licensure laws contain language that explicitly authorizes psychotherapy, even for these two older professions, and Pennsylvania does not explicitly permit diagnosis by any non-physician.
Is there A “Guild” Environment?
The American Psychological Association has referred to the subject of prescribing privileges for psychologists as a “guild issue” (Herndon, 1997), because of the consistent opposition to such privileges by psychiatrists. Another facet of the guild environment is the systematic elimination of master’s level psychologists from independent practice in nearly all states, helping to better position the profession in its quest for prescriptive authority. Citing similar outcomes of care for different mental health specialists in cross-disciplinary studies, Ivey, and colleagues have identified “role diffusion,” the overlapping of roles and functions, as a factor contributing to “turf wars” (Ivey, Scheffler and Zazzali, 1998).
“A system in which multiple providers perform similar services is unstable, divisive, and potentially inefficient.” (Ivey et al., 1998, p. 26)
We frequently found evidence of the guild environment in state licensure laws, where one profession was explicitly prohibited from performing functions that were considered the domain of another profession. Typically, these prohibitions emphasized that psychologists were not authorized to engage in activities that were exclusively reserved for medical providers, and that the other three provider types could not perform functions that were deemed to fall within the purview of psychology. For example, the following excerpt from the Washington State psychology laws exemplifies a common “boundary” statement:
Nothing in this definition shall be construed as permitting the administration or prescribing of drugs or in any way infringing upon the practice of medicine or surgery as defined in chapter 18.71 RCW (Psychologists, 18 Wash. Rules RCW 18.83.010, 1994).
Similarly, the laws of Tennessee and Kentucky cited below demonstrate some of the ways that non-psychologist professionals have their scopes of practice constrained vis-à-vis the profession of psychology.
Nothing in this section shall be construed to permit the treatment of any mental emotional or adjustment disorder other than marital problems, parent-child problems, child and adolescent antisocial behavior (General Rules Governing Professional Counselors, Tenn. Rules, Rule 0450-1-.02, 2001);
As these rules suggest, one of the areas where scopes of practice may be limited is the type or severity of mental health problems that a non-psychologist professional can treat. In addition,