b. It is recognized that the psychologist is sometimes the professional person initially consulted. In such cases it is recommended that the psychologist secure general medical and/or psychiatric collaboration, allowing the patient to make the primary choice of whom he wishes to consult but carrying out his responsibility for securing medical collaboration.

2. With reference to the broad concept of "genuine collaboration," it is mutually agreed that the patient should not be removed from the good practice of medicine. The essential problem is how to assure the patient of medical control over his medical care, regardless of the professional background of the psychotherapist. Complete medical control, rigidly interpreted, implies supervision of the psychologist by the psychiatrist. As indicated above, however, in actual practice, the relative rigidity of intepretation of "medical control" will vary according to several factors. For example, the patterns of practice in a university hospital differ from those of a state hospital, and these in turn differ markedly from practice in an urban or suburban upper middle class milieu. From these must be differentiated the small city or rural area where few, and often no, psychologists are to be found.

Mere referral of a patient to a psychologist for psychotherapy or testing, without follow-up contact or consultation between psychiatrist and psychologist cannot be considered "genuine collaboration," although it is recognized that in certain cases and circumstances the initiative for further follow-up consultation is properly that of the psychologist. When organic pathology-peptic ulcer, for example, is present, the appropriate consultant for the psychologist, and often the psychiatrist, is the internist, family physician, or other medical specialist. The sustaining principle is that close and frequent contact between the psychiatrist and psychologist is essential, and most especially in borderline cases where they may be a risk of suicide, for example.

While supervision at regular intervals, weekly, for example, might be advisable in some cases, the reality must be faced that it is impracticable in the majority of cases, even when the psychiatrist and psychologist desire it. The manpower and the man-hours are simply not available. Some psychiatrists insist on this as essential to their collaboration, as is their right. It is the Committee's opinion, however, that the rule cannot be universally applied since to do so would make it impossible for psychiatrists generally to meet all of the requests for supervision in all cases together with their other obligations.

3. Responsibility for medication for patients in psychotherapy with psychologists is clearly that of the physician. The responsibility is poorly discharged, and good medical and psychological practice are subverted when the physician merely furnishes prescriptions without consultative contact concerning the over-all care of the patient. The same applies to the physician who accepts referrals for electroshock therapy. Such practices are strongly condemned by the American Psychological Association and the American Psychiatric Association.

4. The care of children, whether in a public or private agency, school, or court setting, is a collective responsibility of psychiatrists, psychologists, pediatricians, social wrokers, and other specialized personnel. Further liaison and study are needed to spell out how the responsibility can be more effectively discharged. For example, in the case work-up of a child with a reading disability there should be careful evaluation by an ophthalmologist, a neurologist, and general physician as well as by the psychologist and psychiatrist. A study of the home setting, the family milieu, and socio-economic factors are similarly pertinent.

CONCLUDING COMMENT

There is increasing public awareness of mental health needs and of the serious manpower shortage in all of the mental health disciplines. The problem will become more acute as more mental health centers are established under the provisions of new Federal legislation. It will severely tax both professions to staff these centers and to ensure that they are operated according to sound medical, psychiatric, and psychological standards and practices. There is similar public awareness of the need for intensified research looking to improved treatment methods and ultimately to the prevention of mental illness and mental retardation. Psychiatry can only express its gratitude to psychology for the contributions it has and is making to mental health research, particularly in psychotherapy, and cherishes the hope that the full potential of that contribution will be realized in the years ahead.

Thus, the overwhelming public interest leaves no place for petty squabbles in building more effective interprofessional relations between the two major pro

fessions dedicated to the better understanding of human motivation and behavior. What is called for is a sustained, thoughtful seeking of answers to the fundamental questions posed herein-answers which will be in the best interests of the mentally ill. The American Psychiatric Association proposes to work to this end and urges upon its District Branches that they lend support in every feasible way to improving the liaison between psychiatrists and psychologists at the state and local level.

Senator SPONG. Dr. Levy, in addition to the additional questions and the comments to Mayor Washington's letter, we will be asking you to comment on the suggestions made by Dr. Legault in his testimony, and the suggestions made by Dr. Bacon in his statement at the time. with regard to the pending legislation.

Dr. LEVY. We will be pleased to provide those.

Senator SPONG. Thank you, gentlemen.

Dr. Meltzer?

Dr. Meltzer, we are pleased to have you with us this morning. Do you have your counsel with you also?

Dr. MELTZER. Right.

Senator SPONG. I feel like I am running a court here today.
Dr. MELTZER. I was afraid that I would get lonely.
Senator SPONG. All right.

STATEMENT OF DR. MALCOLM L. MELTZER, ASSOCIATE PROFESSOR AND DIRECTOR OF THE GRADUATE TRAINING PROGRAM IN CLINICAL PSYCHOLOGY, GEORGE WASHINGTON UNIVERSITY; ACCOMPANIED BY REID P. CHAMBERS, ATTORNEY

Dr. MELTZER. Mr. Chairman, my name is Malcolm Meltzer, I am associate professor of psychology and director of the graduate training program in clinical psychology at the George Washington University. I speak not only as an individual, but I am also representing the departments of psychology at the other major universities in the District of Columbia: American University, the Catholic University of America, Georgetown University, and Howard University. All of us have indicated support for the principle of legislation regulating the practice of psychology in the District of Columbia. In addition, we view the bill currently before this subcommittee, S. 1626, as an effective vehicle for implementing that principle.

In taking the viewpoint of the academic community, I first wish to indicate that this bill would in no way infringe upon academic freedom nor force the field of psychology into any fixed or set pattern. Psychology is one of our last frontiers, and it is important that the growth of new knowledge and techniques continue unimpeded. This bill sets standards but it does not prevent growth, creativity, or the development of new approaches. This issue is important to the academic community, and we are reassured by the contents and style of the current bill. We are also pleased with the nonrestrictive nature of this proposed legislation. Other professionals, such as social workers or psychiatrists, rely on knowledge and techniques of psychology, and it is important that our bona fide colleagues in other fields suffer no interference.

Finally, we are pleased that S. 1626 will prevent ill prepared and poorly trained persons to take "quickie" degrees or who have no degrees at all from calling themselves psychologists and offering psy

chological services to the public. This bill would recognize how important it is that only careful, ethical, competent psychological services be offered to our citizens, and it would set adequate and realistic standards.

Thank you for the opportunity to testify in favor of this bill.
Senator SPONG. Thank you very much.

I agree with you that it is important that professionals in other fields suffer no interference by virtue of what is provided in this bill. But who decides whether another profession is established or whether a particular member is qualified? Under the terms of this bill would it be the Board of Psychologist Examiners made up of licensed psychologists? If so, wouldn't that be giving life-and-death power over these other businesses and professions to the psychologist?

Dr. MELTZER. Well, of course, this relies heavily on the mechanisms involved in the bill for the course in judicial procedures, and I would ask my attorney, Mr. Reid Chambers, to comment on it.

Mr. CHAMBERS. Senator, you are referring to section 5(E) which states that qualified members of another established profession be recognized by the Commissioner and the Commissioner's power would be delegated to the Board. The Board may be made up of psychologists and be consistent with their training and code of ethics of the profession.

We would have no objection to making it more clear and making it appear in the bill so that it would cover of her businesses or professions. I think the District of Columbia Psychological Association and all of the members would be glad to see the provision broadened. We would propose language and we would be glad to comment on proposed language.

Senator SPONG. Our staff will make available to you, in some modesty, the Virginia law in this area and we would invite your attention to it and your comments upon it for the record.

Mr. CHAMBERS. On this aspect?

Senator SPONG. Yes. Thank you very much.

Dr. MELTZER. Thank you.

Senator SPONG. Dr. Zimmerman.

Good morning, Dr. Zimmerman.

STATEMENT OF DR. ISAIAH M. ZIMMERMAN, PSYCHOLOGIST

Dr. ZIMMERMAN. Good morning, Mr. Chairman.

My name is Isaiah Zimmerman. I am a psychologist in private practice in the District of Columbia. In addition to my office practice, I am dean of the group psychotherapy training program of the Washington School of Psychiatry, and I serve as a consultant to the U.S. Air Force, the Veterans' Administration, the District of Columbia, and to a number of other agencies and mental health facilities. I come before you representing myself, a resident of the District of Columbia.

I might add that I do engage in practice in McLean, Va., on a parttime basis. I hold a license from Virginia as a psychologist.

In the course of my work, I frequently teach and supervise psychologists, psychiatrists, social workers, nurses, and guidance personnel. Referral questions frequently are placed before me. I go by my personal knowledge of the people I have worked with plus my knowledge

as a trainer. Still, I have difficulty ascertaining who is equipped to do what in the psychological field. How much more difficult it is for the average citizen to know to whom to turn when he or someone in his family needs help. Insurance companies increasingly offer coverage for psychotherapy by psychologists. Where can the insurer find a list of qualified psychologists? Federal and private agencies use consultants and award service contracts to individuals for psychological services. How can they readily ascertain who is operating under proper sanctions? In security and sensitive matters and in courts, experts in psychology are often sought. Where does one begin if he wants someone from the District? A licensing law covering psychologists in the District of Columbia has long been needed. The measure before you, S.1626, is in my opinion a thorough and effective proposal. The absence of such control through licensing allows a number of bad situations to prevail here. I will not recite the most obvious and gross abuses which can occur in any professional field. They are usually few and come to light eventually. I would rather direct your attention to other abuses which can be chronic and less dramatic. They can drain the public's money, lead to consistently inferior service, and last indefinitely. Let me cite two examples. An individual who is otherwise very well trained in a related field may practice psychological counseling, consultation, or evaluation without benefit of full and proper training in psychology. His work in these areas is often mediocre and sometimes retarding, if not dangerous, to the client. Can he practice in Maryland or Virginia, where there is pertinent law? No. But he can flourish in the District.

As a second example, there are a number of people who freelance and moonlight by offering to conduct "sensitivity training" or group psychology exercises for church and community groups. Extreme emotions may be aroused, without regard to the capacities and limitations of the group members. Some people may be pushed into considerable anxiety and have to seek professional help. Later, when asked, the patient will usually assert that he believed the group was being led by a licensed or qualified psychologist. Yet this was not so.

These and many other examples could be cited to show the subtle dangers which exist for an unsuspecting public, where the dispensing of psychological services of questionable quality is concerned. Citizens of the District of Columbia are entitled to competent professional service, correctly identified goal, and I recommend its adoption. Thank

you.

Senator SPONG. Dr. Zimmerman, thank you very much for your testimony.

We are pleased to have the benefit of your views on this legislation. The committee will be in recess until further call by the Chair. (Whereupon, at 11:20 a.m., a recess was taken, subject to the call of the Chair.)

APPENDIX

COMMENTS OF DISTRICT OF COLUMBIA

PSYCHOLOGICAL ASSOCIATION

You have asked that the District of Columbia Psychological Association prepare comments upon (1) certain questions submitted to the Association by Senator Spong; and (2) various proposals to amend S. 1626 advanced by persons testifying before the Subcommittee on June 26, 1969. We tender herewith our comments, and an opinion letter from Arnold & Porter concerning the authority of the District of Columbia Council to promulgate S. 1626 by regulation, without additional legislation by Congress.

QUESTIONS RAISED BY SENATOR SPONG

Question 1. Would you say that most serious problems of malpractice are in connection with psychotherapy? If so, why not limit the licensing provisions to those who engage in that activity?

Serious problems of malpractice in psychology are by no means confined to psychotherapy. In the area of psycholog cal testing, for example, several individuals and groups in the local area have circulated brochures announcing a wide range of claims which clearly exaggerate the strengths and show no awareness of the shortcomings of psychological tests. One such brochure describes "an uncomplicated, yet complete psychological test and questionnaire" which offers the user1 a glimpse into his "better sociological, psychological, and emotional points," an analysis of why his personality is or is not attractive to the opposite sex, and even a description of his "true self."

Another area of psychological activity in which impossible claims have been made in the Washington area is the general area of "self-learning." For example, one group offers a "no risk, 10-day trial" of instruction in self-hypnosis on a home course basis. The use of the phrase "no-risk" is indeed strange when applied to a complex psychological process such as hypnosis. The claimed advantage to accrue from this course include such things as getting rid of "cardiophobia," becoming a "crack salesman," how to "change any negative trait into its exact opposite," and how to give "commands to your subconscious mind." These claims are not simply untrue and impossible; much more, they are dangerous to the user who, by accepting the service, postpones more plausible and realistic solutions to the problems which led him to seek help.

Equally tragic and dangerous are claims having to do with mental retardation. In many ways this is one of the most tragic afflictions with which a family can be visited. To be assailed by claims for miraculous psychological “cures” or other interventions is truly reprehensible. Yet Sylvia Porter, in her column in the Washington Star of April 8, 1969,2 states that any number of persons stand ready to tell parents that their retarded child's problem actually stems from sources which can be treated relatively easily. She gives many examples, and we agree most heartily with her when she notes that there is a great lack of regulation of practitioners in this field.

Many other areas of malpractice may be cited. For example, self-styled "industrial psychologists," without benefit of adequate training or experience, can cost a business firm much time and money in ill-designed services having to do with some personnel or other industrial problems. Or a self-appointed "vocational counselor" can wreck considerable havoc with bogus advice having to do with young people's vocational and educational decisions. Or, finally, "sensitivity training," a technique for improved communications which demands much skill by those who conduct it effectively, is being engaged in by a variety of people

1 A vital consideration in psychological testing involves the methods by which the test's results are communicated to the client. Clearly, this is not of concern of the purveyors of brochures referred to here. 2 Appended hereto as Exhibit A.