2009):
“I agree with Dr. Sam and some others here who find the disconnect between the academic mentality and the actual human.
One thing that I find startling as a patient is the lack of compassion from some of the practitioners I have met. It means a great deal, as a patient to have someone acknowledge one’s pain.
Although I understand the importance of research, I have to agree that too many researchers forget the difference between humans and lab rats.
I will as a clinician, never forget that the person in front of me has a spirit that is ill. That is trying to heal and that my job is to help in that process.”
I cannot forget that one of the most compassionate, dedicated, and skilled therapists I’ve had over the years was a clinician who had a LCSW degree. I’m not sure how the training/education is today in this field (he was in his 60s when he passed away a few years ago), but he sure was a star who shined admist the plentiful faded and dull ones in the therapeutic sky…
Thanks to all the dedicated therapists out there who are truly compassionate and empathetic to those of us who suffer from mental illness. 🙂
Bravo, Mental Health Patient!!!!!
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
To Mental Health Patient:
“Although I understand the importance of research, I have to agree that too many researchers forget the difference between humans and lab rats.”
I hope you aren’t implying that human beings aren’t animals.
Also based on what evidence can you support that researchers aren’t compassionate? Do you have a survey?
I’ll give you one interesting finding in this area… While all therapists surveyed in one study agreed that being in therapy was important for a therapist, cognitive-behavioral therapists were least likely to actually have been in therapy themselves ever. Researchers often love CBT because it is a treatment approach that is amenable to manualization.
Manualization, to many psychologists and therapists, is the exact opposite of what they view as what makes therapy work. Even medicine rarely adheres to any kind of rigid manualized treatment for disease treatment. While there are certainly practice guidelines, they don’t boil down to a step-by-step how-to guide.
And that’s what I think you find clinical psychologists (and therapists) objecting to — the idea that you could train an educated high school student following a manual to do the same work they do. (And why couldn’t you, if manualized treatment was the supposed gold standard? Who can’t follow a manual??)
Dr. Grohol,
I think perhaps also CBT therapists tend to be less disturbed and neurotic than ‘the other type’.
About 25 years ago, I was hospitalized on the psychiatric unit of our local hospital, and before HMO’s and all the ‘bad’ stuff started taking over. There was this one Social Worker who mostly did referrals and paper work. Another Social Worker did the group therapy. This man practiced there for 20 plus years and was never once observed by another therapist, or supervisor of any kind. He was not only ‘worthless’ but totally destructive…horrible, but nobody listened to me, of course. Then there was this art thing, and for all these affairs your psychiatrist decided if you were to go or not.
I was on that same unit again some seven years ago, and now in a time when the moment you arrive your discharge planning begins.
But there was this really, really great change that I saw, and I had absolutely zero experience with CBT.
There were a few of them, and all day long, every hour, a different therapy for patients took place, all CBT. It was no longer your psychiatrist who decided if you were to go or not, but the patient. You could attend as few or as many as you wished although it was greatly encouraged. The therapist would walk around to the rooms and everywhere and encourage you to go.
And they were absolutely fantastic. the therapists, and I don’t know what their education was, were not only nice and kind, but really normal. There was no ‘hidden agenda’, and no ‘bullshit’. These sessions were so effective and even fun, and I totally could use them. example: maybe there were eight of us patients, and the assignment was to organize what we would do if we were lost as a group on some island, or whatever, after our plane or boat, or whatever, crashed. We had just so much food, and so much shelter stuff, and other things. how would we decide what we needed most to take with us on our journey to get back to civilization? (that type of thing)
Then also, another person came to tell us exactly what to do if we had problems or complaints with any staff, and what number to call, and that someone would immediately show up without first telling any staff person.
Every session we had to do an evaluation as well, etc, etc…really great changes to make the stay more effective than it used to be.
(not edited) KAT
Carlos at 3:02 pm on October 7th, 2009 – “Also based on what evidence can you support that researchers aren’t compassionate? Do you have a survey?”
Hi Carlos,
Like many others, I was adding my opinion in response to the article and to some of the comments, so I didn’t feel it was necessary to find definitive surveys that measure the compassion levels of researchers. However, I recently came across this study and thought you might be interested:
Abstract
“Preserving and promoting empathy are ethical imperatives in medical education. The authors of this commentary propose that the hidden curriculum and mixed messages learners frequently receive during clinical rotations may erode humanistic traits essential to high-quality care. Three articles in this issue focus on assessing attitude towards empathy in the health care setting using the Jefferson Scale of Physician Empathy. The authors discuss salient points from these reports, reinforce the concept of empathy as a cognitive attribute, and offer recommendations for teaching and nurturing empathy in health professionals. In the reports, construct validity and reliability of the instrument were confirmed and were comparable with previous results, thus providing medical educators with a sound instrument to measure empathic attitudes in the context of patient care. The authors agree with the distinctions made in the three studies between empathy (described as a cognitive attribute) and sympathy (described as an emotional attribute) and believe that empathy as a cognitive skill can be role modeled, taught, and assessed. Barriers to empathic practice (lack of sufficient role models, failing to teach empathy as a cognitive skill, negative experiences, time pressures, overreliance on technology) can be remedied in medical education through interprofessional education and practice and institutional promotion of relationship-centered care, which maintains the centrality of the patient-clinician relationship while recognizing the importance of relationships with self and others.”
http://journals.lww.com/academicmedicine/Fulltext/2009/09000/Commentary__Identifying_Attitudes_Towards_Empathy_.8.aspx
Although the article does not reference researchers, it does touch upon some of the concepts discussed here.
I have also seen studies that indicate the therapeutic alliance may be more important for positive patient outcomes rather than the type of therapy provided. If one is interested enough, I would guess that anyone here is capable of googling to find relevant articles.
John M Grohol PsyD at 4:20 pm on October 7th, 2009 – “I’ll give you one interesting finding in this area… While all therapists surveyed in one study agreed that being in therapy was important for a therapist, cognitive-behavioral therapists were least likely to actually have been in therapy themselves ever. Researchers often love CBT because it is a treatment approach that is amenable to manualization.”
That was a very interesting comment, Dr. Grohol. I’d like to expand upon that and point out that my T-Doc spent years in psychoanalysis himself and sometimes links his respective experience to my active therapy. I have found this adds to his keen insight.
In my opinion, the manualization of therapy infers exclusion of the therapist’s autonomy, and it seems to undermine the art that encompasses insight, methods, and solutions that should be tailored with the uniqueness of the individual in mind. Patients all have different histories and personality constructs, and it seems odd to lump us all together with the facilitation of one standardized method.
However, I can’t dismiss CBT. While CBT did not help me one bit, other patients have said CBT has been effective for their situation.
Mental Health Patient,
Good source you cited.
I am amused when only “logic” type persons look at intuition, the heart, empathy, etc. like it is a project or a construct. It just shows that they are not from the same planet. It shows that they do not live in the realm of “connection” on deeper levels with persons that goes way beyond simply an intellectual exercise. It is a safe thing to stay in that realm because one can control his/her world via logic… so he/she thinks. Connecting with something like unconditional love is incredibly scary to these folks or there is simply no wiring present or activated to do that.
I personally think that researchers who cannot be good clinicians who connect with patients is simply a reflection of their own emotional developmental deficits. It relates to attachments issues, primarily, growing up in a home where the child learned to disconnect from his feelings because of pain, shame, etc. or it was simply not modeled at all and one parent or both were narcissistically stuck inside themselves. Perhaps that is why these individuals gravitate towards a career in research because that arena does not necessitate being connected with your heart/soul and you can still look good if you live up in your head by becoming good at “logic.” Never mind that perhaps co-workers might not like you or that you could be socially inept.
Again, I reiterate that it is the best to have the head and heart connected (metaphor). One needs the other. Both are best, not just one.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
I remain disturbed by the lack of any conflict of interest statement posted with this article. Despite the fact that two of the three authors are directly involved in an organization they promote within this supposedly scientific article (and same with the accompanying editorial), no mention is made of this involvement in the article’s text. Why aren’t these conflicts declared?
I also failed to note the authors’ mention of the APCS credential, which according to the authors recognizes 52 doctoral programs and 10 internships. Guess how many people know of, heard of, or care about APCS? Even I wouldn’t recommend a person seek out a clinician who’s gone to one of these programs, because it’s a meaningless credential.
I tend to admire the Association for Psychological Science (APS), the organization behind the publication of this article. But with the publication of this article, they demonstrated how clearly they are promoting a political agenda over a scientific one. And because of that, they’ve lost my admiration for their devotion to science. So much for that.
Dear John,
Thanks for uncovering the conflict of interest in the article about psychologists being poorly trained. Could you write a letter to the editor of the LA Times informing them of this? Otherwise, it is an undeservedly negative article about psychologists, of which I am one. They should have looked into it before publishing the article.
Baker et al argue that only some treatments have been validated by the research, and thus psychologists should be implementing that select group of treatments. However, this ignores the dodo bird effect, that all bona-fide therapies are equally effective. Thus, to claim that those who do not use a subset of treatments are unscientific, ignores the scientific data that all bona-fide treatments are equally effective.
Actually, there is a far more serious issue. Namely, psychologists are not taking the vital signs of therapy. There is a vast literature on the importance of the therapeutic alliance. In fact, it is the single most important variable in determining the client’s progress in therapy. If the alliance is poor, the client is far less likely to improve. If the alliance is strong, the client is far more likely to recover. The real problem is that psychologists are not frequently measuring the strength of the alliance. We are not picking up on ruptures in the alliance and repairing them.
So, psychology should be like medicine in routinely and objectively measuring the vital signs of the person we are helping. We should be unlike medicine in thinking that there is only one way to help a client. A burst appendix can only be helped by surgery. A depression can be helped by whatever bona-fide treatment that fits with what the client thinks will be helpful. If we impose a treatment that does not fit with the client’s theory of change, (even if it has been validated in a journal) then we will rupture the alliance, and lose the client.
A fuller discussion of this issue is on my blog at http://revolutioninpsychotherapy.blogspot.com/
I refuted the article by Newsweek on my blog. It also contains links to a rebuttal by Dr. Barry Duncan. He took on Newsweek a year earlier about their reporting on medications, and won that exchange.
http://revolutioninpsychotherapy.blogspot.com/
So what is the most efficacious approach to therapy? How can we maximize client’s responses? These are the main questions, and, I agree with Carlos, the questions becomes, how do we acquire knowledge? We must have a valid way to answer these questions, otherwise we’re all just spouting opinions.
Like it or not, science is the way to do it. Frankly, it worries me that a community of clinicians (not all, but some represented here) seem to be either under-equipped to evaluate scientific claims (or why the rigors of science must be applied to clinical psychology) or antagonistic to the knowledge offered by EBPs and other clinical research.
Much has been said of clinical judgment. I agree that this is crucial in successful interventions – not only in assessment but throughout the treatment process. But clinical judgment cannot be the whole picture. This article outlining the work of Meehl (http://www.psych.umn.edu/faculty/grove/112clinicalversusstatisticalprediction.pdf) highlights the wonderful empirical research which has demonstrated the need for actuarial (basically probabilistic) assessment. This is a classic example of how science demonstrates our fallacies in thinking. Turns out, clinicians don’t have the crystal ball to see into our futures. Despite more certainty in their assessments, they are no better than lay people. HOWEVER, this does not render clinicians useless. Work such as Meehl’s pushes the field to become better – to stop doing what we can’t do and focus on what we can. Clinical psychology is too important to be left to opinions – this is why I believe strongly in a scientifically based science of clinical psychology.
As a military clinical social worker/hospital administrator, I have to say that – in my opinion – it pretty much boils down to who is truly “meant” to be in the counseling profession and who isn’t. This applies to the most educated psychologist or psychiatrist and to the “lowly” clinical social worker as some of you ignorantly proclaim.
I consider myself to be a skilled, experienced, and perceptive counselor; however, I am humble enough to know when I need to refer clients to more experienced/focused counselors in other areas/fields.
However, I have also counseled clients that have gone to see some of the “Ivy Psychologists” on staff first, and then have journeyed to see me because of the sheer unprofessionalism and uncaring nature they encounter with said psychologist within just a few minutes of the introductory session.
These are also the same psychologists that consider advancement and power to be their primary focus (I guess counseling is in there somewhere), and any resentment they have towards me being a flag officer/administrator/CLINICAL SOCIAL WORKER is amplified when I have to have a “conversation” with them (some do not last very long here, as I consider counseling to be my passion and purpose, and I have little tolerance for political BS and resentment). One of my best friends, a high school adjustment/general counselor (with an M.A. in Educational Psychology), has experienced the same level of “nose in the air” antics from various albeit very few school psychologists, without any regard to her proven fifteen year successful track record.
In closing, let’s stop pointing fingers, and do what we’re meant to do. A great counselor is a great counselor, regardless of the degree and/or college/university attended.
Just my two cents…. 🙂
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