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License to Shrink

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To the editors:

It's a cute trick that social workers, psychiatrists, and psychologists perform when talking about vendorship ("On Money and Mental Health," July 14) and who gets it and who should get it. They're so tricky they even pull writer Bryan Miller into it with them. You see when they can get our attention on their turf battle, and how intriguing it is, they then can distract everyone from the sham they and other licensed mental health providers engage in. It's a sham perpetrated upon consumers and also upon unlicensed mental health providers and of course one which is harmful to both.

Try as she might writer Bryan Miller couldn't get anyone to cite facts about cost and harm etc. This battle doesn't engage in facts. Facts are dangerous to revealing the sham.

Let's name a few and see what you think. No one mentions that there are over 240 published schools of psychotherapy, (Corsini, Innovative Psychotherapies, 1981). If no one knows how unscientific this field is you then could believe that social workers or psychologists or psychiatrists have a special knowledge which makes their services expert and worthy of hire.

No one also mentions anything about psychotherapy research. Let's do that now. Many studies compare the effectiveness of various professionals. There are over 60 at last count. Actually mostly what is compared is the effectiveness of professionals--those with graduate degrees like social workers, psychologists, psychiatrists, psychiatric nurses, family counselors, individual counselors, youth counselors, substance abuse counselors, pastoral counselors, and others with paraprofessionals--those without graduate degrees. Oh, yes, from their talking and arguing you would think that just their three groups--psychiatrists, psychologists, and social workers--are the only groups of mental health professionals. I wonder why they don't mention that over 50% of all mental health service is provided by persons other than those three groups according to the National Institute of Mental Health Survey for 1986.

But back to the research. These many studies comparing professionals with paraprofessionals almost unanimously conclude that paraprofessionals are equal in effectiveness to professionals and in a substantial number of studies are found to be more effective!

This finding is quite provocative. When it was first published in 1979 by Loyola psychologist, Joseph Durlak, it got a response. A second team of researchers reviewed the same studies and published their results which stimulated a third team of researchers and then a fourth team, and still again a fifth team of researchers, each trying various methods of analysis to see if in some way the first results could come out different. But no one could overturn the original results. In Durlak's review 42 studies were compared. Paraprofessionals and professionals were equal in 29 studies, paraprofessionals were more effective in 12 studies, and professionals were more effective in only 1 study.

Social worker Elliott, Illinois Society for Clinical Social Work President Alexander, NASW Executive Director Goldstein, social worker lobbyist Lockhart, psychiatrist Biegler of the Illinois Psychiatric Society, lobbyist Paige for the psychiatrists don't tell you this information. They don't tell anyone else this either. After myself testifying before state legislative subcommittees against their licensing acts, I can tell you they also don't tell this information to their legislators.

If this were common knowledge, how could they warrant vendorship for any exclusive group? How could they even claim that licensure should be granted them given that licensure requirements demand graduate degrees which the research shows are completely irrelevant to providing mental health services?

Sure lobbyist Paige for the Illinois Psychiatric Society says everyone should be examined by a psychiatrist for medical problems before going to another counselor or psychotherapist. She doesn't say that medical problems which appear as mental health problems are quite rare and so hidden that psychiatrists frequently miss them too or refer to another specialist e.g., a neurologist for diagnosis. She would like everyone to pay a psychiatrist for virtually no benefit except of course for the psychiatrists. She also doesn't say that most psychiatrists don't even do psychotherapy, just prescribe medication. If clients don't want medication then there's little relief for them with a psychiatric examination except relief of their pocketbooks.

Psychologists were not involved in this current battle. They've already won equal status with psychiatrists for the most part and are temporarily quiet. However two years ago they passed a bill making illegal all other psychotherapists and counselors unless they were supervised by a psychologist. Fortunately with an overwhelming outpouring of objections, Thompson vetoed the bill. Nonetheless it remains the stated objective of their national organization to pass this kind of bill in every state, and you can bet they'll try again in Illinois.

Of course social workers want parity. But to do so they willingly engage in the sham of licensing for which the others have set the precedent.

But it's a sham. Nothing else. Licensing implies that those licensed are both competent and better than the unlicensed, and therefore deserving of consumers' business and vendorship. It's a lie. It's false. It's a fraud, a scam. How else can this be said? It's completely dishonest, shameful and hypocritical from those professionals whose very work--counseling and psychotherapy--is based upon their clients being honest with them.

Now that you've got some facts from research how does their fighting sound?

Allan Rohlfs

Private Practice, psychotherapy

N. Racine

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