Policy Advisory Board Policies and Guidelines for Psychologists
Table of Contents
Board Policy On Defining "Health Service Setting"
To qualify for Health Service Provider certification (HSP), a psychology applicant must complete at least two years of supervised health service experience in a health service setting, one year of which meets the requirements of a health service training program.1 The Board is issuing this policy to clarify its interpretation of these terms, and to describe how it determines whether an applicant’s experience qualifies for HSP certification.
The Board recognizes that the settings in which health services in psychology are provided have expanded and diversified in the last 20 years. Health services today are delivered in settings that have not previously presented themselves to the public as providing such services (e.g., schools). As these settings evolve, the provision of health services is increasingly regarded as essential not only by the program, but also by the community.
- According to Massachusetts law, “health service” is defined as “the delivery of direct, preventive, assessment and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or may be at risk of impairment” (M.G.L. c. 112, §118,).
- Massachusetts law (M.G.L. c.112, , §118) states that “Supervised health service experience” is
-training at a site where health services in psychology are normally provided
-with which the applicant has a formal relationship
-where the applicant is supervised at least one hour for every sixteen hours of training, at least half of which is provided by a psychologist licensed by the board who is a member of the staff of the training site
-at least 25% of the applicant’s time shall be in direct client contact
The regulations of the Board (251 CMR 3.08) stipulate that a “health service setting” is one that “presents itself to the public as providing health services and where clients usually seek health services”.
Therefore, to qualify as supervised health service experience:
- the supervised experience must involve the delivery of health services, and
- the health services must be delivered in a health service setting
- Health Service Setting. The setting must have the following characteristics in order to qualify the training experience for HSP certification. It must
- be a defined entity with programmatic coherence (e.g., clinic, hospital, school counseling center, department, division).
- have a secure place for confidential records.
- teach HIPAA regulations (in addition to FERPA, where relevant)
- provide clinical supervision by qualified licensed professionals who are on-site. The supervisors should have the competencies described in 2 below.
- The health service setting must have a protocol covering emergencies, after-hours coverage, vacation periods, and extended breaks.
- The health service setting must have a referral network for services that are not provided by the health service setting (e.g., medication).
- For facilities in which research is a major component of their mission, the setting must have (i) clients/patients who are not participating in research protocols, (ii) other clinical services not part of the research protocols that are available to all clients/patients (iii) a protocol for ensuring continuity of care for clients who withdraw from research projects.
- In cases where it is not clear whether the training setting qualifies as a health service setting (as defined above), the Board will make a decision based on the following considerations:
- To what extent are the following competencies taught?
- Psychological assessment skills. Comprehensive and integrated assessment from interviews, psychological testing, direct observation. Includes selection of methods and instruments, systematic collection of data, interpretation of the resulting data. Ability to communicate the results to the relevant audience(s) in a manner that is understandable and useful to them.
- Psychological intervention skills. Conducting psychotherapy based on knowledge of theory and research. Includes the whole range of psychotherapeutic intervention (e.g., family therapy, group therapy, cognitive behavior therapy, applied behavior analysis, psychoeducation). Includes case formulation, development of treatment plans, implementation of treatment plans. In child settings, the trainee should have contact with a variety of different family members involved in the child’s care.
- Consultation skills. Includes knowledge of the roles of other professionals, including other health service professionals, and the ability to relate to them in a collegial fashion. Knowledge of the formal and informal organizational structure and the ability to apply that knowledge so that consultations can have maximal impact. Trainees should have significant exposure to other health care professionals.
- Evidence-based practice. Integration of the best available research with clinical skill in all areas of functioning (i.e., psychological assessment, psychotherapeutic intervention, consultation). Application of knowledge from the classroom to clinical situations and problems.
- Relationship/Interpersonal skills. Ability to form and maintain productive relationships with others. Productive relationships are respectful, supportive, professional, and ethical. Ability to understand the role of psychologists in the setting and to maintain appropriate professional boundaries. Ability to work collegially with other professionals and to form positive therapeutic alliances with clients/patients. Ability to work collaboratively with one’s supervisor.
- Does the training involve providing services to a clientele of sufficient number and clinical diversity?
- Is the trainee exposed to clients with psychopathology and a significant level of impairment?
- Does the trainee have the opportunity to work with a variety of clinical problems?
- To what extent are the following competencies taught?
1 A Health Service Training Program is defined as “supervised experience at a site where health services in psychology are normally provided which is part of an organized integrated training program as defined by the rules and regulations of the board” (M.G.L., c. 112, §118).
Practice Advisory: Practicing with children and families in Massachusetts where parents may be separated, divorced, or never married
June 15, 2012
Due to the large number of telephone calls and other inquires from both licensees and parents in this area of practice, the Board of Registration of Psychologists issues this advisory related to the practice of psychology with children and families in the process of separation-divorce, never married, or post-divorce. Given that this policy deals with issues of confidentiality and testimonial privilege, and potential exceptions thereto, licensees are strongly advised to seek consultation from knowledgeable persons, including legal counsel in an appropriate circumstance:
- It is very important for a psychologist engaged in treatment of a minor child whose parents are separated or divorced, or who were never married to each other, to understand the custodial rights that each parent has. Under the law, terms like "physical custody" and "legal custody" have specific meanings that are highly relevant to a professional treating a child.
- The child-client whose parents are divorced or in the process of divorce has his or her own confidentiality rights and evidentiary privilege with respect to his or her relationship with the therapist. In other words, a psychologist may not divulge the substance of what the child client has discussed either orally or by release of written records just because a parent asks for this information. This information may only be released with a court order or with the signed, informed consent of a mature minor. As stated by the Massachusetts Supreme Judicial Court in the 1987 case Adoption of Diane, "[W]here the parent and child may well have conflicting interests, and where the nature of the proceeding itself implies uncertainty concerning the parent’s ability to further the child’s best interests, it would be anomalous to allow the parent to exercise the privilege on the child’s behalf." This case law has been interpreted further to mean that confidential information provided by the child in a psychotherapy environment, including a copy of the child’s record, should not be released to either parent or to the court, even with a signed release from one or both parents. Only the court can waive the child’s privilege and/or make a determination as to the release of confidential psychotherapy records, and Probate courts can and do appoint special guardians ad litem to decide this question for a child.
- Child therapists should refrain from initiating therapy with a child without the consent of both parents, unless there are legitimate protective issues relating to the child or other mitigating circumstances. Reaching out to the parent who did not initiate treatment for the child is a best practice that can help the therapist understand all sides of the child’s family situation and protect against being perceived as biased or allied with one parent.
- Sole legal custody is rarely awarded in Massachusetts except in circumstances in which one parent has died, there are protective issues, or the parents were never married. In these cases, the licensee should inquire as to the circumstances of the family before deciding whether to reach out to the non-custodial parent for his/her consent and involvement in the treatment.
- Psychotherapy and child custody evaluation are two very distinct services with different roles and responsibilities. "Psychologists conducting a child custody evaluation with their current or prior psychotherapy clients and psychologists conducting psychotherapy with their current or prior child custody examinees are both examples of multiple relationships." (Guidelines for Child Custody Evaluations in Family Law Proceedings, 2010). The same individual should not undertake both roles.
- A child therapist should not write evaluative reports to lawyers or the court. Factual reports (providing information regarding the existence of the therapeutic relationship) should be provided only in response to a court order and only after legal consultation.
- A child custody evaluation is a specialized area of practice. In general, such forensic evaluations are conducted by court order and are assigned to specialized practitioners who have been certified in this area and are on the court’s list of approved providers, known as "Category E Guardians ad Litem." A comprehensive set of standards apply to evaluative child custody investigations.
- A therapist for a parent should not write evaluative reports or make custody-visitation recommendations for use in court. Additionally, therapists should never submit evaluative letters or reports regarding the spouse or partner of their patient. (For further information, please refer to the APA specialty guidelines for Child Custody Evaluations http://www.apa.org/practice/guidelines/child-custody.pdf ).
- It is advisable for licensees to communicate to parents prior to initiating treatment with a child, preferably in an informed consent document signed by all parties, that confidential information will not be released to the parent.
- Working therapeutically with children in separated, divorced, or unmarried families requires a higher level of expertise, training, and consultation than working with children in intact families. It is good practice, whenever one is in doubt about how to proceed, to seek consultation with experts or with an attorney familiar with this wo rk.
Policy Bulletin regarding Licensure, HSP, Title, and Training Issues
Policy No. 10-001
The Board is issuing this statement of policy to clarify some of the principles that have guided a number of its recent decisions.
Licensure and Health service Provider Certification. Licensure and Health Service Provider (HSP) certification are two different credentials. A license in Psychology in Massachusetts does not, in itself, permit a Psychologist to provide health services independently. According to the Massachusetts General Laws (M.G.L.), Chapter 112, Section 118, "Health services" involve "the delivery of direct, preventive, assessment and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or may be at risk of impairment."This includes psychotherapy, psychological testing, and the supervision of these services. A licensed Psychologist without HSP certification may only perform health services under the supervision (collaboration) of an HSP certified licensed Psychologist while accruing hours toward HSP certification. The supervisor is legally responsible for the services provided.
"Unlicensed Psychologist." In Massachusetts , it is not permissible for an individual without a license in Psychology to use the term "Psychologist" to describe his/her professional status, no matter what educational credentials that individual possesses. M.G.L. c. 112, §122. Thus, the term "unlicensed psychologist" is a contradiction and may not be used. For example, a person who has a doctorate in Psychology from a Designated Doctoral Program,* but is not yet licensed in Massachusetts as a Psychologist, may NOT call him/herself an "unlicensed psychologist." To do so is a violation of state law, subject to discipline.
"License Eligible Psychologist". This term has a restricted meaning in Massachusetts. It may only be used to describe a person who has applied to the Board of Registration of Psychologists, met all requirements for licensure as determined by the Board (including passing both exams), but has not yet paid the licensure fee or received a license number. The Board (not the individual) must determine that all requirements for licensure have been met in order for the individual to use the term "license eligible" to describe his/her status.
Persons with a Doctorate in Psychology Practicing Independently as Psychotherapists. Unlicensed individuals who have a doctoral degree in Psychology from a Designated Doctoral Program*, who practice independently under the title of "psychotherapist," are considered by the Board of Registration to be practicing Psychology without a license. The Board regards such action as an attempt to circumvent the Psychology licensing law and subject to discipline.
Use of the Term "Psychologist" in Higher Education Settings and by State Government Employees. Individuals who work in colleges and universities, as well as state employees, are not exempt from the Psychology licensing law. Regardless of their training or job position, no person may use the title "Psychologist" in Massachusetts without being licensed by the Board of Registration of Psychologists. To do so is to hold oneself out as a Psychologist without a license, which is a violation of state law and subject to discipline.
*Designated Doctoral Program in Psychology. The Association of State and Provincial Psychology Boards (ASPPB) in collaboration with the National Register in Psychology, designates doctoral programs in Psychology that meet specified criteria as providing adequate preparation for licensure. Most states will issue a license only to those individuals who have doctoral degrees from a designated doctoral program. In Massachusetts, the Board has required since September 2000 that the doctoral degree must be granted by a program that has been designated at the time the degree is granted or within two years thereafter (215 CMR 3.03(1)(b)).
Unlicensed Persons Accumulating Supervised Clinical Hours Toward Licensure. Supervisees are responsible for verifying that their direct supervisors are, in fact, licensed Psychologists (with HSP certification if in Massachusetts). This information is available on the Board's website: www.mass.gov/dpl. Persons who supervise trainees without these credentials will be disciplined by the Board. Individuals accruing hours towards licensure at the post-doctoral level may use such titles as "post-doctoral trainee", "post-doctoral fellow", "trainee", "fellow" or other such title that clearly designates their training status.
Unlicensed Persons who Supervise Trainees under the Oversight of a Licensed HSP Psychologist. The Board will not accept clinical hours toward licensure or HSP certification if those hours have been supervised by an unlicensed person whose supervision has been supervised by a licensed HSP Psychologist. Supervisees accruing hours towards licensure are responsible for verifying that their direct supervisors are licensed Psychologists (with HSP status if in Massachusetts). Persons who supervise trainees without these credentials, as well as the licensed supervisor of such supervision, may be subject to discipline by the Board. Please note, however, that the Board does not regulate supervision that occurs in practicum settings, as these hours are not used for licensure.
Q&A with the Board, January 2008
1. Question: Can a person who works in a setting such as a college counseling center or a state hospital call himself or herself a "psychologist" if he/she is not yet licensed?
Answer: Prior to 1998, the answer to this question would have been "yes." At that time, the law allowed the salaried employees of "corporations, partnerships and associations" to call themselves "psychologists" while providing psychological services under the supervision of a licensed psychologist. But that law (M.G.L. Chapter 112, section 123) was amended in 1998, making the practice of psychology or the use of the title "psychologist" by any unlicensed individual punishable by a fine of not more than $500 and/or imprisonment of up to 3 months. Additionally, M.G.L. Chapter 112, section 65(c) allows the Board to levy administrative penalties up to $1000 for the first offense and $2500 for each subsequent offense for the unlicensed practice of psychology.
We have encountered some situations in which an organization's website uses the term "psychologist" for an unlicensed person, but the individual never refers to himself or herself in that way. Although the organization may not have consulted the unlicensed person beforehand or even informed him/her about the content of the website, the unlicensed person bears responsibility for the way in which the organization presents his/her credentials to the public. Any unlicensed individual working for an organization is responsible for informing himself/herself about the way that organization represents his/her credentials and correcting any misrepresentations.
2. Question: A Psychologist receives a valid authorization form from a former patient giving permission to release all his records to an attorney. In the patient's records are two reports that the Psychologist received from a hospital and a school. Is the Psychologist obligated to withhold these reports and not release them to anyone else or must he release everything in the record?
Answer: There is nothing in Massachusetts law or in HIPAA that confers special status on health information in the client record received from a third party. The question of whether to release third party reports and/or other medical records should be based on one issue: patient authorization.
In the question above, it is stipulated that the former patient provided a valid authorization for release of his records. It should be noted here that information about substance abuse is protected by federal law and a general record release authorization is not sufficient. Release of substance abuse information requires a specific authorization.
MGL chapter 112, section 12CC allows that if "the psychotherapist believes providing the entire record would adversely affect the patient's well-being," then he/she could provide a summary of the record to the patient. But if the patient still insists on release of the entire record, "the psychotherapist shall make the entire record available to either the patient's attorney, with the patient's consent" or to another psychotherapist designated by the patient. Note that there is no mention of third-party reports in the statute.
If there is any question about whether it is in the best interest of the patient to release a report, the Psychologist should certainly contact the patient (or the parent/guardian) and discuss the pertinent issues. If the patient decides to exclude the report from the authorization, then the Psychologist is, of course, not obligated to release it. But the critical issue here is the former patient's consent, not the origin of the document.
It is not uncommon to receive reports that are stamped with a statement that the report is not to be re-released. Stamping a report does not create legal or ethical obligations. Simply put, if it is in the patient's file, and the patient authorizes its release, the Psychologist is obligated to release it, even if it was obtained from another source.
3. Question: A Psychologist completes a testing battery on an adolescent, provides feedback to the patient and her parents, and provides them with a report. Six months later, the Psychologist receives a valid authorization form signed by the parents requesting that the test data be released to them. Is it a violation of the Ethical Principles of Psychologists for the Psychologist to release test data (e.g., patient responses to test questions, raw scores) to non-psychologists who have no training in the scoring and interpretation of the tests involved?
Answer: The Psychologist is obligated to provide the test data, but not the questions which are part of a copyrighted document. MGL Chapter 112, section 12cc provides a possible exception: "If in the reasonable exercise of his professional judgment, the psychotherapist believes providing the entire record would adversely affect the patient's well-being, in such instances, the psychotherapist shall make a summary of the record available to the patient." However, if the patient or parent/guardian insists on having the entire record despite the potential impact on his or his child's well-being, the Psychologist must make the entire record available (including test data) to either the patient's attorney or to another psychotherapist designated by the patient.
[see also Ethical Principles of Psychologists and Code of Conduct (2002), 9.04 "Release of Test Data"]
4. Question: In a graduate course in family therapy, the professor requires each student to present to the class a genogram of her own family and to discuss family issues that might affect her therapeutic work with families. Is it ethical to require the sharing of personal family information in a graduate course?
Answer: This is permissible if the program or training facility has clearly identified this requirement in its admissions and program materials.
[see Ethical Principles of Psychologists and Code of Conduct (2002), 7.04]
Provision of Services Via Electronic Means
Originally adopted in March 2005
Updated October 2015
In response to inquiries from licensees and other interested parties, the Board would like to share its current thinking with regard to provision of services via electronic means. The Board recognizes that this is an evolving practice issue, and its policy may be updated from time to time. However, there are some issues and policies that the Board believes are important to share, even as this area evolves. The Board believes that psychologists should recognize that as he or she loses the kind of direct contact with a patient/client that occurs in an in-person, face-to-face office, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact. For this reason, a psychologist should seriously consider conducting the initial evaluation of a client in-person before beginning electronic provision of services, and holding sessions in-person periodically thereafter. A psychologist should also recognize that without such in-person, face-to-face interaction, patients/clients may misinterpret or feel injured by a psychologist’s statements, tone of voice, or other perceived empathic failures, and the psychologist may fail to observe the signs of this in a timely way. This may lead to the patient filing a complaint, prematurely terminating the therapy, or both.
In addition, delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the psychologist to carefully consider and address a myriad of issues in the areas of structuring the relationship, informed consent, confidentiality, determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm, dealing with fees and financial arrangements, and advertising. Specific challenges include, but are not limited to, verifying the identity of the client, determining if a client is a minor, explaining to clients the procedure for contacting the psychologist when he or she is off-line, discussing the possibility of technology failure and alternative modes of communication if that failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist or are insufficient, identifying appropriately trained professionals who can provide local assistance (including crisis intervention) if needed, informing internet clients of encryption methods used to help ensure the security of communications, informing clients of the potential hazards of unsecured communication on the internet, telling internet clients whether session data are being preserved (and if so, in what manner and for how long), and determining and communicating procedures regarding the release of client information received through the internet with other electronic sources.
The Board’s current position is that the practice of psychology occurs where the patient/client who is receiving the services is physically located at the time of service. In order for a psychologist to provide psychological services to a patient in Massachusetts, that individual must be licensed by the Massachusetts Board of Registration of Psychologists or be exempt under the provisions of M.G.L. c. 112 §.123. If the patient/client is in Massachusetts at the time of service, and files a complaint against the treating psychologist, that complaint will be heard in Massachusetts.
A Massachusetts psychologist who renders psychological services electronically to a client who is not in Massachusetts is advised to contact the psychology licensing board in the state in which the patient is at time of service, to determine whether or not such practice is permitted in that jurisdiction.
Licensees are advised to review the following:
- M.G.L. ch. 112, s. 118-129b
- APA Ethical Principles of Psychologists and Code of Conduct (Standards 3.10(a), 4.02(c), 5.01(a), and 5.04 specifically address electronic transmissions).
- APA/ASPPB/APAIT Joint Task Force Telepsychology Guidelines
Policy Bulletin Regarding Board Member Contact With Individuals or Representatives of Entities with Business Pending Before the Board
The Board of Registration of Psychologists (Board) voted today to adopt the following policy relating to board member contact with individuals or representatives of entities with business pending before the Board.
Policy No. 05-01
The purpose of this policy bulletin is to offer guidance to board members in their interactions with individuals or representatives of entities with business pending before the Board.
BOARD MEMBERS SHALL NOT DISCUSS PENDING OR UPCOMING BOARD BUSINESS WITH ANY PERSON WHO HAS BUSINESS PENDING OR UPCOMING BEFORE THE BOARD.
All government employees must avoid real and apparent conflicts between their private interests and public duties so that public confidence in the integrity of government is maintained. Although technically speaking, discussions with persons who have business pending before the Board are, ordinarily not a conflict of interest or ex parte, they may give rise to an appearance of favoritism and undermine public confidence in the Board's administrative actions. This policy is adopted to assure that the business of the Board is conducted effectively, objectively, and without the appearance of favoritism or improper influence.
Board members who are contacted by persons with business pending before the board, about matters pending before the Board, are hereby directed to decline to communicate with said individual(s) about the pending Board business and to disclose such contact(s) to the full Board at the next meeting.
Board Policy Regarding Medication Recommendations by Psychologists
February 18, 1998
It is the opinion of the Board that a psychologist may offer a medication recommendation to the prescribing physician about a patient he or she has evaluated when such recommendation is within the boundaries of her or her competence based on his or her education, training, supervised experience, or appropriate professional experience. It is then incumbent on the physician, based upon all the evidence before him or her (which may include the recommendations of the psychologist) to decide what, if any, medication or medical treatment to prescribe.