The times are changing

Professor Bob Montgomery FAPS 

By the time you read this, Australia's Federal election will be upon us or just past. The outcome may well mean changes for the governmental context in which the APS operates. But the changes I want to to discuss in this note are those flagged in recent conferences I attended, notably the International Congress on Licensure, Certification and Credentialing of Psychologists, held in Sydney, and ICAP 2010, in Melbourne in July. Incidentally, if you missed this ICAP, it was a sensational learning opportunity. I encourage you to do some planning for ICP in Cape Town in 2010 or the next ICAP, in Paris in 2014. Interesting travel and enriched PD - what a bargain! Whilst hosting ICAP 2010, the APS celebrated the recent signing of our MoU with the Canadian Psychological Association, and signed new MoUs with the Indonesian and Japanese Psychological Associations, further strengthening our international linkages.

A consistent theme emerging at the Sydney conference was the need to move the bases for accreditation and registration from the input side - what courses has a student completed, what qualifications did the teachers have, and what facilities did the university have - to an output model. What competencies should a psychologist have to begin practice, and what competencies should s/he maintain to continue in practice? What should s/he know and be able to do to be recognised as a competent psychologist?

This shift makes sense to me. We evaluate psychological interventions by assessing their outcomes. What has changed for the better for the client? We would not consider it acceptable to evaluate interventions only in terms of the inputs. Nor should we be doing so for our professional training. Assessing competencies raises many challenges of its own, some difficult, but there was very general agreement as to what they should be and some promising reports of developments in their assessment.

Another idea receiving considerable support, and the key theme of my APS Presidential Address at ICAP, is the need to tackle the large and growing gap between our science and practice by making our training much more integrated. Our traditional separation of science to the early years of training, while reserving practice to the later years, has served us poorly. We should not be surprised, if alarmed, that many practitioners seem to see little relevance of their scientific training to their professional practice.

There was also strong support for the idea that an agreed set of psychological competencies could be adopted world-wide, with sensitivity and flexibility toward cultural and regional characteristics. The EuroPsy is seen as one promising model for such transnational agreement, with the benefits of facilitating mobility for psychologists and students, and providing an internationally recognised standard of best practice teaching
as a basis of approaches to governments for adequate teaching support.

At ICAP the President of the American Psychological Association, Carol Goodheart, outlined a bold plan for the future of psychological practice, also proposing better integration of the discipline with the profession. Of particular interest to some of us is the joint project being done between the APA and the World Health Organisation. One part of this is a major revision of the International Classification of Diseases (ICD) with the aim of making it more useful to practitioners. ICD-10 is the official benchmark in Australia, for example, in defining eligibility for Medicare rebates. Yet most Australian psychologists, reflecting the American domination in publishing, tend to use DSM-IV when they make formal diagnoses. It's all the more notable that the APA is leading the shift away from DSM to ICD.

Parallel to this is the development of ICF, the new International Classification of Functioning, which will involve evaluation of a client on a range of aspects of functioning. The revised ICD and the new ICF are intended to provide a much fuller assessment picture, of use to a wider range of psychologists and other health professionals, and of much more use in planning and evaluating interventions.

Just as we are bedding down our sometimes difficult shift to national registration, it may cause a groan to hear that so many cards are being thrown up in the air again. But that is the inevitable and desirable nature of truly science-based professional practice. We expect our science to progress and develop its thinking. So we must also expect our profession, and its teaching and regulation, to also progress. The times are always going to be changing and that's good.

InPsych August 2010