Sunday Reflections: Misinformation Risks of Perpetuating the Inequality of Disciplines in Psychology

I am sitting in bed, nicely, quietly, watching the news, contemplating what a day off will bring.

Scrolling down on Facebook groups lead me to see a completely misinformed post about the training route in Australia, provisional, registered and clinical psychologist, what differs from each of these titles. With a few searches on the web I realise, this article has been written by a professional in a senior role. Last week, some other materials on social media made me reply to another senior professional role as, again, this was a misinformed post.

I am becoming less and less tolerant by comments, information and debates that are misinformed, not well researched, not factual, and completely singling one discipline in particular as better or more qualified when in fact, so many of us as psychologists are working so hard and have done a significant amount of studying, training and professional practice. We need frank, informed and solution-seeking conversations because…

It is constant…

The misinformation needs to be reframed and questioned most days, even amongst professionals

A parent who calls to say they must see a clinical psychologist because the NDIS planner said so…

An NDIS planner who says, surely you need to be more qualified to sign this report…

CentreLinks saying only clinical psychologist can sign this report…

A phone call at reception, do you have a clinical psychologist working here as this is who I need to see as advised by the GP…

An NDIS planner saying we must have a clinical psychologist to diagnose autism otherwise the application to NDIS will not be accepted…

Let’s encourage clinical psychology places, these are needed…

It is so frustrating, but why is it like that?

There is so much misinformation about training and qualifications in Australia perhaps due to historical debates and decisions. A two-tier Medicare Rebate system also does not help to the cause of the diversity of disciplines as it perpetuates that one discipline is better than others i.e. one type of psychologist can charge more because they are perceived to be better skilled.

Is this really ok to perceive that a clinical psychologist has more training?

It’s NOT ok!

It is not the title of clinical psychologist that determines more years of study or more qualifications, it is in fact the endorsement that determines this, and there are 9 different endorsements, see table, third column. All psychologists qualify with a minimum of 6 years of study/internship, whatever program they complete (4+2, 5+1, Masters, Doctorate). This is the minimum years of training for ALL qualified psychologists in Australia. This is also how overseas psychologists coming to Australia are assessed and allocated to a training route. The requirements for provisional psychologist, psychologist and endorsed psychologists are reflected in the table below. PsyBA/AHPRA is also clear that an endorsement does not reflect being a specialist in the field, but having acquired more specific competencies in this discipline of psychology. PsyBA/AHPRA also has a clear syllabus program and differentiates competencies for each endorsement.

A clinical psychologist has 8 years of training as one would embark a 2 years of endorsement post Masters qualifications with a clinical psychologist as a board approved supervisor – or one year endorsement following a DClin program. This is the same for all psychologists who have completed an endorsement, this is not just for a clinical psychologist. This means that ALL psychologists who have completed an endorsement program have at least 8 years of training.

ALL psychologists who have completed an endorsement have at least 8 years of training!

I have a first degree in psychology, a Masters and a Doctorate which equals to 8-9 years study and I am still considered like a psychologist in the Medicare Rebate system and need to constantly reframe the skills I bring when discussing NDIS processes. I am being questioned as to whether I can diagnose autism when in fact I have worked for 30 years in this field, with nearly 15 years as an educational psychologist. Psychologists come to me for supervision on this topic. I have done research, supervision and presentations on the topic. It often feels frustrating to have to present proof to the systems that you can in fact do highly skilled work in assessment and counselling processes.

I certainly trained in systems (Canada and UK) where disciplines were perceived so much more equally and where their purposes/differences were valued and supported by the systems with perhaps clearer boundaries around roles and responsibilities – perhaps this is an important reflection to have about boundaries. It is possible for systems to embrace diversity of disciplines in psychology, support clients together, refer to one and other, engage in dialogues that support client outcomes and not necessarily based on one discipline being better or better equipped.

Clinical psychology students and registrars approach me for supervision in child and adolescent psychology as they feel they are needing more skills in this area. I would approach a clinical psychologist colleague for support around complex mental health, same as I would approach a forensic psychologist for complex court/youth offending matters. Ultimately, the competencies you gained are very based in the supervision you engage in. If you have a supervisor who is particularly skilled in assessments, you are most likely to be more exposed to assessments and therefore will develop more skills in this area. If you have a supervisor who works with children, you are likely going to acquire these skills.

We all have different skills and continue to practice within these specific frames where our skills are sought after for the highly focused competencies gained. Even as supervisors, we continue to develop skills and competencies throughout our career.

There could definitely be something in having clearer boundaries and competencies about roles and responsibilities – do we dilute our specific skills by attempting to do work across the lifespan, or should we have targeted training in child or geriatric psychology? Should we have clinical psychologists in schools, doing psychoeducational assessment work, advising educational programs? Should we have only health psychologists in hospitals? If we allow roles and responsibilities to be slightly more fluid such as crossing disciplines with supervision and skills development, we should do this in equality and value of skills, supervision and training. But…

The Inequality is Real

This table is from the PSyBA 2021 Annual Report and shows the number of psychologists registered in relation to their endorsement.

There is a clear majority of clinical psychologists compared to other disciplines. Of course, students would want to engage in a training possibly offering a higher pay and the conversations are real in this space when offers of training come in. Indeed, students say they choose a place at university in a clinical psychology program over a preferred route where they could follow their passion in a different discipline.

Such a high concentration of clinical psychologists in Australia, this is perhaps the reason for other endorsements being forgotten, going under the radar and not being understood by the systems. One could say ‘What is the problem with that, perhaps we should all aim to be a clinical psychologist?’

I don’t want to be a Clinical Psychologist.

I always wanted to be an Educational Psychologist. This is where my passion lies.

This is a clear challenge for the future with an endorsement system currently like this as this creates a clear dominant discourse and one sided conversations in terms of training, advocating and growing the profession. Indeed, a discipline can only grow if there are qualified supervisors available to supervise. It is evident in the statistics above where clinical psychologists are able to gain endorsement at a rapid rate compared to other endorsements – 329 compared to 15 in educational psychology, for example.

Ultimately, it is even more troublesome as, meeting the needs of the population is the clear aim for offering quality training to the workforce. Humans are different in nature, experience different life events, engage in different systems (education, forensic, sports, community, health, etc.). One type of discipline of psychology cannot claim to be able to meet the growing needs of the population. We need to be able to offer diverse services, unique skills and competencies to meet complex and evolving needs. We should all celebrate this diversity and embrace, clinical psychologists should also champion this too.

But we are all equal, why should we have to do an endorsement in the first place?

As psychologists, we should all aspire to continue learning, extend our skills, encourage discussions, research, support leadership skills in engaging in systemic work, engage in supervision training, develop new competencies, search for new knowledge, allow time and a place to continue learning. We should all aspire for the best in our knowledge and professional practice, so continuing learning is part of this process.

Many countries in the world have adopted a doctorate as a minimum to practice psychology and we should be very highly aware of this international shift to this specific standard of qualifications. I am not saying here that we should aspire for all to have a doctorate but more to be aware this has happened in other countries. This 2 years of endorsement may therefore be a positive route to adopt and ensure parity with qualifications in this country.

The challenge with this endorsement route is that psychologists taking routes of the 4+2 or 5+1 with an internship pathway are not eligible for the endorsement route. Bridging courses are now available in some endorsements but the reason many engage in a 4+2 and 5+1 in the first place is often related to financial challenges which may be a barrier in engaging in further training.

There is also the challenge with some specific psychology programs being more popular due to students wanting a higher pay in the future and being valued for their work by the systems. Clinical psychology training programs are highly competitive when other programs are slowly disappearing. For example, there are only 4 universities in Australia offering a Masters in Educational and Developmental Psychology. There are many other examples of programs reducing in numbers. At the same time, Masters of Professional Practice (MPP) are popular because students can have a one year of paid internship compared to a full Masters where placements are unpaid. This will again create challenges with the further training as these students will not be able to embark an endorsed route in the future, creating inequality in the systems.

What do we need going forward?

We need a rally up of ALL psychologists to support one and other, campaign for high quality training across the board, in ALL disciplines. With support to supervision processes.

We need a clear understanding of all disciplines of psychology, roles, responsibilities, boundaries, referral routes.

A clear campaign for ALL systems to understand psychology training, qualifications and processes with an understanding of competencies and skills not necessarily associated to one specific discipline. And allow the systems to be accepting of this diversity of skills.

We need equality of the disciplines, being recognised for the training and qualifications, years of experience.

Increase of internship in many disciplines and support for those offering them, and university places in diverse areas of psychology.

Broadening the bridging pathways as internship routes to allow ALL psychologists to continue their skills may also be a solution to equality.

Let’s Celebrate!

Let’s celebrate the diversity of our profession.

Let’s celebrate aspiration for lifelong learning and training.

Let’s celebrate a deeper understanding of our skills, competencies and capacity to support one another.

Let’s celebrate and ensure all can work within their areas of passions. This will help the profession with commitment and dedication, reduce possible burn out and invigorate the profession.

We have all worked so hard as psychologists to be where we are, we should all support each other in continuing developing the skills we need, and celebrating being part of this amazing diverse profession!

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  1. Pingback: Why is there a psychologist shortage in Australia? – Peninsula Paediatric Psychology PTY LTD 3ppsychologies

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