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Credentialed Mental Health Professionals: Are They Automatically Entitled to Respect?

September 7, 2010

I have been accused of having “no respect” for credentialed mental health professionals. This is not true. I do have a great deal of respect for ethical, credentialed mental health professionals who engage in safe, evidence-based practices and inform their clients fully.

There are, however, a subset, (I believe a minority) of mental health professionals who somehow managed to obtain and keep credentials, but do not, in my opinion deserve respect. I do not take the position that someone is automatically entitled to respect, much less deference, just because they possess credentials. Such people are not above criticism and to believe they are is a dangerous assumption to make, given what history has taught us about the harm done in the name of therapy, even sometimes by licensed mental health professionals. The reverse is the case: licensed mental health professionals are constantly accountable to the public they serve. While violations and unethical behavior can be reported to state boards, unfortunately, state boards do not always do their job or are very slow to do it. They need to be called out on this behavior and possibly cronyism.

Respect for credentialed mental health professionals needs to be earned. Quite frankly, I find the sense of entitlement among this subset I referred to to be quite breathtaking.  So, to clarify my position, in case people are confused about where I stand, what follows is a list of characteristics I respect in credentialed mental health professionals, followed by a list of characteristics I do not and should not respect in a minority of credentialed mental health professionals.

I respect credentialed mental health professionals who:

  • Take the time to evaluate what evidence supports the interventions they use with their clients.
  • Are transparent about this evidence with their clients. That means that if they are proposing to use an intervention that has no research evidence, they disclose this and let the client know that he or she is, in essence, engaging in an experimental treatment. The client should also be informed of any evidence-based alternatives that exist.
  • Admit when they have made a mistake. Everyone makes mistakes. The difference is that the ethical credentialed mental health professional admits to mistakes and learns from them.
  • Treat their clients with respect and dignity.
  • Speak out against abuses they see in their profession.
  • Question authority and question claims made by colleagues that lack adequate support. This does not mean personally attacking them; it means criticizing and questioning the substance of the unsupported claim. Unfortunately, people who practice pseudoscientific approaches are often unable to tell the difference between the two and see all criticism as “negativity” and personal. In fact, criticism of the substance of the person’s claims is very positive and can result in changes that are highly beneficial for clients.
  • Respond to criticism about their own work in a calm, rational manner rather than engaging in personal attacks on critics.

Now, let’s have a look at the flip side. Here are a list of qualities of the credentialed mental health professionals I have been accused of not respecting and for the record, I believe these folks are in the minority. Note that not everyone I have criticized has all of these characteristics. This is just intended to be a list of some characteristics, any one of which would tell me that the person does not deserve respect.

  • Uses interventions he or she claims are effective that actually have no sound research evidence to support their effectiveness.
  • Fail to inform the client about the interventions being delivered and instead claim that such interventions are highly effective when there are no published randomized clinical trials to support their efficacy. Such claims are based only on testimonials and anecdotes or
  • The interventions being used have some published studies but they are not of the level required to claim efficacy of a treatment (for example, studies that used a comparison group with no random assignment and yet the person insists this is enough to claim the treatment is “evidence-based”).
  • Delivers proprietary seminars for treatments that lack evidence to support their efficacy, and yet claim that they are superior to established interventions.
  • Declares self to be an “expert” and this declaration is repeated endlessly by anonymous individuals, yet little substance can be found for such expertise. As Robyn Dawes pointed out in his excellent book, House of Cards, if so-called expertise has no empirical substance, it means very little (for example, the people who claim to be “experts” in multiple personalities and yet deliver treatments that some former clients have sued over because they made them worse).
  • When colleagues criticize such a person’s work, writings, and/or claims, instead of responding, he/she attacks the critics personally and sometimes with a very loud, public smear campaign.
  • The person feels entitled to automatic respect and deference because of the fact that he or she is licensed.
  • The person asserts that people who are not licensed have no right to criticize him or her without considering the actual merit of the criticisms and responding to that.
  • Makes threats to sue critics or actually does sue critics when he or she has no winnable case. The purpose of such suits is sometimes just to drain the person financially and consume the person’s time and energy. In other words, the legal system is used for the purpose of harassment although now, in many states, defendants who are targeted with frivolous lawsuits can be awarded attorneys fees and sometimes even more in damages.
  • If all else fails, hires an internet “reputation” clean up company to harass and threaten critics. Note that not all internet reputation companies behave in this manner, but some apparently do. For example, last weekend, a certain website was put up that had obscene pictures and attempted to link some of my colleagues and me with hatred of Muslims and other religions and appeared to be inciting hatred and potentially violence. The website’s ISP was traced to a reputation defending company and in an earlier version of the web page actually mentioned the name of a certain therapist we have criticized and we were threatened about what would happen if we did not remove material about him on a certain website. Apparently they realized the stupidity of what they had done and removed the therapist’s name and eventually removed the obscene pictures and religious bigotry, but the evidence has been saved and many people saw the therapist’s name on the website before it was removed, including prominent people in the mental health community and certain agencies. Many of us, including an attorney I recently spoke to, believe that a reputation defending company is behind all this since a “who is” search traced back to them. Although they backed off and what they now have up is just a lame personal attack on the individual, their activities are now being closely monitored by people who have a pretty good idea of what they are up to. In my opinion, if these people were hired by that mental health professional, he should fire them and sue them because their dirty tactics against us have done far more to damage his reputation than the people he is accusing (who’s only intention is to abide by actual evidence for public benefit) have ever done.

These are just some of the characteristics I keep in mind when evaluating whether a “credentialed” professional deserves my respect. I recommend that the public, particularly people who are considering therapy for themselves or their family members do the same. Automatic deference to someone, just because they hold a credential, could be dangerous which is why people need to be good consumers.

Contrary to what certain “credentialed” people would have us believe, it is not libel or defamation for an unlicensed person to criticize a licensed mental health professional as long as the statements are not factually false (note I am not a lawyer but this is, according to my own research, what my own understanding of the libel and defamation statutes in the US that I have read, state). Here in the United States, freedom of speech is for everyone, not just people that the state deems to be in authority. False, malicious statements against anyone, regardless of credentials held, can be legally actionable, but every citizen has the right to express their opinions and make factually correct statements about any other citizen. If any so-called “expert” attempts to tell you otherwise, that is someone who, in my opinion, ought to be avoided.

Also note, to anyone I have criticized, I practice what I preach and am, myself, open to correction. If you feel my criticisms have been unjustified I ask that you please get in touch with me and let me know the following:

  1. What factually false statement you think I made. Please be specific. What, when, where? Note that this must be a statement I made, as I am only responsible for the statements I make, not the statements of others. If you have a problem with a statement made by a colleague, you will have to take it up with that individual.
  2. Provide me with a rebuttal to the allegedly false statement — not an attack on me, a factual rebuttal.
  3. If you can prove to me that I made a factually false statement, I will publicly admit to the mistake and correct it.

It’s as easy as 1, 2, 3. I’m a very reasonable person and my track record proves that I do admit it when I make mistakes. However, thus far when it comes to my recent criticisms of certain interventions for children, I have yet to be presented with any factual statement I made that was incorrect, but I remain open to the possibility if evidence to the contrary were to be presented to me.

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2 Comments
  1. Monica,

    Even though my wife has d.i.d. which probably puts me on the “other side of the fence” from you immediately, I fully support your call for a more scientific approach to this disorder and its healing. However, if I have one criticism of your approach it would be the “snobbery” toward anecdotal evidence. As I understand “anecdotal evidence” in the scientific process, it can never be used as “proof” of something; however, it should not be dismissed as having no merit but should be carefully evaluated to see if it would merit further “proper” study.

    I can independently corroborate the existence of at least one of the insiders years before my wife entered any kind of therapy. In fact, my son says he used to clock his day by when the one insider would watch the Friends sitcom for years: something my wife (the host) still claims she would NEVER do because she found their morals objectionable.

    Anyway, my wife claims the things I’m doing with her insiders is far more healing than any therapy she is receiving from her counselor. She also claims that when she visits support sites on the internet for d.i.d. patients she is far more “together” than even those who claim to be fully “healed.”

    I have tried to lay out the principles I am following on my blog the best I can. I realize it’s only based on one person, but I also have tried to back it up by a detailed journal of my wife’s (host and insider’s) progress over the last 3 years (2,000+ pages right now). But when I try to engage anyone on either side of the debate I wonder if I’m not simply treated as someone who is “uncredentialed” and therefore not worth the time. I realize my blog is anecdotal but I believe an honest truth searcher would at least wonder if what I’m claiming checks out, then it merits more study.

    The approach of ISSTD is NOT the only way d.i.d. can be healed. I fully support your call for them to clean up their act, but sometimes as I read the writings of the critics (actually I read their writings more than anything from ISSTD because I want to understand their reasonable objections to this whole d.i.d. debate) I think they only focus on the abuses going on and have become closed to the possibility of any proper healing methodology. They have thrown out the baby with the bathwater.

    Anyway, enough rambling. Maybe someday, if you have time and want to see a totally different approach, you’ll take a look at my blog.

    Thanks for trying to keep the other side honest.

    Sam

Trackbacks & Pingbacks

  1. In Memory of Robyn Dawes: 1936-December 14, 2010 « Potentially Harmful and Other Questionable Therapies

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