The 4 + 2 Pathway: A valid and reliable training option for psychologists

Clive Jones PhD MAPS

Introduction

As most of us would already know, the 4+2 pathway is one of a few training pathways currently available in Australia today for students who aim to register and practice as a psychologist. The +2 of the 4+2 pathway involves two years of intently focused supervised provisional practice, often taken up after completing a four-year degree in psychology instead of a two-year post-graduate master’s degree in psychology.

While it could be argued that there are currently only a few formal restrictions of practice in place for the 4+2 trained psychologist within Australia, there is a growing stigma towards those who follow this training pathway that suggests to prospective employers, government agencies and the public that the 4+2 trained psychologist is less skilled with greater limits in capacity to practice when compared to their master’s degree trained colleagues.

Feeding in to this stigma of the 4+2 trained psychologist is how the Australian Psychological Society (APS) and the Psychology Board of Australia (PsyBA) defines the 4+2 trained psychologist as a ‘general practicing psychologist‘ while denying opportunity to have formal acknowledgement and recognition of expertise developed through the +2 provisional training pathway and/or through the many years of refined expertise that has developed through their chosen fields of specialised practice.

As a science, it’s important we don’t fall in to the trap of ill-informed stereotypes and prejudice. Unfortunately, it seems we have done so in the growing stigma faced by psychologists following the 4+2 pathway to registration and expert practice in either mental health or any other endorsed field of the profession.

In this brief essay, I would like to redress two (2) presumptions that are often made in the argument against the 4+2 pathway with a focus on how we can successfully train practice expertise.

Presumption One: The +2-training pathway is not an effective training pathway to springboard in to expert practice as a psychologist.

Presumption Two: A master’s degree is the ‘gold pass’ standard approach for the training of practice expertise in psychology.

Ultimately, I would like to suggest that both presumptions are simply not true.

A redress of presumptions about the +2-pathway

In redress of presumption one (i.e., the +2 training pathway is not effective training); it is critically important to firstly understand the teaching model around situated learning and the underlying principles of approach that the +2 of the 4+2 training pathway is based.

Basically, situated learning is the teaching strategy of learning on the job in the context of a supervisor overseeing the student’s learning and development. Its primary aim, as an educational approach, is to facilitate very specifically within the learner successful mastery of the practice setting.

It is ultimately the educational pathway of choice from which the novice develops in to an expert.

Specifically, regular exposure to the complexity and ambiguity of the real world of practice facilitates the development of complex cognition and associated action processes most typically used by experts (Lave and Wenger 1991). 

Ultimately advocates of the situated learning process argue that any knowledge and skill required to practice effectively must be taught in context and not in the abstract. Learners must use associated skills and tools in the same way practitioners do and therefore need to become “cognitive apprentices” in that discipline’s community and its culture (Lave & Wenger, 2002).

There are two key principles of situated learning that are essential for the development of skilled professional practice. These are:

  1. knowledge being presented in an authentic context and
  2. learning that includes social interaction and collaboration from within the authentic context. (Lave, 2002; p.151). 

Since authentic context and social interaction are critical components of situated learning, student psychologists need to be involved and regularly immersed in the relevant community of professional practice to develop expertise in practice.

The social interaction and associated learning that occurs in communities of psychological practice between experts and novices is crucial and should begin with the student psychologist observing members of the psychology practice community and then slowly move the student psychologist from the periphery of that practice community in to being fully participating members, applying practice skills effectively and in context (Jones, 2008; Jones, 2010).

By its very nature, the +2-pathway or the 4+2 psychology training model is a highly valid and reliable situated learning approach offering student psychologists an excellent way to develop authentic, practice based expertise.

In redress of presumption two (i.e., master’s being the ‘gold standard’ of training as opposed to the situated learning process of the +2 pathway); I firstly need to flag that I am in a minority of academics teaching in psychology who have a master’s degree in education.

In this context, I am quite intrigued that while many see master’s training as the gold pass standard of training for specialist work as a psychologist, the specialist areas of teaching psychology and research supervision in psychology does not require, as a fundamental prerequisite, a master’s degree in education. Specifically, a master’s degree in education is not considered essential for the specialised psychological field of degree program development, subject writing/teaching and research supervision in psychology.

While students who choose to pursue formal endorsement in an area of psychology practice within Australia need to complete a specialist master’s degree as a compulsory ‘must have gold pass’ to formal recognition in that specialist field, psychologists with the very serious responsibility of training other psychologists through university degree programs, post graduate research projects and practice placements do not need a specialist master’s degree in education to be considered an expert in this field.   

The reason post graduate master’s degree training in education is not required of academic psychologists who write university programs, teach and supervise research projects & oversee practice placements is because psychology academics learn how to teach on the job, through a situated learning approach.

Academia & Situated Learning

The pathway to specialised practice as an academic in psychology within the university setting will often begin after the student psychologist completes their 4th year of psychology training whereby the novice academic will then take on a provisional practice approach to both teaching and research as a PhD student whereby they will pick up teaching some tutorials while doing their PhD and then move on to more responsibility in teaching, course/program development and research supervision as their capabilities build while they continue learning through the situated learning approach on the job.

The situated learning approach in the teaching of academics is considered valid and reliable in the development of practice expertise in the crucial role of psychology teaching, degree program development, research and practice placement supervision.

The PhD – an example of a Situated Learning Model

To clarify further the quality of education within the +2-pathway, it’s important to understand that the highest degree anyone can obtain – a PhD – is based purely on the situated learning model of teaching and learning.

How do academics become expert researchers? Through being fully immersed in the practice environment of research via the situated learning process of the PhD project and being cognitively apprenticed by a principal supervisor through ‘on-the-job’ training in research.

That’s how a PhD works. Being fed knowledge in class room lectures is a very basic and limited form of education. Hence why the highest degree anyone can obtain from a University focuses purely on a situated learning approach through the PhD thesis … because overall it is considered a higher form of learning that has a greater influence on the development of expertise. Ultimately the +2-path of the 4+2 applies the same learning model of approach as a PhD. 

Conclusion

The question needs to be asked… what drives the push of the compulsory master’s degree for specialist endorsement in psychology? Particularly when:

  1. various forms of research over decades have done very little to support the simple notion of quality educational practice being most likely through a master’s degree program
  2. those variables found to be most critical in the development of practice expertise can be applied through both master’s programs and the +2-pathway equally.
  3. the 4+2 pathway is a high quality situated learning approach that is already effectively applied not only through the +2-pathway but also through its application in the training of academics (in their capacity to teach, research, develop and accredit psychology programs) and with the PhD student as a cognitive apprentice of research. 

Ultimately the 4+2 pathway is a very legitimate and highly effective form of education that does develop practice expertise across all specialist fields of psychology and therefore should be upheld and promoted as such.

Situated learning continues throughout our careers as a lifelong learning process. Learning does not stop once graduating; it is only the beginning.

What Should We do?

Processes should be established to ensure the 4+2 trained psychologist can gain specialist college membership and nationally endorsed registration in their specific area/s of practice expertise. To do otherwise simply ignores the science of situated learning and the role such learning has in the development of valid and reliable practice expertise.           

 

60 thoughts on “The 4 + 2 Pathway: A valid and reliable training option for psychologists

  1. This is a personal narrative, on training both ways. I apologize in advance, the angle taken here has not been more systematic.
    I trained two ways: 4+2, and clinical masters – I also have a PhD.
    Have supervised extensively 4+2; 5+ 1; clinical masters and clinical doctorate registrars. Objectively and subjectively, I have found very little difference between groups on the job and with client outcomes. In fact, some of my most outstanding colleagues were 4+2 trained – they were the ones who received great feedback from their clients, and I always wanted to learn from anyone who achieved those results. The best managers I ever had were social workers, sports psychologists, organizational psychologists, clinical psychologists, and psychiatrists. I feel so fortunate that I could learn so broadly and deeply within the context of psychology supervisory requirements. I loved our profession before 2006, it was united, supportive, and inspiring. I did, however, panic in 2006 fearful I would not work in the field if I didn’t obtain post-graduate training in clinical psychology. I was resentful that I had been encouraged in the early 90’s to do a PhD over masters. In fact, I don’t think our university had a ‘clinical’ course at the time (and, I had never heard of a professional doctorate). So, back I went, to see what all the fuss was about and found the culture was completely different. I struggled to fit in. Coming from my experience and as you would expect, I found the coursework relatively easy including the exams. To be honest, I am not sure I can compare and contrast the pathways with any metric – I think they both have their strengths and weaknesses. I will say I am relieved I did the 4+2 pathway first, I don’t think you can beat on-the-job-training like that, despite the stress. Today, I am devastated by the division in our profession. How one complex decision alienated many of my colleagues and made them feel so degraded and unworthy, was and is intolerable to me. There has to be a way to assess recognition of prior learning and options to upskill but first, there needs to be an apology, as a way to initiate healing. The last decade has been completely soul-destroying. Thank you for allowing me this space to finally express my experiences publically, and like so many others, to express the hope there will be a path towards unification.

    1. thank you for your honesty and integrity. It is a timely reminder that there are clin psychs out there who are embarrassed and sickened by what has been done to their colleagues by the APS and PBA- its called integrity. What an excellent example you are for speaking the truth, even though it is contrary to the privilege, status and higher income which has been bestowed upon you. You are totally right- most Australian psychologists (who research demonstrates have been doing an excellent job for many years) have been hurt by the false narrative spun by the APS/PBA. Healing does need to occur, and it can only be instigated by confronting the truth of what has been done, and the truth of what the research evidence tells us. I do hope more clin psychs can see you as a role model of integrity and contribute to the healing (rather than simply inflicting more damage to enhance themselves). Bring on the APS Board spill.

  2. Clive, no where have you actually addresses my reality based criticisms of the 4+2 and the reality / experience of many that 4+2: has been largely mixed and with a variety of learning experiences – surely we would all agree that this dors not equate to ‘valid and reliable’ – as ive said above, no doubt some had great experiences and are good psychologists, but when the teaching and outcomes are so varied this surely needs to be addressed? Situated learning occursvacross all pathways, however is only one part of the training and development structure.

    1. what we do know (from research based evidence- which is what we are meant to honour, above mere conjecture and opinion) is that Australian ‘generalist’ psychologists who underwent the 4+2 pathway have achieved excellent outcomes with their clients (‘clin’ psychs almost achieved the same level of successful outcomes, but the difference was not statistically significant). As such, whatever has gone on under the 4+2 system should be held up as an exemplar of good training – consistent or otherwise.

      1. It looks like the goal of some here is to keep psychology at the level of the ‘lowest common denominator’….. a shame as there is so much psychology can offer compared to psychiatry, social work, nursing, etc. Those sitting in their private practices need to step outside their offices and think beyond their narrow view of the profession and what they think it is.

        1. if you want to call vast improvements in people’s lives ‘the lowest common denominator’ (as though there is something more important for psychologists than having a positive impact on people’s lives), then i must wonder what your agenda is, and why you are in this profession?

        2. Hi David,

          The debate here is about equivalence of training options for psychologists (i.e. masters and the +2 provisional internship). The post is raising awareness specifically on the quality of the +2 provisional internship for student psychologists.

          So in the context of the original post and the discussions, I’m not sure how your comment contributes to the debate around the pros and cons of the +2 year provisional internship and the master’s degree as legitimate pathways for spring boarding in to full registration and practice.

          Kind Regards
          Clive

        3. Hi David,

          Every commentator so far that has opposed the initiative RAPS stands for, has focussed their arguments towards dismantling or ridiculing the views of RAPS supporters, without actually articulating a meaningful counter position or the real basis they object so vehemently to the equality in recognition and professional standing RAPS and its supporters are arguing for.

          So I would personally be very interested to understand what in fact you stand for in this debate, as I am sure so would the others? If the ‘lowest common denominator’ is private practice – what would you consider the pinnacle to be? And more importantly, how does achieving equality of standing amongst the whole profession detract from that?

          1. “Tia”, this post seems a convenient way of outright dismissing any legitimate arguments against such RAPS positions as the sweeping statement that all clinical masters students have been indoctrinated into believing that they are intrinsically superior to psychologists that you yourself argued, or your point that clinical psychologists do not have better outcomes then other pathways because you claim a clinical psychologist told you once at a party they abandoned a client because the client had an affair, a story which allowed you to expound on how you had a much more reasoned and compassionate response to the story as a generalist, simply by claiming any such argument is “focussed their arguments towards dismantling or ridiculing the views of RAPS supporters,”.

            I note that when psychologists like JHemsworth provide one of their many rational, well-thought out arguments against the RAPS position (which you just claimed never ever occurred) you refused to engage with them, and insisted on trying to only debate students like myself on the points they raised:

            https://reformaps.wordpress.com/2017/07/09/early-election-is-looking-pretty-fishy/

            I also note that as soon as JHemsworth replied directly in response to your attempts to discredit their points (again, not addressed directly to the author, but rather directed at a student who was not involved in the interaction and demanding they answer on JHemsworth’s behalf ) you failed to respond. It is concerning how some supporters of one position are attempting to stifle debate by only daring to attack students while conscientiously avoiding engaging with psychologists with similar levels of experience.

            1. Thank you – this is a key issue, there is no acknowledgement of the fact that the 4+2 is an inconsistent and unstandardised training process – this has been talked about for years, and acknowledged over the years by the APS, state reg boards and now PsyBA, with no other jurisdiction utilising this model of training. And it is acknowledged that some who have gone through this process are good psychologists. But dont we want a higher reliable standard? Obviously those who have gone through 4+2 are going to defend it, but to not even acknowledge the short comings and just repeat the same thought over and over is quite concerning and points to a lack of objectivity or capacity to remove the emotional and personalised component.

              1. Hi JHemsworth,

                The issues you raise in your comment, from July 18, 2017 at 6:47 pm, have been very clearly answered repeatedly throughout this post and related comments. Please read my comment from July 18, 2017: 12:38am; as it offers succinct clarity to your voiced concerns. As do many of the comments raised by others throughout this post on the 4+2 pathway.

                You keep raising the issue of the 4+2 being an inconsistent and unstandardised training process that has been talked about by the APS, state rego boards and now the PsycBA.

                As communicated already both the +2 internship and masters programs were both considered very loose in standardisation and external quality control processes back in the day; but the talk of inconsistencies and lack of standardisation has resulted in a shoring up of both the +2 and all psychology degree programs.

                And so yes, I agree, it has been talked about for years the need to shore up and standardise all training paths including the +2 internship, masters degree programs and also the undergrad and 4th year.

                Hence the establishment of the Australian Psychology Accreditation Council in 2009 to shore up the inconsistent and unstandardised training process of psychology degree programs across Australia and then the introduction of the national psych board of Australia to, among other things, shore up inconsistencies to full registration, including building greater consistency and national standards (as opposed to individual state standards) of the +2 provisional internship.

                Here is a link to the PsyBA page with all the documents related to the standardised process of the +2 internship. The standardised +2 internship path has been recently updated on 1st June 2017. After clicking on the link I encourage you to download the PDF document that is titled: “Guidelines for the 4+2 internship program – 1 June 2017”. This offers a very detailed review of what the +2 internship actually requires. The document confirms it is an excellent path offering a comprehensive and demanding learning experience to full registration and practice as a psychologist.

                Here is the link:
                http://www.psychologyboard.gov.au/Registration/Provisional/4-2-Internship-Program.aspx

                On a provocative side note it’s important to remember that the ‘4’ of the 4+2 is completed by masters students and +2 internship students alike. So in this sense there is far more in common than different in the training paths taken by masters students and +2 provisional interns.

                In light of this I would like to suggest that we expect some pretty dramatic changes in only 2 years of a 6 year training path when suggesting statistically significant differences will occur in the quality of service provision between a +2 internship and a masters degree. Particularly when the additional two years of both pathways do cover a lot of the same things. There is no evidence to suggest a statistically significant difference in the quality of service between +2 provisional intern trained psychologists and master’s trained psychologists. Research does not back this presumption at all. But please, if I have missed any research to the contrary, I would appreciate the heads up.

                Kind Regards
                Clive

                1. Clive, i have re-read your post from July 18 at 1238 as you suggested, seeking clarification of issues regarding the short comings and criticisms of the 4+2. Unfortunately you offer no argument against these citicisms apart from attempting to liken the +2 to other internships across health, allied health, and medicine. Aside from clear differnces in the internship programs of other health professions, which all contain multiple placement experiences with multiple supervisors and multiple forms of standardised assessment across the training, and clearly differs to the +2 mosel, i find it interesting, telling, and concerning that you view this in such a black and white way with not one acknowledgement of problems with the 4+2 apart from saying all pathways could be improved; your original thesis was re:4+2 being valid and reliable – it is not. I guess what this is saying is that it is highly unlikely there will be a constructive and reality based discussion re 4+2, its short comings and challenges, need for change in professional training, the future of the profession, and how to build and prosper psychologists for the future.

                  1. JHemsworth, you obviously have not been paying attention. Dr Jones PhD has stated on multiple occasions that a PhD uses situational learning, and that a 4+2 uses situational learning. What more evidence do you need that a 4+2 guarantees uniformity of learning? Obviously you are suffering from the same delusions that Dr Alexander PhD has diagnosed every single person who disagrees with any proposition put forwarded by any RAPS supporter with.

                    1. i couldnt possibly offer a diagnosis, or anything useful for that matter as i dont have the magical masters degree.

                    2. Even more interestingly, “Tia”, you do not actually deny that you had access to the APS document you posted showing the APS actively advocating on behalf of generalist psychologists and elected to intentionally not publicize its existence when multiple generalists were reporting their distress at feeling abandoned by the APS. Instead you use the hardly original “if you think I would do such a thing, you don’t know me” strategy to avoid explaining your actions. There is already a serious rift within the field of psychology; it is a shame some choose to intentionally inflame it rather then trying to work collaboratively to find a collective response that helps all of us.

                  2. Hi JHemsworth,

                    I have repeatedly flagged that I agree with you that each pathway has its shortcomings and that each pathway has its strengths and criticisms. That is a given. So rather than it being unfortunate that I have not argued against this, it is actually a point of agreement.

                    So I think the issue is, rather than me not answering your questions, you are expecting some other answer from the one I offer.

                    I am gathering (please correct me if I’m wrong) the bottom line for you, and others on this forum who oppose the +2, is to argue that this training path is a ‘bad’ path that will be more likely than a masters degree to produce less skilled practitioners. While everyone is free to think what they like, this opinion does contradict the wealth of literature on the topic of how to build competence for skilled professional practice. It also contradicts the reality of experience from the many thousands of patients using the services of psychologists trained through the +2 pathway. And it also ignores all the research that has tried for quite a while to differentiate between undergrad and post grad trained practitioners to no avail.

                    The bottom line for me, if our motives were to be collaborative rather than competitive, is to pool resources of our profession to ensure there is ongoing quality improvement in the development and growth of both the masters pathway, the +2 pathway, the undergraduate degree and 4th year.

                    But instead of collaboration, we are faced with a competitiveness that only serves to defame (i.e., harm the reputation of, by communicating false statements about) colleagues of the +2 pathway and slander (e.g., statements towards another defaming their capacity to perform one’s occupation effectively) colleagues of the +2 pathway.

                    The fact remains both the masters and +2 pathway are very sound ways to train psychologists. Ongoing refinement, in the right direction, will continue to enhance the strengths and iron out the glitches within each pathway.

                    In the full acknowledgement of both the strengths and any short comings of each pathway we should respectfully collaborate for the ongoing improvement of each, rather than go about slandering and discrediting the pathways on offer and those who have trained through them.

                    I will reiterate that I believe we do our profession, colleagues and community a great disservice to spread polarised, over generalisations of the supposed catastrophes faced by anyone who has chosen to train through the 4+2 or for anyone who is being treated by someone who has spring-boarded in to clinical practice through the 4+2.

                    We need to reel the erroneous perceptions right in and show a genuine and authentic respect not only for our colleagues, but also for the community and the treatment they value and appreciate due to the very real life changing outcomes achieved through psychologists trained through the +2 pathway.

                    To offer yet again evidence of how both training pathways do build quality practitioners as the norm, here is a small snapshot example of the outcomes achieved by the ‘generalist’ and the ‘clinical’ psychologist alike: Pirkis, J., Ftanou, M., Williamson. M., Machlin, A., Spittal, M. J., Bassilios, M., Harris. (2011). Australia ’ s Better Access initiative: an evaluation. Australian and New Zealand Journal of Psychiatry 2011; 45:726–739

                    “Participating patients who received care from clinical psychologists, registered psychologists and GPs under Better Access shifted from having high or very high levels of psychological distress to having much more moderate levels of psychological distress (as assessed by the K-10). Patients who received care from clinical psychologists and registered psychologists also showed shifts from moderate or severe levels of depression, anxiety and stress to having normal or mild levels of these conditions (as assessed by the DASS-21). These outcomes are of a similar level of magnitude to those experienced by patients who receive care from psychologists through the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care programme.” (p. 736-737).

                    “The findings suggest that Better Access is playing an important part in meeting the community’s previously
                    unmet need for mental health care. The initiative has enabled patients with clinically diagnosable disorders and
                    considerable psychological distress to access care; many of these patients have not received mental health care in the past. These patients ’ mental health status improves markedly during the course of their care; their symptoms reduce and their psychological distress diminishes. These achievements should not be under-estimated.” (p. 738).

                    Kind Regards
                    Clive

                    1. Hi Clive,

                      Thank you for your words – as a 4+2 trained Psychologist, it is so heartening and humbling to see an experienced and well-regarded colleague defend the validity of my training with such passion and respect!

                      If I may add one tiny thing to what you have already expressed so eloquently; I came across this brief from the APS to the NSW Mental Health Commissioner in January 2014, actively advocating for the 4+2 pathway and the benefits of utilising interns within the public mental health system, as part of their training.

                      http://nswmentalhealthcommission.com.au/sites/default/files/A%20briefing%20paper%20on%20Psychologists%20in%20NSW.PDF

                      I found particularly interesting the point made about how since 2010 and the inception of PBA, changes to the Internship pathway have been so severe, that this training pathway has become so intensive and rigid that many organisations are unable to accommodate all the training requirements of this pathway. A direct contradiction to the stated view that this pathway is lax in standards and structure.

                      This paper not only advocates for the survival of this training pathway (contrary to perceptions that it has been scheduled for retirement for the past 20 years), but explicitly implies that the growth of the psychology workforce in general relies on it and directly requests government intervention to protect it from extinction.

                      Quite a different position from what is being presented by those criticising it’s value, isn’t it?

                    2. Tia, interesting. So all this time, while RAPS supporters have made numerous claims that the APS were indifferent to, or were outright attacking, the best interests of 4+2’s, you had access to documented evidence to the contrary and yet you chose to remain silent. Only when you found yourself feeling defensive about the value of the 4+2 did you decide to publicize this information which would have reduced a lot of the distress experienced by your fellow 4+2’s who incorrectly felt the APS had never advocated on their behalf to the government. Why did you choose to conceal
                      this information each time a RAPS supporter revealed distress based on a false belief the APS had never advocated for them?

                    3. JD, if you honestly believe that I had this document all along and purposely chose not to post it in response to you or JHemsworth (or others) before now, then you haven’t paid enough attention to the things I have been saying and what they reveal about me as a person.

                      Honestly, after all our spirited debate these past few days, this comment disappoints me – how unoriginal….

            2. Hi JD,

              I think you and I have very different views about what the issues are. The core and primary issue at the heart of all of these discussions, is the fact that the vast majority of psychologists in this country are being adversely impacted, both in terms of professional standing and financially, for reasons that as of yet remain unclear.

              Regardless of how I or others have chosen to express our views of the landscape we all find ourselves in, the only reason any of us are having these discussions at all, is the fact that we currently face an inequitable professional landscape and we wish to redress this.

              Every argument against RAPS has focussed on side issues, such as 4+2 v Masters trained, Clinical v everyone else, etc…, however I am yet to see a clear pronouncement from yourself or any one positioning themselves against RAPS, that has clearly articulated why the current inequality is valid and should remain. I can only assume the perpetual focus on side issues or nitpicking what is being said, is being relied on to deflect from a lack of valid/reasoned opinions about this central issue – or perhaps because there is simply no legitimate way to justify it! However, if I am mistaken and you happen to have an opinion about this, I would LOVE to hear it!

              As far as your curiosity about my response to JHemsworth, we have been having a discussion on this very thread regarding those issues – just scroll down for the details. Once again, if you have an actual opinion about the points I am raising with him or any others, I would love to hear it!

              1. So you want to move away from discussing the specifics of the different arguments for why different psychologist may be receiving different treatment (e.g. finishing a post-graduate program rather then an internship, finishing a clinical program rather then a program with a different focus) and instead want to make the whole discussion around the vague “some psychologists are treated different, and that’s not fair”? Wow, talk about avoidance.

                Thank you for (inadvertantly) highighting the deceptive attempts by some to conflate providing the higher rebates to psychologists with endorsements other then clinical (for which in my opinion, there is a solid argument given the equal studies and time required for any endorsement, and which I believe the APS is already advocating for) with providing a higher or equal endorsement to both psychologists who have completed a Masters or Doctorate, and to psychologists who have completed a 4+2, a position which is far less defensible.

                1. Surely you can see that these issues were conflated when Medicare split the profession into 2 camps – clinical and non-clinical, with little consideration for the complex training backgrounds of those already in existence within the profession at the time the rebate was introduced?

                  Prior to 2006, all registered psychologists in the country sat within a flat structure and were considered equal in terms of professional standing (with the exception of WA, who had ‘specialist titles’ as a part of their registration structure). Until that point there existed various masters alternatives and the majority of psychologists entering the profession, did so through the 4+2 pathway.

                  However, when Medicare introduced the rebates, the landscape of psychology changed from all Registered Psychologists (albeit Masters trained vs 4+2 trained), to Clinical vs non-clinical. This affected all those lumped as non-clinical in the following ways:
                  1. Decreased earning power
                  2. Decreased employment opportunities
                  3. Lowered professional standing

                  It also affected the entire professional landscape by diminishing all advanced training opportunities that were not deemed clinical. This is why those who possess higher degrees of non-clinical disciplines and those who trained through the 4+2 pathway are banding together through this initiative.

                  But if I have understood JHemsworth, yours and others position correctly; you each believe that the current discrepancy in rebate between the tiers is directly resulting from the perception that those who have entered the profession via the 4+2 pathway are not trained to a high enough standard and shouldn’t be granted access to the same entitlements given to those who have trained via a Masters path (whilst actively ignoring the discrimination of those who possess higher degrees that are not clinical).

                  In this attempt to simplify the issue in that way, there is an active dismissal of the fact that several psychologists who today possess Clinical Endorsement, were trained within the 4+2 pathway and never progressed their training to acquire a Clinical Masters, but have earned the ‘title’ by virtue of their experience/professional standing.

                  So if the only argument is that those who have trained via the 4+2 pathway and do not possess advanced training are lacking in standards and this needs to be redressed and the 2 tier system is one way of achieving this; then it raises the question about what should happen to those currently encased in the endorsement of ‘clinical psychologist’, but who fall within the same base description of those your arguments are actively vilifying?

                  Can you see how this whole mess was made significantly more complex by the introduction of the 2 tiers? Purely by virtue of the introduction of the clinical/non-clinical structure, the landscape of psychology has become this convoluted mess where some with higher degrees are diminished in status, whilst others without higher degrees have been able to elevate their own status and a whole third group of practitioners are vulnerable to being cut off from the profession entirely.

                  No wonder it has become such a contentious and divisive issue!

                  I asked this of you once before, but you never answered my question: – if Medicare had introduced a single rebate from the start; would Clinical Psychologists have been disadvantaged in some way? Is so, how and why?

                  And if the goal has always been to increase the standards of the profession, in what way would a single rebate from the start have detracted from that?

                  1. That’s a lot of words to avoid answering a very basic question; how do psychologists who did not complete a Masters and are not willing to complete one citing expense, difficulties in working for free etc (which ignores the fact that people in their early twenties completing their Masters somehow do seem able to make the same sacrifices) justify wanting to piggyback onto efforts by the APS to lobby for holders of any endorsement (not just Clinical but counselling, health et al) to be made eligible for the higher rebate? Also when you speak of psychologists who have clinical endorsements without having completed a Masters, you are referring to those psychologists who completed a bridging program, a program that was open to all psychologists with the prerequisite level of experience, yet was not only not undertaken at the time but whose reintroduction is now being met with bitter resistance by some RAPS members on the grounds it is too much trouble and that they have nothing left to learn in the field of psychology.

                    1. I completed my (non-clinical) masters in my early 20s. That wasn’t overly difficult for me then. I worked part-time in the field and studied part-time, and took 5 years to complete it. It had to be that way because my parents could not afford to support me and at that time AusStudy was not available for postgraduate degrees. Now I am a parent and I have a mortgage. If I was to forgo seeing clients or to significantly reduce my caseload I would lose my house. It is not the same.

                    2. If there was a question in your previous statement, it wasn’t readily visible.

                      In regards to your direct question above; I can’t speak for all my colleagues and their individual circumstances, but I have explicitly stated here several times that I am absolutely open to completing any bridging course or additional options that become available.

                      My question on the other hand, was as direct this time, as it was the first time I asked it and yet you continue to refuse to answer the question. Who’s avoiding here?

                      You know, in hindsight – choosing the alias ‘Ivanka Trump’ was very apt!

                    3. Hi Melanie,

                      Thank you for highlighting one of the many, very real obstacles that exist for those of us who have already been in the profession for a while.

                      JD claims she is still a student, so perhaps this explains her expressed belief that life is simple and the rest of us are just lazy and entitled…

                    4. Well, “Tia”, here is the question that you seem so desperate to avoid answering:

                      “That’s a lot of words to avoid answering a very basic question; how do psychologists who did not complete a Masters and are not willing to complete one citing expense, difficulties in working for free etc (which ignores the fact that people in their early twenties completing their Masters somehow do seem able to make the same sacrifices) justify wanting to piggyback onto efforts by the APS to lobby for holders of any endorsement (not just Clinical but counselling, health et al) to be made eligible for the higher rebate?”

                      For future reference, “Tia”, when a sentence ends with a question mark, that denotes it is a question.

                      I find it quite telling that you think it appropriate to stereotype each and every clinical student as being easily indoctrinated into believing they are superior to all others … but then declare you can’t speak for your fellow generalists and their individual circumstances. Why is it ok for some RAPS supporters to stereotype all clinical students (who again had nothing to do with the establishment of the current two tier system) as being unethical elitist bumblers while still maintaining we should treat generalists as individuals?

                      I also find it quite telling that you continue to harp on my decision to use my actual name, after being requested to do so by yourself and Dr James Alexander PHD, while still hiding behind an obvious pseudonym “(One) Tia”. I guess that is easier then providing an explanation for why you withheld documentation of the APS supporting generalists even when multiple generalists were reporting feeling abandoned by the same organization.

    2. Hi JHemsworth,

      I believe I have addressed your question of validity and reliability comprehensively. I will summarise, just quickly off the top of my head, some of the things I have either addressed directly or alluded to in one way or another through my various replies and through the original post.

      The 4+2 applies a robust (e.g., well researched and applied educational model of internship) that is used across all health, allied health and medicine fields, that is introduced after 4 years of intense university study and research.
      The +2 internship and masters are equivalent in their capacity to produce experienced practitioners.
      The +2 internship and masters are equivalent in their vulnerability to outliers of poor quality experiences for the student and poor quality educators/supervisors.
      Both the +2 internship and masters pathway are equivalent in the demands of ongoing refinement in national standardisation and quality control of the educational experience.
      I have not read or heard of anything in the literature to the contrary of the points I’ve raised above. l suggest that the literature searches across the health, medicine and allied health fields support far more than refute the points I have raised above. Please though, if there is any evidence to the contrary of the points above I would appreciate the heads up.
      I believe we do our profession, colleagues and community a great disservice to spread polarised, over generalisations of the supposed catastrophes faced by anyone who has chosen to train through the 4+2 or for anyone who is being treated by someone who spring-boarded in to clinical practice through the 4+2. We need to reel that erroneous perception right in and show a genuine and authentic respect not only for our colleagues, but also for the community and the treatment they value and appreciate due to the very real life changing outcomes achieved.

      A small snapshot example of outcomes achieved: Pirkis, J., Ftanou, M., Williamson. M., Machlin, A., Spittal, M. J., Bassilios, M., Harris. (2011). Australia ’ s Better Access initiative: an evaluation. Australian and New Zealand Journal of Psychiatry 2011; 45:726–739

      “Participating patients who received care from clinical psychologists, registered psychologists and GPs under Better Access shifted from having high or very high levels of psychological distress to having much more moderate levels of psychological distress (as assessed by the K-10). Patients who received care from clinical psychologists and registered psychologists also showed shifts from moderate or severe levels of depression, anxiety and stress to having normal or mild levels of these conditions (as assessed by the DASS-21). These outcomes are of a similar level of magnitude to those experienced by patients who receive care from psychologists through the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care programme.” (p. 736-737).

      “The findings suggest that Better Access is playing an
      important part in meeting the community’s previously
      unmet need for mental health care. The initiative has
      enabled patients with clinically diagnosable disorders and
      considerable psychological distress to access care; many
      of these patients have not received mental health care in
      the past. These patients ’ mental health status improves
      markedly during the course of their care; their symptoms
      reduce and their psychological distress diminishes. These
      achievements should not be under-estimated.” (p. 738).

      Kind Regards
      Clive

      1. thank you again Clive. Unfortunately, some people dont like having the evidence brought to their attention when it fails to support their argument. Whatever happened to the scientist/practitioner model?? The APS leadership is as faulty in this regard as are their protege (but have more responsibility to rise to the best of psychology, not peddlers of misinformation and self-interest).

        1. Hi James,

          I agree. It’s quite a worry how any evidence that comes through science and expert practice seems to be so blatantly ignored. As you suggest I think it does boil down to the science and practice of psychology being strong-armed by the politics of sub-group peddling for territorial gain and control of key areas of practice.

          And when political agendas end up ignoring both the science and the broad cohort of expert practitioners in the field… well, we know that never ends up in a good place.

          Kind Regards
          Clive

      2. Clive, belief is the problem here as opposed to facts. You can believe you have addressed it but not once have you tackled the facts that I’ve presented regarding the 4+2 pathway. Instead you’ve repeated the same line over and over. Im more than happy to have my points criticised and challenged.

  3. The other problem here is that the concept of ‘situated experience’ is put forward as ‘proof’ of a minimum standard and level of skill / expertise, but without any actial reference or explabation of how the 4+2 achieved this, so the ‘argument’ is more opinion than a lucid or defendable argument. And… clearly masters courses include situated experiences anyway….

  4. Dear Dr Jones,

    Thank you so much for articulating the value and legitimacy of this training path in the way you have!

    Sometimes in this debate, I have found myself getting disheartened by the way it tends to be discredited as a means of acquiring applied expertise. So reading your conceptualisation of why it is still a worthwhile approach to training, has filled me with a little more pride in the journey I have had and hope for how things could yet be. Thank you!

    1. it is particularly heartening to have a well regarded academic showing acknowledgement and respect for the ‘non-academic’ +2 training pathway- perhaps all is not lost. We need more of this type of honesty in the whole discussion of the way forward for our profession. Without it, we are all sunk (including the ‘clinicals’).

  5. I wonder how Clive explains the fact that master of education degrees, which he makes reference to, are not required in any profession in order to teach, develop content, research, etc. Do medical practitioners, nurses, engineers, etc etc need a MEd degree to teach in their field? No, they all have profession specific degrees with profession specific and applied practice content, and they teach how to be that particular professional. Further, they all have a combination of uni (dismissively refrered to as ‘book learning’ on this website) and field/practice placements. They have standardised learning and multimodal assessment. The 4+2 process has been a poorly standardised, variably and at times minimally assessed process with wide and disparate outcomes, largely reliant on the skills of one primary psychologist to teach and assess – with wide variation in supervisor quality and expertise. That is a fact and why both an exam was introduced and why this pathway is being retired. No other profession has this model. Situational learning, while part of the picture, is ONE part of the picture, not the picture in totality.

    1. Hi JHemsworth,

      That’s exactly right in that university academics across all specialities do not need specialist master’s degrees in their field of practice expertise (i.e., program writing, accrediting & teaching). This is exactly my point.

      On your voiced concerns over the 4+2, I do need to flag my concerns with arguments that attempt to discredit the 4+2 training pathway through various cognitive distortions. In that sense I cannot help but feel bombarded with overgeneralisations, catastrophising and polarization of the 4+2 pathway and those who have trained and are training through it.

      It is important to remember that the 4+2 is a legitimate pathway. Through it our community has and still does benefit from the quality of psychologists produced through it.

      It is also important to clarify that of course all pathways, whether the 4+2, all masters programs and now the new 5+1, all need ongoing monitoring and refining to help ensure all pathways continue to maintain the high standards we have upheld and continue to uphold as a profession across our training, practice and research.

      Kind Regards
      Clive

      1. Yes, the 4+2 has been a legitimate pathway, and has produced some very good psychologists. My comments regarding this pathway to registration however still stand; rather than reflecting ‘cognitive distortions’ as you assert, my comnents are based in reality and reflect the unfortunate spectrum of experience and skill the 4+2 pathway produces – this is what i said “The 4+2 process has been a poorly standardised, variably and at times minimally assessed process with wide and disparate outcomes, largely reliant on the skills of one primary psychologist to teach and assess – with wide variation in supervisor quality and expertise”. Not distortion, but reality. This has lead to a blurring of the minimum skill set required for practice and has been an inherently flawed process for many through the poor-semi standardised structure. An unfortunate but reality.
        And while many psych lecturers do have specialist masters degrees ( just look at your colleagues at Bond), other professions generally dont because of the professional / applied practice focus of the profession specific undergrad degree. A masters in psych (whether clin, couns, for, neuro etc) is the applied training because of the broad nature of undergrad psych degrees.
        This is also about where we want the profession of psychology to be in the future – a highly trained and expert profession with ‘clout’ (to put it admittedly rather crudely) or a profession where a minimum standard of skill and knowledge cannot be guaranteed due to such a wide and poorly standardised variety of training experiences with limited objective and standardised assessment – as is the case in other professions?

        1. This is where you want the profession of psychology to be in the future- “with clout”- but for what purpose? To persuade the public to have confidence in our services? The public already has, as seen in their eagerness to utilise our services. They clearly have confidence because most people who see psychologists (which means ‘generalist’ psychs) get the results they want- see the research. All that the APS has done is to erode the confidence which the public can rightly have in Australian psychologists, by instigating the 2 tiered scheme (and thereby feathering the nests of academic clin psych teachers and their graduates). It is not possible to create ‘clout’ with either the public or gov’t by relegating the majority of psychologists to a second tier status- this is clearly irrational and self-defeating; and can only occur via an ulterior motive of the self-designated elite (ie. ill-gotten elevations in money and status). The elaborate and convoluted arguments simply dont stand up to scrutiny- each one is just another step away from intellectual honesty, at the expense of our entire profession. Changing the APS (and their ethically bankrupt narrative) is perhaps the only way forward.

          1. This is argument about minimum standards in training psychologists. The argument by Clive was that 4+2 is valid and reliable – we must have different understandings of these concepts as 4+2 has had wide variation in supervision, training experiences, and outcomes, with variable assessmemt of skill and knowledge. This does not equate to ‘valid and reliable’. And this is not my opinion, this has been talked about for 20+ years and if people arent aware of this, well they’ve had their heads in the sand. When i went through Syd Uni in the early 90s we were told then that a masters was the way forward and 4+2, because of its inconsistencies, was on the way out and did not match to any other training model internationally. Situated learning, while clearly an important part of training, is however put forward by Clive the argument why 4+2 is v and r and perhaps by extension equal to or better than a masters. But thats it, no further explanation, deconstruction of how it works, or even reference to ‘SL’ in the 4+2 context. It appears more personal opinion than valid and reliable argument.

            1. Hi JHemsworth,

              We must be able to differentiate between a university selling its product and evidence.

              There’s a lot of info to get the head around in the arguments that advocate for the qualities of the 4+2, that is by no means a statement against the master’s path, but simply clarifying the +2’s merit as a sound path, of a few on offer.

              Mud can be slung to degrade any training model. Just one small example that always sticks in my mind, I remember one time back a few years at a different Uni to where I am now, (I think it was the semester I was teaching abnormal psychology, counselling psychology and lifespan developmental psychology so maybe around 2004) walking down the hallway past a lecture theatre and being accidentally bumped in to by a group of students as they just about fell out of the lecture room in hysterics at the lecturer, saying things like; what a nutter! – that guy is insane! I’ve personally been employed/contracted under numerous roles across 6 different uni’s, a number of different faculties and maybe around 10 different departments/schools and by golly I have some stories! 🙂 !

              Point being; quality control is crucial for all pathways on offer for student psychologists in training whether a master’s degree or 4+2.

              Back in the 90’s when you were training, psychology academics had much freer rein to do what they pleased as employees of self-accrediting institutions (i.e., the university) running psychology programs. While the APS did have a look and a say in what went on, back then subjects were more a reflection of the academic teaching it than a standardised, quality controlled model of approach.

              Hence the reason for the development of the Australian Psychology Accreditation Council (APAC); to rein in the personal influences of the academic to have instead a nationally standardised model of training. This is being done with the 4+2 as well. Both pathways have been and continue to be shored-up and standardised quite a lot compared to back in the day of the 90’s and prior.

              As a side note, there are pros and cons to this highly standardised ‘franchised’ approach to training (re: all undergrad, post grad and +2 pathways) whereby a ‘lack of standardisation’ is not inherently a bad thing. I’m personally more a fan of the local hamburger joint than the McHappy meal standard pack; but that’s just me, and either way, striking the best balance between the two is the key.

              One quick example of a con to over-standardisation – just imagine taking a university subject run by, or a +2-provisional path supervised by, the likes of e.g., Piaget, Beck, Ellis, Rogers, Bandura, Piaget, to name a few and they were all completely hamstrung in what they could teach you due to the requirements of following the standard course content determined by some other dude in the accreditation process. You would undoubtedly want them to have some free rein to include in the content of your learning their own knowledge and expertise. Again though, striking the best balance between the two is the key.

              Ultimately, the goal is to ensure the training path taken is one of quality and achieves the goals it sets out to. While standardising plays an important part, and continues to occur across all pathways on offer; supervisors of +2’s and academics at Universities all have an important responsibility to uphold too. In this point, we should not presume that a university lecturer is inherently more competent than the provisional supervisor or the provisional supervisor is at greater risk of poorer performance in their duties than the university lecturer.

              There is ongoing standardisation and refinement of the masters and 4+2. Bugs are continually being ironed out of both while at the same time the merits of both should also be openly acknowledged and upheld.

              Kind Regards
              Clive

              1. Clive, i lstgely agree with everything you say, especially the point about quality control. Of course all pathways can improve and absolutely there needs to be room for both standardised content and the ‘style/interests’ of the teacher/supervisor. But, quality control and too wide variability in quality has been one key issue with the 4+2. No doubt some supervisees have had fantastic teachers and learning experience. But actually assessing this is the issue – apart from a single supervisor saying the supervisee is competent. How valid and reliable is that? Vs multiple forms of objective assessment by multiple teachers and supervisors in a postgrad masters?

                1. Hi JHemsworth,

                  I’d suggest that the issue is not so much on whether supervised internships are valid and reliable, but more about when an internship should be applied along the training path to registration as a psychologist.

                  The reason I say this is because the literature on it is very clear and every other health, allied health and medical field understands how critically important internships are in moving the ‘newbie’ graduated novice towards a level of competence to full registration and practice.

                  In this context psychology really needs to keep up to speed. Debating over the validity and reliability of internships is more a testimony of how far off-track psychology is with its educational practice compared to every other health, allied health and medical profession.

                  Just as one small example, below is an excerpt of the most updated info from the Medical Board of Australia & the Australian Medical Council’s Guide to the provisional registered medical practitioner’s intern training. Their ‘plus two’ is 47-weeks and is a requirement for all 4th year graduate medical students seeking full registration as a medical practitioner. While following the same situated learning model as our ‘plus two’, unlike us, it is mandatory for every 4th year medical graduate to complete their 47-week provisional practice internship before being allowed to gain full registration as a medical practitioner.

                  Direct Excerpt from the Medical Board of Australia: “In Australia, all medical graduates must successfully complete an internship before becoming generally registered with the Medical Board of Australia. Your internship is a key part of the transition from medical school to independent practice and speciality training, and focuses on practical (on the job or work based) training under supervision from senior colleagues, who also provide you with support, feedback, teaching, and assessment. You will have the opportunity to apply, consolidate and expand your clinical knowledge and skills, and progressively increase your responsibility for providing safe, high-quality patient care. By the end of your internship, you should be able to demonstrate the skills and knowledge described in the Intern training – Intern outcome statements. The outcomes focus on ensuring the provision of safe, high-quality patient care.”.

                  In contract to all medical students needing to complete a 47-week provisionally registered internship as a transition from four years of medical school to independent practice, psychology students have the choice of completing either a 2-year internship or a master’s degree instead.

                  Seeing it all from this perspective sheds some light on the argument that a 2-year master’s degree in psychology will not necessarily provide the best transition from school to independent practice when a lot of the time is still within the learning environment of the school; including the first practice placement usually being through the school’s own clinic. What is even more concerning for some is that the master’s student can become fully registered as an independent practitioner without ever being fully immersed in a long-term internship and thus never having the opportunity to be under the close scrutiny of experienced professionals in the practice setting over an extended period of time.

                  I am not saying the mater’s is not a viable option. I am simply pointing out the very real pros and cons of that option.

                  We should not be neglecting or degrading our two-year provisional internship to registration and practice. It is a high quality situated learning path that every other health, allied health and medical profession understands and upholds. Psychology really needs to keep up.

                  There is so much more to talk about around all this but I will save further discussions according to any other questions that might crop up.

                  Kind Regards
                  Clive

            2. if it is all about producing effective psychologists (and what else could it possibly be about?), then there is plenty of evidence already that 4+2 psychs are effective in working with the same client populations as ‘clin’ psych, using the same approaches, and getting excellent results. What other evidence is needed that this is an effective means of education and training? (if it is all about producing effective psychologists). But, due to the inability of some ‘clins’ to hear repeated presentations of evidence, it would appear that (for them at least) this is not about producing effective psychologists- so what is their actual agenda? And the actual agenda of the clinical academic cohort who have hijacked the APS? Because it couldnt possibly be about producing effective psychologists- thats has already been achieved by the 4+2 pathway (and ‘clins’ appear to get as good results as ‘generalists’).

    2. Hi JHemsworth,

      The other day I posted on a different thread about my fears that the National Exam was introduced as a means of slowly choking off the 4+2 pathway. I see from your point above that I may not have been ‘reading too much into things’.

      I had a look through the last PBA Consultation paper for lifting the exemption for Higher Degree students and I noted that the Board indicated that they had concerns about the perceived inequity of not having all applicants sit for the exam and also they reported concerns about the increasing variation in standards between institutions producing Higher Degree students currently. They explicitly stated that they believed the exam would provide an effective measure of consistent standards across all applicants.

      I was particularly struck by the fact that almost every single submission to this consultation paper made the exact same 3 points against lifting the exemption. These submissions came from the APS, various Universities and Students themselves.

      The first most striking and relevant objection was that the relevant skills could never be adequately assessed in an exam format. Given it is made up of 150 multiple choice questions covering only 4 domains of practice, I tend to agree. And yet, until such a time as the intention to permanently retire this pathway, as allude to by you, is made public, this exam remains the gatekeeper for emerging General Psychologists.

      The other 2 primary objections that were raised were
      1. that any concerns about the standards of the programs themselves, should be addressed with the assessing institutions, not the students
      2. That if the exemption were lifted, there were grave fears that prospective students would elect to not pursue the higher degrees as a pathway to registration.

      How curious that they felt that concerns about the assessing standards should be addressed with the assessors directly and yet 4+2 students are the ones demonised for perceptions of poor assessor standards, rather than mechanisms being implemented to accredit those who are guiding students through that particular pathway. I also found it curious that there seemed to be a consistent belief that if higher degree students were made to sit a 3 hour test at the end of their training, they would elect to not pursue the Higher Degree path – what does that say about the motivations of those who pursue such degrees currently?

      I am 100% in agreement that we can only benefit as a profession if the standards of our emerging colleagues are of the highest caliber. However, there continues to be a significant gap in the number of Masters offerings, to accommodate the major demand for these programs; not to mention a frightening narrowing of specialisation options.

      All other professions you mentioned above, are guaranteed to be able to pursue their chosen profession, once they successfully complete their core studies. Physiotherapists, Nurses, Social Workers, Doctors and Engineers all know that once they graduate from their undergraduate degrees they will be able to join their respective professions – higher degrees are not necessary, but optional to practice. And yet, if alternate pathways of Registration are killed off, without replacing them with something more suitable and accessible, then we risk being the only profession that turns out thousands of undergraduates with nowhere to go. And who exactly would ultimately benefit if this were to occur?

      Something about that just feels very morally wrong!

      1. All good points. I don’t think however that the exam was about ‘choking’ the 4+2 pathway, it seemed more about guaranteeing a minimum knowledge base. The 4+2 pathway was already on its death bed well before this came into play.

        1. Perhaps; but I must admit I remain skeptical. Firstly because according to the Board, initial work on the exam began in 1986 and was subsequently parked in 1990, until it was formally developed and introduced in 2011.

          But secondly and most conspicuously, the exam curriculum comprises assessment of DSM V diagnostic understanding and psychopharmacology knowledge, which according to current descriptions detailed in the APS website and in line with the current Medicare delineations of scope of practice, seems to be solely within the domain of Clinical Psychology.

          It’s odd that General Psychologists must demonstrate knowledge of subject matter that have been publicly deemed to fall outside their scope of practice, don’t you think?

          1. Tia, basic clinical skillscand knowledge are required of anyone working in mental health.
            Dont forget also that the APS werr already preparing for the end of the 4+2 when they required all new full members to have a masters – way back in 2000! This was the aps also saying training standards had to change. However because the 4+2 wasn’t shut down due to govt fear of not having enough mental health workers, people kept doing it and the APS had to introduce the problematic associate member category.

            1. Hi JHemsworth,

              Thank you for making that point, because that is precisely the basis for this whole initiative. As you’ve stated, all psychologists working in mental health must have and utilise the same core/basic skills and knowledge. If you agree that diagnostic and pharmacological understanding comprises core skills and not specialist skills, then surely it follows that Medicare’s current delineation of scope of practice is erroneous, when it attributes those skills only to Clinical psychologists.

              So something is amiss here – either the Board is expecting general psychologists to demonstrate skills that they are not trained in and are therefore not actually qualified to apply or Medicare has grossly undermined the skill set of thousands of non-clinically trained practitioners.

              Which is it in your opinion, because it certainly can’t be both…?

  6. thank you Clive- it is always great to read the clarity and rational argument which you bring to these issues. I wish the APS and PBA had a similar respect for the evidence.

  7. Thank you so much Dr Jones for that elegant and eloquent critical analysis of the stigmatising of the situated learning process of the 4 + 2 pathway. And for the clarification of the sophisticated learning model it is in reality.

    1. I find the comment/essay compelling. Thank you for a contribution that very much helps with coming to balanced conclusions and affirmative actions!

    2. Hi J Dwyer,

      A couple of things with what you flag about the PhD and practising as a psychologist. If you mean clinical practice in psychology then this would depend on what year the psychologist registered. If you mean university teaching/program development/research practice in psychology, then the PhD is usually considered a requirement.

      The key point is that the PhD uses the situated learning approach to build expertise in research and the +2 of the 4+2 uses the situated learning approach to build expertise in practice. A quality approach to building expertise across a range of applied disciplines.

      Master’s programs are trying very hard to squeeze in situated learning in research through the supervised research project, additional coursework and situated learning in supervised practice through two placements. Some have flagged concern that this is too tight in trying to do too much in too little time and thus risk detracting from the practice learning experience for students.

      The development of expertise needs time in practice and time to reflect on that practice. Squeeze this out or make it tight for time to achieve and it could impact negatively on the practice learning experience.

      Not too long ago the APS had proposed a masters training model that would take out the research component to allow more time for situated learning in practice placements for master’s students and possibly allowing room for more practice relevant coursework too; possibly to stimulate further reflection on the practice expereinces. I’m not sure if this idea has gotten any more traction in any master’s programs somewhere or if its still just an idea expressed one time by Lyn Littlefield at an APS conference possibly 5 or 6 years ago now… I think it was the APS conference in Canberra… ?

      All training pathways, whether 4+2 or master’s, are refined and modified over the years which is a good thing. Ongoing refining of the 4+2 and masters programs is important to ensure they both continue to provide the high standard of training they both currently achieve for students.

      Kind Regards
      Clive

    3. Sorry – that was badly phrased. I meant that while a PhD is an academic qualification that it’s holders should be rightfully proud of earning, it is not a pathway to registration as a psychologist (excluding the new Clinical PhD’s which are closer in content to a D.Psych) so advocating for recognition of 4+2’s as a legitimate form of training psychologists by comparing it to a PhD has little logic.

      1. Hi J Dwyer

        If I’m correct in my understanding of your written words, you seem to have twice misunderstood what Clive has written – what he says does have logic as I see it as Clive clearly states that both situations (4+2 and PhD) utilise situated learning. One, a situation to produce academic PhD’s and the other, a different situation in which the students can learn to be practitioners. So Clive is referring to the learning process itself not the content.

        Clive, thank you very much for writing the above on situated learning. I would like to respectfully suggest that all who are interested read, if not familiar with, some of the writings of Donald Schon. In particular Educating The Reflective Practitioner. Also much of the literature on Experiential Learning. We are often comparing the Hypothetico Deductive Research Model (or academic practice) and the Action research Model (or practitioner practice) here. They are both valid within their arenas of expertise but you cannot learn to be a good practitioner by following the academic model unless your practice is intended to be entirely based upon content. Instead, and if your practice is intended to be largely based upon the process, you need to follow a training model that is based largely upon action research. There is no hypothetico deductive model that can adequately evaluate skilled process practitioner behaviour. Such behaviour is evaluated by direct engagement with it in the complexity of the arena in which it manifests – traditional exams will render an inaccurate outcome. It is actually skilled behaviour to be able to recognise and evaluate tacit knowledge. There are many in the academic world who do not understand this or who discount it’s worth.

        There are many potential ways by which the 4+2 could be improved and the same statement could apply to all the pathways. However improvements to the world of the practitioner are best left to those who understand the world of practice. Improvements to academia are best left to those who understand that world. In the 4+2 what we currently have, from a broad perspective, is psychologists who want to enter the world of practice (and here I am mainly referring to process practitioners) participating in a more academic world of learning as an initial foundation. Following this they participate in a more action oriented world of learning. Both forms are valid as a progression toward practice. The “teachers” within each learning form could do well to acknowledge the validity of the teaching processes involved and where and how their differing learning preferences and associated skill sets “teach” best. In short we do not need academics “ruling” the world of practice and we do not need practitioners “ruling” the world of academia. The two different learning preferences are best left to operate within the arenas where they are most valid.

        Clive – I haven’t yet read your two papers (2008 and 2010 referenced in your post). Will get to them when I return from holidays toward months end. I may then be keen to begin a joint article with you, if so I’ll shoot you an email.

        1. Dear Peter,

          Brilliantly articulated! I resonate with everything you have stated and agree that it is precisely the points you have raised that keep getting overlooked in this debate!

          Thank you!

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