Which group would feel more at home with Sen. Bob Packwood (R) (or Sen. Ted Kennedy (D) for that matter), licensed or unlicensed psychotherapists?
If you are a well-educated psychotherapist, are you less likely to do bad things to clients?
There won't be a test at the end of this column, but these and other interesting questions are "somewhat" answered in a report entitled "An Analysis of Complaints Filed Against Mental Health Professionals in Colorado", released in July by the Department of Regulatory Agencies (DORA).
Why was it written? Well, here's the background. Colorado established a grievance board to provide discipline against ALL licensed and unlicensed psychotherapists in 1988, and the new law also added marriage/family therapists and professional counselors as licensed mental health groups. Up until 1988, only psychologists and social workers were licensed.
Quoting from a 1991 DORA Sunset report, one major reason for the 1988 law was because psychology and social work independent boards "were found to be less than aggressive in pursuing disciplinary actions against their peers. The Psychology Board pursued ten actions doing a 26 year period (1961-87). The Social Work Board pursued three actions in a 12 year period (1975-87)."
Six years later, Colorado's novel approach of 1988 became model legislation sponsored by the Council of State Governments in their 1994 volume, page 138, entitled "Psychotherapy Grievance Board Act". That's of some significance to me, since I and former Sen. Steve Durham (R) wrote and sponsored the 1988 law.
In 1991, the Colorado law came up for further Sunset Committee review. One issue raised by unlicensed psychotherapists was a complaint that their group had no role in disciplinary hearings and actions taken against the unlicensed.
Revisions made to the law in 1992 included two major changes: Every unlicensed and licensed psychotherapist had to be listed in a "data base" so that potential clients would know about their background. And, when hearing a complaint against an unlicensed psychotherapist, the grievance board would add three unlicensed psychotherapists to the panel.
Colorado's psychologists were unhappy. First, they disliked being placed under the same law as (ugh!) people without doctorate degrees, such as social workers, marriage/family therapists and professional counselors. Second, they thought the unlicensed psychotherapist should be eliminated (figuratively, of course). The idea of even recognizing that unlicensed psychotherapists were out there legitimately practicing made them frenzied.
The end result was CRS 12-43-220 (4): "The Department of Regulatory Agencies shall gather statistics about the numbers, types, and outcomes of complaints about licensed and unlicensed psychotherapists so that a determination can be made from that data concerning any need for a higher level of protection for the public. Such information shall be reported to the joint sunrise and sunset review committee no later than June 1,1995."
In plain English, psychologists (and possibly some other licensees) want the unlicensed to undergo the same rigors of education, testing, and licensing as the licensed. And the psychologists felt fairly certain that end results of the data collected would weigh heavily against the unlicensed, "so that a determination can be made...concerning...need for a higher level of protection for the public."
There are presently 7,269 psychotherapists in the Colorado "Data Base". Unlicensed total 2330. Licensed psychologists total 1548; social workers, 2046; professional counselors, 1085; and marriage/family therapists, 262. Basically, one out of every three practicing psychotherapists in Colorado is unlicensed.
In the back of the report is a list of 133 individuals against whom disciplinary action was taken between July, 1988 through December, 1994. Some persons had more than one type of violation proven. Numerical breakdown is four marriage/family therapists, three counselors, sixteen social workers, 47 psychologists, and 63 unlicensed psychotherapists. The list doesn't include those whose cases are still under investigation or whose cases have been sent to the Attorney General's office for consideration.
Strictly looking at who came out the other end as deserving of punishment, the unlicensed with 32 percent of the total in the data base, had 47.4 percent of the punishments. Psychologists, with 21 percent of the data base total, had 35.3 percent of the punishments. Social Workers, Counselors and Therapists, with 47 percent of the data base total, had 17.3 percent of the punishments.
From the report, page 34 "In terms of the number of actions taken against each type of psychotherapists compared to the number of each psychotherapist in the data base, the percentages are as follows: 0.3 percent of the counselors, 0.8 percent of the social workers, 1.5 percent of the marriage/family therapists, 2.7 percent of the unlicensed psychotherapists and 3.0 percent of the psychologists."
To put it another way, there were more psychologists doing bad things in relation to their total numbers than in the unlicensed group.
Are the unlicensed "uneducated"? According to the analysis report, the psychotherapy data base shows 69 percent of the unlicensed hold at least a master's degree and eleven percent hold a doctorate or equivalent. The analysis states:
What about our first question relating to sex? On grievance board decisions in which sexual acts were alleged in the complaint, the unlicensed were way out in front, although the information released doesn't tie the sexual act complaint to the punishment, when other violations were also charged.
There were 41 decisions in which sexual acts were charged. The numbers were: Unlicensed, 26; counselors, one; marriage/family therapists, one, social workers, four; psychologists, nine.
What is the end conclusion by the author of the complaint analysis report? Kara Schmitt, Ph.D., hedges on page one because of "too many unknown variables". Her "tentative" conclusion is that what is presently being provided are "alternatives for the public as well as protection should problems occur."
That's not the answer the psychologists wanted, according to my sources, as they and their lobbyist Freda Poundstone prepare for the 1996 session when the psychologists hoped to use the 1995 report as part of an overall plan to get out from under the grievance board and to also ask for the right to prescribe drugs.
Amos Martinez, program administrator for the grievance board, summed up his view in last year's annual report:
"Colorado's law holds both licensed and unlicensed therapists accountable for misconduct. It has also made psychotherapy practice outside of one's area of training, experience and competence a criminal as well as regulatory wrong. In doing so, Colorado has purposely ventured beyond the question of licensure to ensure that consumers are protected from harmful psychotherapy."
This 1996 battle could be an exciting clash of public vs. private interests.
Jerry Kopel writes a column for the Statesman based on 22 years experience as a state legislator.
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