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How some therapists slip through the review process

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Posted: Wednesday, October 31, 2012 12:00 am

Last week, a triple murder took place in Stockton. Not an unusual story by itself, considering the city's recent history. But what made this tale unique was the alleged suicidal perpetrator. He was a licensed marriage and family therapist.

One might ask: "How could a mental health professional commit such a heinous act? Aren't there safeguards to prevent mentally unstable people from being licensed by the state?"

Unfortunately, due to requirements of reduced costs, plus a need on the part of the Board of Behavioral Sciences and some lawyers to be "totally objective," the filter to catch such individuals no longer exists. It was called the "oral examination."

I served as an oral examining commissioner for several years during the 1980s. We met twice per year to interview potential licensees. After receiving at least a master's degree, a 3,000-hour internship and a written test, the oral exam was the final step before state authorities issued a license.

At first, there were three-person panels. Two out of the three members would have to agree that the candidate was competent to engage in a solo practice and would not bring harm to the public. Later in order to save costs, the panel was reduced to two members.

If they failed to agree, the prospective therapist would have to go before another two-member panel. If candidates could not jump that hurdle, they could return in six months for another try.

Sometimes, the failure rate was as high as 50 percent. In the vast majority of cases, the cause was not mental instability, but a failure on the part of candidates to articulate a formidable treatment plan that would adequately treat hypothetical cases.

It was obviously a highly stressful and emotional time for those who had worked so hard to become psychotherapists. Some felt the process was unfair, and that's when the lawyers got involved.

Various attorneys harassed the board with challenges of inequality. They complained that the candidates were not all asked the same questions. Some examiners probed deeper than others. Some were asking "prejudicial" questions such as: "Where did you go to school?" or "Have you ever been treated for depression?"

In order to make things "more fair," an outline was prepared of questions for all candidates to be asked. Examiners could bring up additional points, but they had to be related to the scripted scenario. Under later guidelines, panelists could not discuss the pros and cons of each prospect until both had written their recommendations.

The new rules affected my usual line of inquiries. For example, if a candidate was weak in a particular area of examination, I was told that I could no longer ask a question such as, "What books have you read on this subject?"

On various occasions before the restrictions, my team had discovered three potentially "loose cannons" that needed to be placed on the sidelines.

The first was a former minister who was asked, "If you had emotional and sexual feelings toward a client, and she felt the same about you, would you engage in a personal relationship?" (An obvious question that no one in this position should ever answer in the affirmative.) To our amazement, however, this man did!

Another was a laid-back "hippie" type who munched down a box of Kentucky Fried Chicken during his entire interview.

The third, and most dangerous, was a paranoiac guy who told us, "I've flunked this exam twice, and it better not happen again or people are going to get hurt!"

Today, after candidates complete their degrees and internships, they simply take an "objective" multiple-choice test on a computer. The questions primarily deal with theoretical aspects of the profession. If passed, they're licensed. There are no probes as to the mental stability of candidates.

Whether or not the lack of a subjective oral examination allowed an alleged Stockton killer to slip through the cracks, I do not know. However, I do know this: A state license today does not necessarily guarantee competency or safety. The public simply needs to be aware that the "patient," although an unusual situation, might actually be sitting on the wrong side of the desk.

Steve Hansen is a Lodi writer.

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