Prosper K Mushauri

1a). In this day of Our Lord Jesus Christ of 3 February 2020. We now welcome, therefore, the opportunity to provide brief submissions to assist The Professional Board for Psychology Allied Health Practitioners Council of Zimbabwe (AHPCZ) in reconsidering the appropriate scope of practice for Counselling Psychologists. We have endeavoured to keep our submissions brief, research based according to psychological scripture and trust that they will be useful to the AHPCZ.

1b). Counselling Psychology began in the USA in 1946 and with the influence of the Veterans Association (VA) (Lueong, Leach, and Malikiosi-Loizos 2012). After the world war demand for psychological services went high and psychiatry could not continue monopolies in issues of madness and also the fact that people’s needs to talk at length about their war experiences opened the wide door for psychological practice. Its then after 74 years of practice under Division 17 and its background of emergence that one cannot argue in a sound fashion that Counselling psychology (i) has never dealt psychopathological issues (ii) that it cannot deal with pathological issues. The Society of Counselling Psychology has proved to be popular as a division within APA, and currently has the second largest division membership after clinical psychology (Leong and Leach, 2007). Leong and Leach (2007) report an increased blurring of the boundaries between Clinical and Counselling Psychologists, with both professional groups working in similar environments.

Qualifications of a Counselling Psychologist

2. A minimum of a Master’s degree in counselling psychology from an accredited educational organization and an accredited  Psychology honours qualification. Eligibility for a Counselling Psychologist  practice shall require a Board approved practicum or internship involving a year’s time of supervised practice ( Allied health Psychology Regulations of 2016).

Counselling Psychologist Scope (American Psychology Association)

3. Counseling psychology is a general practice and health service provider specialty in professional psychology. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well‐being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms. https://www.apa.org/ed/graduate/specialize/counseling (Accessed 8:37am 25/01/2020)

Problems Addressed

4. The problems addressed by counseling psychology are addressed from developmental (lifespan), environmental and cultural perspectives. They include, but are not limited to:

  • School and career/work adjustment concerns.
  • Making decisions about career and work, and dealing with school‐work‐retirement transitions.
  • Relationship difficulties‐including marital and family difficulties.
  • Learning and skill deficits.
  • Stress management and coping with negative life events.
  • Organizational problems.
  • Dealing with and adjusting to physical disabilities, disease or injury.
  • Personal/social adjustment.
  • The development of one’s identity.
  • Persistent difficulties with relating to other people in general.
  • Mental disorders.

Source https://www.apa.org/ed/graduate/specialize/counseling (Accessed 8:37am 25/01/2020)

5. The regulation on scope of practice published as Government Notice No. R. 704 of 11 September 2011: HPCSA Health Professions Council of South Africa. Professional Board for Psychology

Scope of Practice for Counselling Psychologists

 In addition to the scope of the profession as prescribed in the regulations, the following acts fall within the scope of practice of counselling psychologists:

(a) Assessing, diagnosis, and intervening in clients dealing with life challenges, and developmental problems to optimize psychological well-being; assessing cognitive, personality, emotional and neuropsychological functions in relation to life challenges and developmental problems; assessing developmental process (eg career choice), and adjustment;

(b) Identifying psychopathology, and its impact on developmental processes, and adjustment; identifying, and diagnosing disorders of adjustments; applying psychological interventions to clients with developmental challenges, and adjustment problems; performing therapeutic counselling interventions; referring clients to appropriate professionals for further assessment or intervention;

(c) advising on development of policies, based on various aspects of psychological theory and research; designing, managing and evaluating programmes dealing with developmental, and adjustment problems;

(d) training, and supervising other registered counseling psychologists in counselling psychology;

(e) designing, managing, conducting, reporting on, and supervising psychological research; conducting psychological practice, and research in accordance with the Ethical Rules of Conduct for Practitioners registered under the Health Professions Act, 1974; adhering to the scope of practice of counselling psychologist; and

(f) providing expert evidence and/ or opinions

It is a generalist field by training, meaning that counseling psychologists can work in diverse areas such as academia, business, industry, government, and agencies such as the Veteran’s Administration and other hospitals, community mental health, and private practice. They also can work with individuals of all developmental levels, couples, families, and groups (Leong, Leach, and Malikiosi-Loizos 2012).

  1. SCOPE OF PRACTICE OF COUNSELLING PSYCHOLOGY AS SUPPORTED AND SUPPORTING (Quad pro quo) THE CONSTITUTION OF ZIMBABWE AMENDMENT NO.20:2013

16.Children-adopting policies and measures that put the best interest of the child first.

19.Recognising persons with disabilities.

22.Protection of the family

26.Provision of adequate and accessible health to all

27.Provision of social security and social care to those in need.

Rights of Persons with disabilities-The state must take appropriate measures ,within the limits of the resources available to ensure that persons  with disabilities realise their full mental and physical potential including to enable them become self reliant, give them access to medical, psychological and functional treatment and protect them from all forms of abuse and exploitation.

  1. Our submissions seek to follow international benchmarks of psychology as pronounced in the American Psychology Association (APA) so that psychology in Zimbabwe follows proper sound researched guidelines of psychology as a protected field. That there is synchronization of Counselling Psychology with demands within our Constitution mainly that of section 26 Provision of adequate and accessible health to all. That such accessibleness is met by competent Counselling Psychology practitioners in regards to mental health issues, being fully functional in their prescribed international scope.
  1. The Counselling Psychologist within his/her scope can act as an expert witness and or examine eyewitness testimony in his legal capacity as amicus curiae (Friends of the Court) and as supported by Mental Health Act 1996.
  1. It is our submission that the effect of the decision to remove and or cite that Counselling Psychologists should not practice in mental hospitals and or practice with issues of mental disorders is to unduly limit access to mental health care services in a manner that undermines the rights enshrined in section 27 of the Constitution and more so renegades against benchmarks of psychological practice, precedence and research. Given the high prevalence of mental health disorders in Southern Africa, and the severely limited availability of mental health care services, particularly in the public sector, these restrictions on access to mental health care services have a dire impact. Hence Counselling Psychology within its scope can competently ease this burden by providing such services to everyone living with mental disorders.
  1. In addition, the Regulations create mutually exclusive silos of practice that envisage neat, but artificial and overly rigid, divisions between mental health disorders and the interventions that may be used to address them. In our view, what is required is not the creation of a generalist category of psychologist, in terms of which all registered psychologists would perform the same functions through the same approach. However, despite differences in qualification and focus, there are several commonalities across all scopes of practice, as well as overlaps in some of the functions different psychologists perform. With the advancement of technology, societies are becoming more interconnected and interdependent. In order for psychology to advance as a science, it is imperative that psychology becomes internationalized (Leong, Leach, and Malikiosi-Loizos 2012). The overlap of psychological practice should be viewed as complimentary than antiprogress.
  1. While scopes of practice are necessary to regulate the profession of psychology and ensure that members of the public receive mental health care services from appropriately qualified professionals, any regulation of scopes of practice must take commonalities across scopes of practice and overlaps in function into account in the interests of ensuring access to mental health care services. Comporting to the mores of the scope of practice for Counselling Psychology will ensure that majority of the public will receive mental health care from appropriately qualified professionals and overlaps such as found between counselling Psychology and Clinical Psychology work in the interests of ensuring access to mental health care services.
  1. As the AHPCZ is well aware, the burden of mental health disorders in Zimbabwe is high, with  very few Hospitals in Harare and Bulawayo operating with  psychologists and situations becoming worse outside the two cities and extremely worse in rural areas. This burden is even higher among particularly vulnerable groups, including people living with HIV/AIDS, TB and those who have physical disabilities or happen to become such. Counselling Psychology being operational in its scope of practice as clearly espoused by APA https://www.apa.org/ed/graduate/specialize/counseling will ease the burden of mental health disorders  in Zimbabwe in a competent professional manner. The scope of practice as espoused by APA will be herein cited as Annex 2
  1. We attached the scope of practice as espoused by America Psychological Association, with it is the link https://www.apa.org/ed/graduate/specialize/counseling , submissions found in the book A Short Introduction To Counselling Psychology written by Vanja Orlans with Susan Van Scoyoc, 2009. Vanja Orlans and Susan Van Scoyoc’ s qualifications are cited as annex 1. In the time of writting publication of the book Susan Van Scoyoc was currently Registrar for the Qualification in Counselling Psychology at the British Psychological Society and Past Chair of the BPS Division of Counselling Psychology. Hence our submissions cease to be hocus pocus as they are well informed by persons who have been within the practice of Counselling Psychology as heads of reputable legislated Psychological Boards.
  1. There is enormous inequity between provinces in the distribution of mental health services and resources, with rural provinces receiving far less access to mental health services. As Counselling Psychology would practice within its approved international scope such inequity between provinces would ease as rural provinces would get to access direct professional services from competent psychological personnel.
  1. While there is a recognition of mental health care in Zimbabwean hospitals and some prisons, due to extremely limited resources, mental health care is often confined to management of medication for those with severe mental disorders, and does not proffer pure alternative care from medication such as psychological clinics. Increasing and improving access to mental health care services outside of psychiatric institutions will be achieved better with the practice of Counselling Psychology in its internationally accredited scope of practice. Counselling Psychology as heavily underpinned with the humanistic philosophy will provide care to those in need of services which are alternate to psychiatric care in a competent and professional manner. “…the central aspect being the location of its philosophy and practices within a humanistic paradigm which emphasizes the importance of subjective and intersubjective perspectives” (Orlans and Scoyoc 2009)
  1. There is very few personnel qualified to work as mental health practitioners in Zimbabwe. The operations of Counseling psychologists in their total scope can ease this burden even in psychiatric prisons were persons go for long periods without receiving or even have the hope that they will get the service of a psychologist. Given the lack of access to much needed mental health care services, we believe AHPCH is no doubt concerned to ensure that decisions it takes expand rather than restrict further access to such services.
  1. Counselling Psychology division was also created within International Association of Applied Psychology (IAAP) in 2002 (Leong, Leach, and Malikiosi-Loizos 2012). With such growing recognition of the field of Counselling of Psychology at international level it is expedient that psychology in Zimbabwe follows these international benchmarks so that we don’t have a psychology alienated from international best practice.
  1. There is an importance of acknowledging the reality of how mental illnesses are diagnosed, and how mental health interventions are implemented to achieve the best possible outcome. Mental health issues are worked in within multimodal teams, comprising psychologist, psychiatrist, physician, psychiatric nurse, social worker, occupational therapist among other. Hence in Zimbabwe some referral hospitals such as Ngomahuru have been operational without the psychologist, a issue which has been of negative effect to mental health of the region and persons committed in that institution. Hence the practice of a Counselling Psychologist in the international acknowledged scope will help in mental health interventions and best functional outcomes of persons committed in facilities were they are present.
  1. Counselling Psychology and other categories in psychology should not be defined by rigid categories. By dividing the scopes of practice into rigid categories of mental health disorders, we fail to take account of the complexities of mental health, mental well-being and available and appropriate interventions. While each category of psychologists has a critical role to play in the provision of mental health care services in Zimbabwe, there are overlaps in the skills and functions of these psychologists, and they should be allowed to utilize these skills and perform these functions where they are competent to do so.
  1. Urgent need for quality mental health care services will not be addressed by allowing all psychologists to freely practice in any area they choose. Nor will a more appropriately defined scope of practice automatically lead to better access to health care services in the public sector. For such change, we would also need to see the full operation of a Counselling Psychologist scope of practice as espoused in APAhttps://www.apa.org/ed/graduate/specialize/counseling

 

  1. Any delineation of scopes of practice involving Counseling Psychology should take account of the range of mental health care services required, the overlap in the skills and qualifications of psychologists, and the fact that scope of practice drives the availability of posts for different types of psychologist in the public sector. An exercise as that should maximize access to appropriate mental health care services and ensure that mental health care users receive mental health care services that are comprehensive and effective in addressing their needs.

 

  1. Oral Submissions as at Blair Research Institute 24 January 2020

    1) Mental Disorders

2) Expert witness

3) Forensic Issues

       4) Work organization

 5) Community

   6) Learning Deficits

7) Family Therapy

8) Physical Injury

                    9) Child and Adult Counseling

             10) Assessment and Research

  1. On the day 24 January 2020 of Our Lord Jesus Christ both intern psychologist and psychologists unanimously agreed that the issue of settings in the issues of psychological praxis is not important in pursuit of both practice and psychological registration. Hence from that meeting no persons should be barred from practicing in a setting as long as such practice in that setting is under their ethical scope of competence.
  1. A B C test qualification and test level. International practice follows that psychological measures are used according to qualification status of the test administrator. Hence following psychological scripture a Counselling psychologist in Zimbabwe qualifies to use level C tests which are the highest test level in psychological tests. Hence for the benefit of the profession of psychology and those in need of its services in Zimbabwe be it the courts, work organizations, schools among others it is expedient that Counseling Psychology operates within its scope so that these services are easily available in a competent manner.
  1. Conclusion: Psychology remains a protected field and by so it comports to the mores of psychological ethics, research and practice. The scope of Counseling Psychology like any other psychological praxis by following psychological scripture can only defined by psychological ethics, research and precedence in practice. In adhering to psychological scripture Counseling Psychology in Zimbabwe should be patterned after the scope of practice of APAhttps://www.apa.org/ed/graduate/specialize/counseling. A scope of practice can either limit access to mental health care services where the ability to provide these services exists, or it can expand access. In a our country (Zimbabwe) with severely limited access to such services currently, it is incumbent on the AHPCZ to take all steps possible to expand access where it is safe and possible to do so. Such access to mental health services can be achieved by allowing Counseling Psychology to operate in its full scope as supported by psychological scripture, ethics and precedence.

 

 

ANNEX 1

ABOUT THE AUTHORS CITED IN THE TEXT

Vanja Orlans, PhD, Dip. GPTI, AFBPsS, is a chartered counselling psychologist, a chartered occupational psychologist, a UKCP Registered Psychotherapist, a Foundation Member with Senior Practitioner Status, BPS Register of Psychologists Specialising in Psychotherapy, and Visiting Professor at Middlesex University. She has extensive training and experience in a range of approaches to therapeutic work, as well as in the understanding of group and organizational dynamics, and has been working with individuals and groups in many different settings for over 20 years.Vanja is currently Joint Head of the Integrative Department at the Metanoia Institute

in London, and Programme Leader of the BPS accredited Doctorate in Counselling Psychology and Psychotherapy by Professional Studies (DCPsych), a joint programme with Middlesex University. She also runs a private practice in psychotherapy, counselling, coaching and supervision.

Susan Van Scoyoc, BSc, MSc, is a chartered counselling psychologist, a chartered health psychologist, and a Foundation Member with Senior Practitioner Status, BPS Register of Psychologists Specialising in Psychotherapy. She is currently Registrar for the Qualification in Counselling Psychology at the British Psychological Society and Past Chair of the BPS Division of Counselling Psychology. Susan is also an Integrative Psychotherapist with a special interest in relationships, and a registered ‘expert witness’ working in areas such as human rights, family law and cognitive testing.

ANNEX 2

Counselling Psychologist Scope (American Psychology Association)

Counseling psychology is a general practice and health service provider specialty in professional psychology. It focuses on how people function both personally and in their relationships at all ages. Counseling psychology addresses the emotional, social, work, school and physical health concerns people may have at different stages in their lives, focusing on typical life stresses and more severe issues with which people may struggle as individuals and as a part of families, groups and organizations. Counseling psychologists help people with physical, emotional and mental health issues improve their sense of well‐being, alleviate feelings of distress and resolve crises. They also provide assessment, diagnosis, and treatment of more severe psychological symptoms. https://www.apa.org/ed/graduate/specialize/counseling (Accessed 8:37am 25/01/2020)