Specialty designation in psychology: conceptual issues

Canadian Psychology, Jan 1994 by Byrne, Joseph M

Abstract

Several conceptual issues are reviewed as they relate to speciality designation. It is argued that specialties already exist in the discipline of psychology and that this subdivision of special knowledge base and skills is the sign of a healthy, maturing discipline. The advantages and disadvantages of establishing a specialty designation system in Canada are reviewed. It is concluded that if such a system is decided to be desirable, it should be national in scope and should employ a certification for advanced expertise, which recognizes extra qualification related to additional training, experience, and rigorous direct evaluation of competency. Such a system of specialty designation more closely approximates an excellence - based competency model.

In recent years, few topics have collectively roused passions within the psychological community as the issue of Speciality Designation. Service, Sabourin, Catano, Day, Hayes, and MacDonald (this issue) have provided a very good working document that will facilitate the undoubtedly rich discussions to follow on this topic. When requested to write a 'commentary' on the Service et al. (1993) article, the editor asked that I not confine myself to the specifics of their survey, but rather to expand on the issues that one might consider when debating this important and timely topic. I will endeavour to do just that by first revisiting some of the main factors that may affect one's support or lack of support for specialty designation. Although this topic has only recently captured the Canadian psychological scene, it has been the focus of debate for many more years in the United States, a debate that has intensified with time. Much of the published commentary and supporting data are derived from there. Given the available space, I will limit my comments to speciality designation as it relates to clinical applications. However, the comments may be of value in discussions for other areas (e.g., neuroscience, school psychology). I will frequently make comparisons with the discipline of Medicine, as the experience with speciality designation is well documented and provides an illustrative example of methods psychology might wish to adopt in its struggle toward consensus with this important professional issue.

There are two commonly formulated positions regarding specialty designation:

Position 1. Psychology is a generic discipline, easily differentiated from other disciplines, and is composed of broad content, processes, and principles which allows its application to a host of service areas.

Position 2. Psychology was a generic discipline, was easily differentiated from other disciplines, but now the rapidly accumulating body of knowledge combined with ever increasing demand for identifiable expertise from within and outside the discipline, has made necessary the designation of specialists in selected service areas.

The impetus for designating a speciality may be seen in its simplest form as emanating from two forces: a) Market Force; b) Discipline Force. The market force often comes in the form of a specific clientele which demands access to specific skills or techniques (Sales, Bricklin & Hall, 1983). The discipline force often comes in the form of a group of professionals, with a common knowledge and skill base, who offer a specific clinical service which is distinguishable from the service currently offered (Matarazzo, 1987). Both forces must be in play for a speciality to have sustained life. In some cases a Market Force may be initiated such as in the case of the disease, AIDS. Once identified specific needs are articulated and services are tailored to meet these needs. In other cases, a Discipline Force may be initiated, such as the rapidly growing area of Clinical Neuropsychology. The brain - behaviour relations identified in this area combined with the assessment/diagnostic protocols to generate a consumer or market base. It is often difficult to discern whether a market on discipline force began the process toward specialty designation.

Other Disciplines

Before exploring the pros and cons of speciality designation in psychology, it may be instructive to look to two disciplines to see how they have handled the issue of speciality designation. First, let us look at the profession of Law. Lawyers are trained with a core curriculum, with electives taken to meet the specific interests of students. They then choose to practice as a generalist or as a specialist, the choice driven by market demand (i.e., economic survival), individual academic interest, or both. There are no separate areas of practice for which one completes specified training and completes competency examinations. There is a rather concrete system of competency determination, one's track record. If your 'speciality' is criminal law and your rate of acquittals or sentence reductions is consistently unimpressive, your 'speciality' status may suffer a major challenge! The discipline of psychology is currently much like law. After successful completion of an accredited program of study, an internship (clerkship), and written examinations (an additional oral examination for psychology), the individual is free to practice within the scope of his or her competency. The provincial (state) regulatory boards exist, in part, to ensure that individuals practice within their areas of competency and act in a professional manner. The legal profession seems to operate relatively well with this system of informal or de facto specialization. If the volume of law revisions and decisions are increased substantially, lawyers may choose to concentrate in that area or abandon it for another, so as to ensure that he or she is not behind in that area of law. Psychology is essentially operating in the same manner currently. Specialty journals and conferences are further testimony to the operation of specialists, without a formal system of credentialing. This is an example of predominantly a Market Force defining speciality. Is there a need to change?