Scope of Practice Issues

By David Feinstein, Ph.D.

Energy psychology represents a new paradigm. Not surprisingly, it is controversial, particularly since many of its procedures seem quite strange and the field's early claims of extraordinary clinical outcomes far exceeded research substantiation. Beyond this, the introduction of these methods into clinical practice has been a case study of cognitive dissonance. Experienced therapists are incredulous on hearing reports of almost instantaneous and lasting cures for longstanding psychiatric conditions such as phobias and generalized anxiety disorder. Therapy is not that rapid. Time is needed for building rapport, examining the antecedents of the problem, exploring the meaning of the symptoms in the person's life, assessing which therapeutic modalities are most appropriate for situation at hand, and applying them. Attempts to explain the purported dramatic treatment outcomes of energy psychology in terms of insight, cognitive restructuring, reward and punishment, or the curative properties of the therapeutic relationship make no sense.

The mechanisms that explain how energy psychology is able to produce the rapid outcomes that are being widely reported have, however, recently been detailed. For instance, stimulating specific acupuncture points by needling, tapping, holding, or massaging them sends signals to the limbic system that deactivate the threat response (as demonstrated by functional MRI studies).

As efficacy research is now supporting earlier anecdotal reports that the methods used in energy psychology may be more rapid and more effective than standard treatments for certain psychological problems, some of the field’s advocates have been turning the tables, saying that practitioners who do not include a somatic component such as tapping on acupuncture points when a client encounters a traumatic memory are failing to meet the highest standard of care for treating PTSD. While such claims are premature pending further efficacy research, they also raise the question of whether psychotherapists are qualified to practice these procedures. Do they fall within the appropriate "scope of practice" for psychotherapists?

This issue is being addressed within the profession of psychology in particular. It has not been resolved. But even as the question is being debated, the tide of clinical practice is clearly moving toward the acceptance of energy interventions. The 900-member professional organization that has grown around energy psychology since its establishment in 1999 (The Association for Comprehensive Energy Psychology) has developed formal Code of Ethics and Standards of Practice statements. Its membership is composed primarily of licensed health and mental health professionals and includes individuals who hold positions on the faculties of psychology departments at distinguished universities, who hold ABPP Diplomate status, who work in highly regarded clinical settings, and who represent a broad range of clinical backgrounds and orientations. The organization, as well as its individual members, has developed training programs that provide mental health professionals the knowledge and skills to incorporate the methods of energy psychology into clinical practice.

The essential question regarding scope of practice, now that preliminary evidence suggests that energy psychology is a viable clinical approach, is whether it is practical and reasonable to expect psychotherapists to be able to learn the techniques at a level where they can be practiced competently and safely. Following is the thinking on this question of the Board of 27 pioneers and leaders in energy psychology who developed Energy Psychology Interactive.

The experience within the energy psychology community is that its methods can be taught to licensed clinicians at a level where they can responsibly introduce them into their practices within less than 100 hours of training (the Certification Training offered by the Association for Comprehensive Energy Psychology requires about 85 hours of class participation, home study, and supervised practice). The number varies widely depending upon the practitioner or organization conducting the training. There is no established standard on this issue, and one of the reasons that Energy Psychology Interactive was created was to offer standards regarding the specific knowledge and skill areas that should be mastered before clinicians introduce the methods into their practices, based on a consensus of the field's leadership.

The Energy Psychology Interactive Advisory Board, under whose auspices the program was developed, consists of 27 of the field's pioneers and recognized leaders, including 12 psychologists, 5 physicians, and 10 other licensed health or mental health professionals. On the opening page of the Energy Psychology Interactive CD, the program represents itself as a 40-hour course. Whether requiring 40 hours or 100 hours, however, the experience of the energy psychology community is that the methods can be taught to psychotherapists within a reasonable training period and without mastering a separate discipline such as acupuncture or qi gong.

In fact, the essential techniques used in energy psychology are unregulated. Anyone, as long as they are not diagnosing or treating illness, can teach another person to self-stimulate energy points for positive effects. Energy psychology does not utilize invasive procedures. It does not involve surgery, medication, physical first aid, or even the superficial insertion of tiny needles. The methods are closer to teaching progressive muscle relaxation than to administering an invasive procedure.

The closest established clinical precedent to the methods of energy psychology actually exists within rather than outside the field of psychology, and that is systematic desensitization. As with systematic desensitization, a stimulus that causes an unwanted or dysfunctional emotional response is brought to mind and a physical intervention is used to replace a disturbed response with a neutral response. In systematic desensitization, muscle tension is replaced with muscle relaxation by teaching the client the willful induction of muscular tension and release. In energy psychology, an unwanted or dysfunctional emotional response is replaced with a neutral response by teaching the client to stimulate electrically reactive areas of the skin. Systematic desensitization is of course not the only clinical procedure to utilize overtly physical interventions, and many physical interventions used by psychotherapists, particularly in aversion therapies, are not only physical but also invasive. The physical interventions used within energy psychology are non-invasive, painless, and generally self-applied by the client.

Still, clinicians considering the use of energy interventions are wise to investigate the positions of both their licensing board and their malpractice insurance carrier. Assuming they are not specifically prohibited, one of the most responsible and self-protective steps you can take during this period while the professions are coming to terms with the energy paradigm is to be certain that you have obtained clear informed consent from your clients before you utilize energy interventions. The Energy Psychology Interactive CD includes sample wording that can be copied into your word processor, revised for the particulars of your practice, and integrated into your informed consent statement.

In deciding how to regard energy interventions, the clinical professions will best serve themselves and their clients by being very careful not to define their scope of practice so it omits safe, unregulated procedures that are, according to evidence that is rapidly accumulating, also highly effective for treating certain psychological issues. The profession of psychology, for instance, which is fighting to gain drug prescription privileges, would be taking a significant step backward if it defines these non-invasive methods as being outside the scope of practice of psychologists who have taken training in stimulating the body's energy centers for psychological benefit. The clinical professions should, in fact, be leading the way in setting standards for the responsible application of energy interventions as their use by laypeople is proliferating, sometimes in troubling ways. Energy Psychology Interactive offers clinicians a readily accessible and authoritative resource for educating themselves about the responsible uses of energy interventions with psychological issues.