To some of you who are perfectly competent to practice "with safety to the public" but have been denied the right to exercise your skills in private practice by the arbitrary and, in my opinion, unethical and illegal procedures of the Board of Psychology, this interchange might seem familiar. I include it here in the hope that it will encourage further submissions; questions, answers to questions, comments or similar correspondence by other psychologists licensed or otherwise as well as any other material which may be of relevance. As the material comes in, I will organize the submissions into categories. I am doing all of this to create a clearing house for this information which eventually should have its own site. If you want to participate in this project please write me or ask me a question.
Board of Psychology
Department of Consumer Affairs
March 8, 1995
Dear Ladies and Gentlemen of the Board of Psychology:
I am a clinical psychologist from the University of Michigan (1965) and received my California license #4972 in 1967. I have impeccably practiced my profession in public agencies, public service and privately for the last thirty years. I have published seven books about alcoholism, psychotherapy and relationships which were translated into seven languages, totalling about two million copies. I lectured, supervised and taught, mediated relationships and conflicts, practiced group and brief and long term psychotherapy all over Europe, Australia and North. Central and South America. In short I am a globally recognized, respected, fully competent senior member of my profession.
In July 1990 I found that my license had been cancelled in 1985 for failure to pay fees. I reviewed my records and discovered that indeed the fees had not been paid since 1981. I discovered further that my accountant had unwittingly failed to make license payments because she received no statements starting, precisely, in 1981.
It turns out that, at that time, I had received a letter from the Board requiring me to take a human sexuality course. I responded by arguing that I didn't need such a course, human sexuality being one of my areas of expertise. It was after this exchange that the Board of Psychology, without comment, stopped sending me yearly statements to the address I have occupied for the last twenty five years. No efforts were made to notify me of the fatal process taking place and the license was cancelled after five years of non-payment.
I was advised by the Board's Executive Officer that I had no recourse but to go through the full licensing process anew. Upon application I was exempted of all the requirements save the oral examination. I was confident that, given my level of competence, I would easily pass the examination with some study to update my knowledge of the law and a refresher of my DSM and testing skills. Not being a whiner I was willing to submit to this procedure even though I had to suspend my private practice and refer away my hapless clients.
At this point my predicament turned from an Orwellian scenario to a Kafkaesque nightmare. I was not able to pass the examination and could not discover why, no matter how hard I tried. At first I thought this was due to overconfidence or failure to perceive or assimilate some modern nuance of the profession. But in this last examination I got an inexplicable 46% score. This score is grossly out of line with my knowledge of the matters the examination covered. This especially since I had, by coincidence, reviewed avoidant personality disorders and their treatment in detail, the day before the examination. If you care to review my responses to the January 95 examination you will see why I say that the ineptitude of the oral examination finally became inescapably evident. To wit:
1. We are subjected to a process which I am told eliminates 75% of candidates, this based on criteria relevant to restraint of trade rather than competence to practice.
2. We are given an examination which has no bearing on the skills that it proposes to test and demands instead skills which are largely irrelevant to professional practice.
3. We are refused access to feedback from the test makers that might aid us in improving our skills and performance.
4. We are prevented, through illegal infringements of our rights, from communicating with each other and discussing the examination to assist us in our test taking.
5. We are caught in the cross fire of an escalating power struggle between the Psychology Board and the multimillion dollar "exam preparation" industry which is no wiser than we are, regarding the ciphers needed for success, so that
After spending many tens of thousands of dollars and decades of our lives on our education, a large number of us who are qualified, are prevented from pursuing our chosen profession on the basis of a largely arbitrary and irrelevant set of criteria.
I cannot adequately describe the suffering, humiliation, anxiety, fear and loathing that I, and hundreds of other competent psychologists are being put through by your oral testing process. I have only mentioned the major injuries that we sustain. I will not go into a description of the many, minor and humiliating annoyances which contribute to our feeling like so many cockroaches lining up, biyearly, to be squashed under the bloodless gaze of your examiners; it would fill too many pages. I can tell you that, pass or fail, it leaves us with a bitter feeling about our profession.
You may argue that this exam is no different from other professional examinations. Even if that is true, which I question, I am sure that you will agree that, as psychologists, we have a special duty to validly and humanely conduct our testing activities and that we are not exempted from this obligation with regard to our colleagues. We must assess professional competence, but the dreadful procedures that the Board of Psychology has developed, driven by the pressures of increasing numbers and the "exam preparation" business are in violation of the APA code of professional ethics and are an embarrassment to our profession.
I will no longer submit to the oral examination as given, though I plan to continue to appear for the testing process. I expect the Board, as is its prerogative, to find an alternative way to have my license reinstated so that I can return to the full practice of our profession. I also expect the Board to carefully reexamine and improve its examination assumptions and procedures, a process in which I, and many other California psychologists, licensed or not, would be glad to be expert consultants.
I await your response.
Claude Steiner Phd
As a result of this letter the Board of Psychology assigned Dr. Martin Greenberg to give me a call. We spoke for quite a long while. At first I thought that the call was the indication of an interest in reaching an understanding but soon realized that while Dr. Greenberg was willing to stay on the phone as long as I wanted he was not going to make any concessions.
Mary McMillan
c/o Board of Psychology
April 10, 1995
Dear Ms McMillan:
In response to my letters to the various members of the Board of Psychology I received a call from Dr. Martin Greenberg.
Dr Greenberg was courteous, patient and forthcoming for which I am very thankful. However, I am having problems with his point of view and how it applies to the matter at hand.
We spoke about many thing, some of them repeatedly. but the bottom line of what I heard was as follows:
1. Dr. Greenberg listened to my test and it was his opinion that my performance warranted not only my failing the test but also achieving an abysmally low score.
2. Regarding my license, Dr. Greenberg asserted that absolutely nothing can be done other than for me to take and pass the oral test as given by your examiners and that the Board has no legal alternative to that process.
3. Regarding the test itself we both agreed that it was probably highly reliable. Regarding the test's validity:
A. At times Dr. Greenberg seemed to concede that the test might not be valid, if by a valid test one means a test that determines a persons competence to operate as an independent practitioner. When Dr. Greenberg conceded that the oral might not be a valid measure of clinical competence he seemed to argue that such arbitrary practices are basically rites of passage and are common occurrences in other fields (i.e.: language requirements for the Phd, the bar and architecture exams, etc.) and therefore should be acceptable in our field as well.
B. On the other hand, at other times, Dr. Greenberg defended the tests validity in terms of a variety of arguments:
i. That it is a valid test of being able to organize one's thinking regarding important issues in the profession in response to clinical situations. Therefore it is a reasonable approximation to the validity that it espouses; a test of professional skills and judgment.
ii. That whatever the test, there would always be a group of people, those who fail, that would argue it was unfair. Therefore those who argue with the test's validity at this time are suspect and must be wrong.
iii. That whatever the test, as it has changed over the years, the pass rate does not vary much from 50%. Therefore the test must be a valid indication of something.
4. Finally, Dr. Greenberg fervently argued that what I should do if I wanted the license was to find somebody and practice vignettes until "I was blue in the face."
I gather these are well-practiced arguments in behalf of the Board. I, however heard them for the first time and was not prepared for a thoughtful response. Having consulted my notes of the conversation let me now respond to these points in turn:
1. The fact that even after listening to my performance on the oral Dr. Greenberg concluded that it was in every respect correctly assessed was hard to believe at first. I assumed he would look for evidence that I might be a competent practitioner in spite of the fact that I failed the test criteria. Upon consideration, however, his judgement was predictable. In Dr. Greenberg's eyes the test is both highly reliable and you see no problem with its validity. Therefore, logically, he would have to arrive at the same score as the examiners and that score (46%) means I am incompetent.
2. Regarding the reinstatement of my license, it is not the State's laws but the Board's regulations, written by the members of the Board, that prevent you from making a special provision for my case. Let us be candid as fellow professionals; the Board could, by a motion and vote, modify the process, to suit the circumstances of my case, if you thought that was deserved. For Dr. Greenberg to say that you can't is a time-worn bureaucratic tactic that has no legal basis.
3. Regarding the validity of the oral examination:
A. To say that there are other arbitrary situations in life, and therefore I should accept the haphazard nature of the oral, is no argument at all. As psychologists we are especially responsible to construct valid as well as reliable tests and not just go along with the rest of the arbitrary rites of passage in our culture.
B,i. The Board is charged by the State to "examine the candidate with regard to his or her professional skills and his or her judgment..." (Code Section 2943) The test in no way reflects on the professional skills and judgment of the candidate. We are faced with made-up bits and pieces of hypothetical scenarios with little tricks and surprises thrown in, which bear no resemblance to the situations that we deal with in real life.
Every test pits our skills and judgment against a different, manufactured, totally arbitrary slice of "reality." It is, in fact, a test of one's ability to organize one's thinking according to a scheme (completely opaque to me) that you have wrongly decided is telling of our competence. In real professional life I see real people and their real families, I have time to reflect, I am able to take notes, ask questions and consult texts, none of which I am allowed on the oral test.
B,ii. True, there will always be those who find any test unfair. But some tests are actually unfair and some tests are fair. Four centuries ago people were judged by being thrown into an icy pool of water and seeing if they floated. Many, particularly those who were found guilty (if they survived) and their families, felt this was not a fair test. There are objective ways of determining the fairness of a test, regardless of how many find it unfair. Isn't that what psychometrics is all about? What validity does this tests purport to posses? And what is the evidence for said validity?
B,iii. Dr. Greenberg argued that regardless of the nature of the test over the years the failure rate has been about 50%. I find this argument dazzlingly muddled. Is it supposed to mean that since 50% of the applicants are in fact incompetent any test will tell them apart? Does it mean that the examiners' omniscience will cause them to construct tests which regardless of content will inevitably separate the competent from the incompetent? Am I missing the significance of this fact?
I would argue that it is far more likely that the miraculous 50% pass rate is an artifact of test making and test administration. All it says about the test's validity, in fact, is that it is highly invalid and therefore modifications in its content have no effect on its power to discriminate the competence of candidates.
4. This last, well meaning point was in fact the hardest to take. What Dr. Greenberg is suggesting is that a seasoned, senior, respected and competent member of our profession spend thousands of dollars and endless hours practicing an intrinsically meaningless ritual with a self-appointed expert with the faint hope that this, in some way, will lead him to the correct code of the orals riddle. How is this suggestion, without any access to a person who knows what the code is, different from a suggestion that I assiduously pray for guidance from the Goddess?
In short, I wish to reassert my appreciation for Dr. Greenberg's kindness and concern, but unpersuaded by our conversation I must reemphasize the points in my letter of March 15, 1995:
1. that the Board should find a way to reinstate my unjustly cancelled license by means other than passing the oral examination as now given, and
2. that the oral examination process is intolerably arbitrary, not valid in any meaningful sense of the word, hostile to any efforts to gain feedback, discriminatory and oppressive, as follows:
Invalid Test: We are given an examination which has no bearing on our professional skills and judgement and requires, instead, skills which are largely irrelevant to professional practice.
No Reliable Access to Feedback: We have no access to information that explains our scores or that would improve our performance. We are forced to seek expensive guidance from people who, after a point, are no wiser than we are, regarding the information needed for success.
Interference With Self-Help: We are prevented from legally gathering information on our own or from communicating with each other and discussing the examination to assist us in our test taking. Meanwhile, your ludicrous security measures notwithstanding, recordings are being made of the examination, giving those less burdened by fear or scruples an unfair advantage.
These violations of ethical testing procedures, perpetrated by psychologists who are supposedly serving as role models for professional practice are an embarrassment to our profession and must be reformed.
I await your response,
Claude Steiner Phd
This letter was followed by a letter to me from Thomas O'Connor the Executive Officer of the Board.
June 2, 1995
Dear Dr. Steiner:
In your April 10, 1995 letter to the Board of Psychology, you recapped your telephone conversation with Dr. Martin Greenberg, a member of the Board. Dr. Greenberg called you in an effort to discuss with you issues regarding your difficulty in passing the oral examination. I will not rehash your discussion of these issues nor will I reiterate this Board's position and the position of the Department of Consumer Affairs that the psychology oral licensing exam is, in fact, sound and valid and the most researched, defensible and respected oral licensing examination in the United States. However, in response to your comments on your conversation with Dr. Greenberg, and in response to your conversations with Judith Fabian, PhD, Chairperson of the Board's Examination Committee, staff was asked to have the tape of your January oral examination listened to and constructively critiqued by an outside expert. Staff followed through with this request and on May 4, 1995 your written concerns and your exam tape were reviewed by an expert not affiliated with the members of the Board of Psychology. This expert concluded from listening to your tape that you definitely need to retake the examination as you did not demonstrate that you know the material well enough to pass the examination. The expert further commented on his observations of your performance on the examination tape, as an aside, that you should definitely not bring your opinions about the examination and your situation into the examination room with you as such expressions or attitudes could serve to bias the examiners.
Although direct, the comments of this expert, who is unaffiliated with the members of the Board, could prove to be helpful as you consider approaching the oral examination in the future.
In the conclusion of your letter of April 10, 1995, you request that "the Board should find a way to reinstate my unjustly cancelled (stet) license by means other than passing the oral examination as now given. The board cannot break the law. Your license was cancelled (stet) due to failure to comply with statutory license renewal responsibilities. Section 2984 of the California Business and Professions Code formerly stated that licenses not renewed within five years after expiration shall become void. Currently, Section 2984 which was amended by the Legislature in 1994 states that licenses not renewed within three years after expiration shall become void. Your license was justifiably cancelled pursuant to Section 2984 of the California Business and Professions Code. If you wish to obtain a new license as a psychologist, there is no alternative for you than to reapply (which you have done) and meet all current requirements which demonstrate minimal competence to practice psychology independently with safety to the public. This is mandated by Section 101.6 of the California Business and Professions Code. Finally, remember that each packet license states the expiration date of a license. The Board sends out a renewal notice prior to the expiration date as a courtesy and not receiving such notice does not justify failure to renew a license. The same would hold true for your driver's license.
By now I am sure you have received your notification that you have been scheduled for the June 1995 oral examination on June 24 in the 3:00 PM time block.
If you have any questions about the upcoming oral examination please feel free to contact the Board's staff at (916) 263-2699.
Sincerely,
THOMAS O'CONNOR
Executive Officer
My response:
July 23, 1995
Thomas O'Connor
Executive Officer, Board of Psychology
Dear Mr. O'Connor:
Thank you for taking time to write regarding my difficulties with the Board of Psychology and its oral examination.
In your letter you give a detailed explanation of the legal justifications for the loss of my license and the new rules which regulate such losses. You needn't have bothered; I accepted that I have no legal recourse to the cancellation of my license many years ago when you first explained that fact to me.
On the other hand you hastily claim, falsely I believe, that you would have to break the law to reinstate my license outside of passing the oral test. In fact, the Board of Psychology members have the mandate from the state "to insure that I posses the minimal requirements to practiced with safety to the public." The requirement that I pass your oral exam is a regulation which you could suspend if you saw a sufficient reason. If you wished to take some risks and behave flexibly and humanely, you could, at your next meeting, make a motion, and put the question of my safety to the public to a vote. This would be perfectly just and legal, and would not set some terrifying precedent that would threaten your mandate. The State would accept your decision, there would not be any lawsuits from others making claims to orals-free licenses, no fearsome precedent set. In fact most licensed or unlicensed, junior and senior psychologists (many of whom I have spoken to about my situation) would applaud your decision because it would show them that you are creative professionals rather than faceless civil servants hiding behind your desks.
As to my competence, as you probably know I have taken the exam again. I did nothing to prepare for it other than to review the materials the morning of the exam. I did, however, for the first time skip any mention of how I lost my license and how I felt about my ordeal. Instead, I was saccharine friendly and sweetly submissive.
Miraculously, my score jumped 20 points to 70.34 which I guess validates your recommendation that I "should definitely not bring my opinions about the examination and my situation to the examination room as such expressions or attitudes could serve to bias the examiners." I must say that I was surprised when I read that suggestion in your letter because it so blatantly admits to a possible contamination of the test scores by the examiner's subjectivity. What does that imply about the test's reliability? However, I thought I would try this approach, just to see what would happen and because at the same time my daughter who passionately believes that I am being persecuted for not being obedient, passive and well behaved, begged me to.
Again, I flunked the test. Again, I haven't a clue about or any way of finding out what, exactly it is that your accursed test found deficient. Evidently, I am wanting in "Legal Mandates and Related Issues." Nonsense; do you really imagine that after all these years of examinations knowing that the law is a valid central concern in the practice of psychology that I would fail to know and do the right thing in a real situation? I know the laws, I know how to apply them, I know what to do when in doubt. What's more I know the realities that govern the applications of the law in my city and county in this state at this time and you know as well as I, that they don't neatly fit the theoretical answers that you expect from your examinees.
I got a poor score on Treatment Planning and Implementation. Need I remind you that I have treated hundreds of alcoholics with mood problems and that I have written two highly regarded books and have made major, widely accepted recommendations on the subject? I was the first to introduce and write about no-drinking and no-suicide contracts in therapy in the early 70's, at a time when such ideas were considered radical. I have many cured alcoholics and not a single suicide to my name. The judgment that the answer your examiners had in mind is a better answer than the one I gave is merely a matter of opinion and I challenge you to prove otherwise.
If I failed the test it is because the test fails to adequately sample my expertise in these matters. Yet, again, you will claim that my performance shows that I need to the test again. And again I say, nonsense!
Finally I have to comment on the matter of the expert who you engaged to evaluate my performance on my January test. What would you have done if he had found my performance sufficient? Are you suggesting that you would have considered given me back my license absent of a passing orals score? Or did you take it for granted that he would confirm the examiners judgment?
I don't know what you mean when you say that he was "not affiliated with the members of the Board." Is that supposed to imply objectivity regarding the validity of the test? What is his affiliation with, and knowledge of the test? Did he have a standard to evaluate my level of expertise compared to those who pass the test? Or did he find my performance so poor that it need not be compared to the average passing performance? Or is he just making the outrageous claim that he can tell from my answers that I do not have the minimum competence to practice safely?
He determines that I "definitely needed to retake the examination as (I) did not demonstrate that (I) know the material enough to pass the examination." Is he just saying that the test was correctly graded? Is he being as blatantly tautological as to say that I deserved to flunk the test because I flunked the test? You say in your letter that his comments could be helpful to me. Could I have access to them?
The bottom line is that I am competent far beyond what reasonable standards require, rather than a neophyte who needs to be screened lest he damage the mental health of California consumers. A long list of licensed psychologists and health professionals in this state and around the world and hundreds of clients would gladly bear witness to that fact and your test, claims of national respect notwithstanding, fails to detect that fact because it is not a valid (and it seems, not even reliable) test.
You say about the test that it is "sound and valid and the most researched, defensible and respected oral licensing examination in the United States." I am not surprised that you claim validity and defensibility for the test; it is, after all, being imposed on your watch, on thousand of people and it would be unthinkable that you believe otherwise. Government regulators have believed in their methods as long as bureaucracies have existed; that belief is not prima facie evidence of their validity. Regarding the test's command of respect, I would say that fear is a far more applicable word; one colleague who after many attempts finally passed the test told me after I congratulated her and asked her how she felt: "How do I feel? I feel numb and battered, this has been the worse experience of my life." I am interested in the research that you speak of; how do I gain access to it so that I can satisfy myself as to its aims, methods and results?
I understand that my score automatically qualifies me for a review. I expect that the Board will come to the conclusion, based on my recent score and the fact that I am a competent California practitioner of long standing, that I exceed the minimum requirements to practice with safety to the public and that you will reinstate my license.
Sincerely
Claude M. Steiner Phd
Finally I wrote the following letter:
December 20, 1995
Members of the Board of Psychology:
On August 31, 1995 I wrote you a letter in which I asked the Board to review my latest oral examination based on the high score I received and to put the matter of my license to a vote.
Three and a half months later I have not received a response to my request.
I am afraid that you have become a bit highhanded in your procedures. I find your resounding silence rude and offensive. You may question my qualifications to practice with safety to the California public but I am still a professional and scholar in the field of psychology and I believe I deserve the courtesy of a response.
Please let me know your reply to my request so that I can decide whether or not to show up for the January 1996 oral examination.
Sincerely
Claude M. Steiner Phd
One final letter
Dr. Martin Greenberg
President, Board of Psychology
1422 Howe Ave Suite 22
Sacramento CA 95825-3200
April 17, 2002
Dear Dr. Greenberg:
I read with pleasure (BOP Update, March 2002) about the decision to drop the oral examination requirement for licensure and welcome your detailed and forthright description of the process.
I see that you express appreciation for “all the time and effort by the people who contributed to this important change to regulations regarding licensure.” Fair enough but I am afraid that I am not as thrilled as you seemed to be by the “dedicated oral examiners who came together to give something back to the profession and toil through long and tedious days of examinations.” Not to exaggerate, but isn’t that is a bit like thanking Torquemada’s minions for the long and exhausting hours they put in, to give something back to the Holy Church? They were right there looking into our eyes and I know a few who fled in horror when they saw what it was really all about. Those who stayed should reread Obedience to Authority (Stanley Milgram, 1984, Harper) and say a few “mea culpas.”
I believe it would be fitting for you to apologize, in the name of the BOP, to the many hundreds of competent psychologists who took the oral examination and failed it, many repeatedly, and who were thereby exposed to emotional and financial trauma as the Board ratcheted up rather than let go of what was, on its face, a fatally flawed procedure.
I am happy that you finally bowed to the obvious fact that
the test was neither valid nor reliable and that it violated APA standards of
ethical testing conduct while adding nothing to the discharge of your mandate to
protect the public.
At the risk of being puerile I want to say that I told you so. Any one who wants to read how I totally anticipated your findings years ago, should feel free to look up my correspondence with the Board on www.claudesteiner.com/orals.htm.
Still, bottom line, the Board did have the integrity to face the obvious and yield to the inevitable, and for that you are to be commended. An apology would be appreciated and is likely to diminish my resentment and the likelihood that I and others would join a rumored class action suit against the BOP for damages.
Sincerely
Claude Steiner