SEVEN PAPERS ON EXISTENTIAL ANALYSIS ... - Wagner College

our work may parallel that of our cousins abroad, its status rests on entirely different grounds.
Our situation is radically different from theirs. In what ways?
Consider, for example, the payment of fees. Psychotherapists are now typically caught
up in the tangle of third-party reimbursement by insurance companies, which are locked in a
battle of influence and power with organized medicine. Outside of that system or
reimbursement, those who practice existential psychotherapy autonomously must do so at very
low rates so that patients can afford their services. In order to qualify for third-party payments, a
therapist must be licensed as a psychologist by the state in which he practices. Worries about a
few psychotherapists' unethical behavior are usually cited as the primary reason for licensing
clinical psychologists. In fact, however, the real reason for instituting such controls was the
identification of psychotherapy as a sibling of psychiatry and social work. The close cooperation
of the three professions required subjecting psychotherapists to the same constraints that had
been enforced on medical doctors and social workers. The increasing incidence of third-party
reimbursement by insurance companies in medicine and similar reimbursement of large health
and social welfare institutions with government funds called for limiting those who might receive
such reimbursements. Earning a license was the ticket to qualifying for corporate or government
funding of one's practice as a social worker, a physician, or a clinical psychologist. For many
years, clinical psychologists, like nurses, have been battling for more power of the kind that has
been limited to physicians, especially prescribing medications.
The national licensing examination for clinical psychologists – the Examination for
Professional Practice in Psychology – which is given twice a year in every state (the norms for
passing the examination vary from state to state), is a lucrative venture for the states and their
boards of psychology as a professional practice which are the licensing agencies, as well as for
the company that writes and administers the tests. As the name of the examination (which has
been given since 1964) indicates, it is not a test of clinical aptitude but, rather, of general
knowledge of the profession known as psychology. A number of corporate educational
entrepreneurs offer training and preparation for these tests. Much like the organizations that
prepare high school students for the SAT test or college graduates for the GRE, MCAT (for
admission to medical schools) or LSAT (for admission to law schools) tests, they employ university
professors and others to teach examinees what they should know for the examination. The best
known of these organizations is the Association for Advanced Training in the Behavioral
Sciences, in California. They are also very lucrative operations, which are informed of who has
failed the examination so that they can contact these individuals with advertisements for their
training programs. The psychology licensure examination is the basis for assessing the
competence of prospective clinical psychologists. A few states have, in addition, an oral
examination and a separate multiple-choice state professional practices and ethics
examination. In effect, a clinical candidate must prove herself to be a card-carrying member of
the academic mainstream before being given access to licensing as a clinical psychologist.
The names `psychoanalyst' or `psychotherapist' are not legally defined and controlled.
This means that existential psychotherapists must prepare themselves as research scientists until
they have acquired the necessary licensing, since the content of the national psychology
licensure examination consists primarily of items on research and experiment design, test design
and validation, and psychometrics and statistics. Items from these areas and items on
professional ethics account for more than half of the total of 200 multiple choice questions on
the licensure examination. The remaining questions are about the use of the DSM-IV in
formulating a diagnosis (which determines how many hours of psychotherapy will be paid by the
insurance carrier), psychopharmacology, industrial and organizational psychology (increasing
year by year in the number of test items), and social psychology. There are only a few items on
theories of psychotherapy, personality theory and developmental psychology, altogether
accounting for about 20% of all of the test items.
The heavy emphasis on ethical issues in the practice of psychotherapy arose in response
to legal actions taken against psychotherapists which cost insurance companies who sell