I have never been a food driven person. I am, however, a fact driven person and by connecting through dialogue with like-minded individuals. In a nutshell: I love to learn and talk about what I have learned more than anything else. There’s a popular assessment called Strengthfinder that was utilized both by the graduate school I attended as well as an organization I previously worked for. My top two on this, Learner & Input – and if you’ve been a colleague or classmate, you likely concur with this finding.
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The scrutiny I have with the structure of the licensing process is both personal and professionally based. The original intention of the licensing process is amiable. It can be recognized as a standardized means to assure your provider possessed adequate credentials to fill the role they are in. It was supposed to protect the consumer. What it has become over time is a way to protect the system – both the larger business entities and the individuals who call themselves professionals. As the great-granddaughter of the town doctor before licensing was considered and the granddaughter to one of the first of Board certified physicians, I can understand the intent. As a person who has been diagnosed with PTSD to do with the treatment received by medical providers, I personally experienced the negative impact. I have worked in the professional field of mental health for a decade now and have been studying it twice as long. The intention of application of services is so far awry, I fear it may need shattered altogether for repair.
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One of the ways that I believe most notably reveals how different my brain works from those around me has always been my takeaway from readings. In school, this resulted in the unnecessary reinforcement of second guessing myself and affected my confidence in my abilities. It was during my first Abnormal Psychology class, where the classifications of licenses and their intended roles that I could immediately relate back to my own experience as having been carried through in an in appropriate manner. I attempted to type an explanation of these licenses in longform, but it came off fairly dense and will say couldn’t help but pick up the undertone of my own disdain and judgement. As much as I want a platform for my own voice at this time, I want the ability to provide sound education for others to draw their own opinion more. So I have decided to provide it in a more broken down and digestible form. This should highlight some related facts that I believe are relevant to the potential of the quality of care. **My synopsis should not be considered all-encompassing and is a generalization to be used as a tool for broad understanding, I recognize exceptions exist**
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- Psychiatrist – A medical doctor, M.D. or D.O. who has also gotten training from a 4 year Psychiatric Residency Program – intended to role of medication expert– GPA to get in program: 3.8+
- Psychologist – Doctor of philosophy in psychology. PhD / PsyD – 5 year neuroscience/behavioral work who also does 4 years of postdoctoral work – intended role of diagnosing and directing treatment method2s – GPA to get in program 3.8 -4.0+
- Therapist – This role is trained in the theory application methods – the tools to use to help certain diagnosis based on Evidenced Based Practices from Research in the above roles. These roles should provided information to and direction from those same roles. These are divided into 3 types of licenses.
- LMHC – 2-3 year Master’s in Psychology or Counseling – studies are geared around structural mental health + 2 years under LMHC – Licensed Mental Health Counselor GPA for program 3.2-3.5+
- LMFT – 2-3 year Master’s in Psychology or Counseling –studies are geared around relational psychology + 2 years under LMFT – Licensed Marriage & Family Therapist GPA for program 3.2-3.5+
- LCSW – 1-3 year Master’s in Social Work + 2 years under LCSW – studies geared around community care and recognizing oppressive tactics – Licensed Clinical Social Worker GPA for program 3.0
This is as concise and limited to a general factual basis. I intend limited personal prejudices of any kind. I am positive there are discrepancies, but this allows potential for understanding and laying ground work to assess the current system. The intended application in the current mental health field based upon decades longitudinal research would be for a psychologist to diagnosis and direct the treatment. The psychiatrist should take direction of diagnosis from the psychologist and provide medication. The therapist would use theory to target behavioral change based from what has worked with this diagnosis in similar situations. All three of these providers should have ongoing continuous conversation with not only each other but any other medical provider of the individual. This is best practice. And even this takes far more cultural humility to the populations being served than has ever been availed. Unfortunately, the people of the United States have been provided a romanticized version of what a psychiatrist does through the portrayal by Hollywood on the big screen. This depiction shows what would be most ideal, which is a medical doctor who also has psychology doctorate who is able to fully provide both therapeutic support as well as medication management. It takes a remarkable amount of work and ability to train for the described role, in excess to what the majority individual may be expected to achieve.
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Over time what we have seen, largely, is coastal driven policies which we in the Midwest have done our best to adhere though we do not have the same resources. This has included the demotion of individuals who were, by skill, qualified for their roles but forced into lower positions. I had the honour of my first lead supervisor being a woman closing on her retirement who had filled the role of an intake counselor for substance use disorder for twenty years prior to legislative change stripping of her title due to missing those letters at the end of her name. It was a shame to witness professionals undermining what they could have learned from her. I felt like the lucky one and absorbed all that I could from her.
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As someone who was a nontraditional adult student for both my undergraduate and graduate level degree, I was in a unique space of bringing lived experience to the lessons learned in each. What I have come to learn through many observations is that a person with intuitive clinical knowledge, or learned through lived experience, and that which we have learned and shown through theory are matching one another. This is incredibly great news. One of the conflicts we are seeing in an increasing way, is that those who have the lived knowledge are too often not the same who become privy to theoretical learning. And yet, these are the best individuals to be awarded this knowledge. Not only do they deserve the opportunity from a basis of equity, but they can help others through what they’ve gone through. In my own recovery, it was direct exposure to educating myself that allowed ultimate understanding and is tremendously useful in my efforts to help others.
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I was meeting with a Clinical Psychologist who utilizes EEG for the purpose of diagnosis in a way that is way over my head. I know enough to know we need more biomedical ways to rule out mental health diagnosis based from external symptoms. It was during this time that I was experiencing a health phenomenon that made me ever grateful for his expertise in working with manic-depression and manic-like symptoms. His nonjudgmental compassion with my impulses and inattention over the conversation show how a genuine nature and a mind like mine could really work well together. Our meeting took place in the latter part of November 2024. He was fairly disheveled in appearance, no doubt to do with the feelings someone in his position was having surrounding that tumultuous election. There was a push-pull over the conversation in a way that made my intellectual heart giddy. At nineteen minutes exactly before the end of our one hour slotted meeting, my frustration with liability and regulation and its negative impact on the field of mental health surfaced. He looked at me with a bit of disgust and said “I think this is where we stop talking”. I looked at the clock and saw what time it was and the voice inside my head started to panic. This is where further explanation of my observations and insights in the ten years since I worked for him that led to his intrigued expression of “Let’s keep talking”. I included reflection on how there is a lack of interdiscinplinary care taking place. Specialties are specialty driven i.e. Psychiatry research is only interested in pscyhiatry research. Social workers are interested in social work research and active in legislative process at higher rates. Meanwhile the psychologists keep being excited about what they are learning with the false confidence that what they are passing down is being applied appropriately. It is not common that someone whose brain works like mine would rise to a level such as Clinical Psychologist with the way the current system is set up. Though I would argue someone like myself would aptly fill the role.
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We ended our conversation with a plan to touch base in six months or more. I am learning that starting a large business is playing the long game. In his parting words he shared the sentiment “Keep your vision” with regard to the business plan and proposed partnership this meeting had all been about. That moment, right there, was the highest I have ever been in my life. And I can tell you with the mental status I had at the time of our meeting, the last thing I was in need of were any extra hits of dopamine and oxytocin. Now, here I am. Leveled out and in pursuit valuable use for all of the knowledge I’ve acquired.
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