Consumers of psychotherapy have virtually no assurance that the therapists they consult are qualified, say a growing number of professional mental health workers, health insurers and state officials.
Because the field of psychotherapy - the treatment of emotional problems through "talking therapies" - is virtually unregulated, virtually anyone can call himself a psychotherapy, advertise, treat people, funnel insurance claims through a licensed provider and receive reimbursement.
While there is no statewide figure on how much is spent annually on psychotherapy, Ma Blue Shield alone paid out $34 million last year for outpatient psychotherapy.
The 1984 New England Telephone Yellow pages contain nearly two full pages of listings of psychotherapists.
Although three of the recognized classes of professionals who provide therapy - psychologists, social workers and physicians - must be licensed, there is no state licensing procedure for the many others who call themselves psychotherapists but may have little or no recognized training.
One of the first major responses to the situation came this month when Massachusetts Blue Shield announced that, effective July 1, it will dramatically tighten the terms under which it pays for mental health services. Under the policy, licensed providers (physicians, psychologists and social workers) will be able to claim reimbursement for no more than three "assistants" each in the past, following the model of doctors billing for the work of a large staff, a number of mental health providers have maintained large "stables" of assistants.
Furthermore, though they need not actually possess licenses, under the new Blue Shield policy the assistants must nevertheless meet the state requirements for licensing as clinical social workers, as certified social workers or as registered nurses authorized to practice in an expanded role. To submit claims in conjunction with assistants, providers must be on the premises and "immediately available" during psychotherapy sessions. Telephone or electronic contact is insufficient.
John Larkin Thompson, Massachusetts Blue Shield president, said the policy changes are "intended to tighten up the whole system, to rationalize what has been an unacceptable nonsystem. It will either drive some people out of business or (force them to) upgrade their skills."
Mental health providers make up about one third of all Blue Shield participating providers, with one mental health provider for every 500 members, as opposed to one internist for every 1750 members and one general surgeon for every 4400 members.
Meanwhile, Massachusetts Secretary of Consume Affairs Paula Gold last week began a computerized check to determine whether people advertising as psychologists, social workers and psychotherapists are actually licensed to practice psychology, social work or medicine. A preliminary check showed that at least five persons currently advertising themselves as psychologists do not have valid licenses.
Said Gold last week: "It may be that our current laws do not adequately protect consumers, and that should be reviewed."
In the legislature, efforts are under way to require the licensing of al psychotherapists. Without such a measure "There is simply no protection for consumers who opt to seek care from someone calling himself a psychotherapist," noted Anne Pulsifer, Chairwoman of the state board of Registration of Psychologists.
Pulsifer's board is currently investigating 18 complaints against licensed psychologists. One of the most controversial was filed by Wallace Ralston, a former patient, against Peter Lawrence Gill, who runs the Cambridge Psychotherapy Institute in Newton. The Board discussed the complaint last Friday but has not yet announced any action.
Gill freely admits that many of the "members" of his Institute, who practice psychotherapy, are not licensed as physicians, social workers or psychologists. A large, genial man who described himself as a psychotherapy "dissident," Gill said he believes that academic degrees and licenses are not essential to the practice of excellent psychotherapy.
Ralston contends that the therapy he received was h armful and the 50 or 60 members of Gill's institute compose a sect, of which Gill is the guru. Gill replies, "It is a cult, it's a family. But is that good or bad? You tell me." Gill's lawyer, Paul Gitlin, said last week he filed a lawsuit in Middlesex Superior Court against Ralston, whose statements, he said, are untrue and defamatory.
Gill's practice has also been under review by Blue Shield. Gill and the insurer recently agreed, following a $30,000 settlement of past claims, that neither Gill nor clients who see him will be reimbursed in the future. Ultimately, notes Cambridge psychologist Alexander Anderson, among others, "the only real solution to this is licensing reform." In addition to stricter enforcement of existing licensing regulations, says Anderson, "There has to be university accountability as well. As it is, there are no qualifications to enter the field of psychology, and once you are in the field there is no accountability."
Part of the problem, Anderson says, is doctorates from "diploma mills" like Heed University in Hollywood, Fla., which has graduated about 300 people with doctorates in psychology in the 14 years of its existence. About 10 percent of these are from Massachusetts. The Wash-based APA does not list Heed among the 650 university psychology departments that it accredits. Nor is Heed accredited by the US Office of Education. According to Heed president Marvin Hirsch, it is possible to enter the school with a Master's degree, pay about $8,000, spend "a total of 10 weeks" over the course of two summers and one week each in April and December, do "external research" and emerge with a doctorate.
At Chestnut Hill Psychotherapy Associates in the Chestnut Hill Mall, an elegantly furnished suite with numerous couch-filled offices, two directors hold doctoral degrees from Heed. The two are Noble Turner, executive director, and Lucy Parker, clinical director. Turner, who is not licensed to practice psychology in Massachusetts, was unavailable for comment last week.
Parker, who is licensed and also holds a doctorate from Boston University, said in telephone interviews, "I worked harder for my degree at Heed than for my degree at Boston University. Everybody at our center has ongoing training and we pride ourselves on the high quality of our work."
Psychology board charwoman Pulsifer said the question of licensing people with degrees from Heed has come up a number of times, though she said she did not know if any currently licensed Massachusetts psychologists got their licenses on the basis of Heed diplomas. "There should have been no licenses granted on the basis of diplomas from Heed," she said.