A Profession of Neurofeedback?
Author: Dr. Siegfried Othmer
Last year Tom Allen wrote a newsletter
for us on the issue of a licensed profession around the emerging
field of applied psychophysiology. We have decided to take up
this issue at the meeting of the Allied Professionals
Section of the AAPB, and Tom Allen will be there to help lead
the discussion.
I am personally agnostic on this issue, and just want to see happen
what will be best for the progress of the field. In reviewing
historical material for the preparation of our Alpha/Theta web-course
I came to realize what deep roots this issue has. Even 100 years
ago Hans Berger confronted the same issue. In deciding on his
professional course he judged that the emerging field of neurology
did not sufficiently take the mind and behavior into account,
whereas the emerging field of psychiatry did not concern itself
sufficiently with the data of experimental science with respect
to the nervous system. Freud had made a similar judgment with
regard to neurology, namely that it was simply not ready to tackle
the issues that most interested him, but then he, Jung, and Adler
left the brain completely out of the discussion. The legacy of
this decision has carried forward to this day, causing fellow-traveler
Daniel Amen to lament that ~psychiatry is the only branch of medicine
that does not look at the organ it treats.~ Neurology, on the
other hand, has migrated even more toward dealing with the piece
parts of the nervous system and their ills, and thus the journals
take them even farther from the domain of behavior and of functional
medicine.
The result for Hans Berger was that with respect to the EEG research
he worked essentially alone, despite having a high university
position in his day job.
And even after his findings were recognized, his objective of
coupling the realm of behavior and psychophysiological measures
did not bear fruit at that time. Had he been more imbedded with
conventional research, had access to funding, and been surrounded
by eager graduate students, he might well have found much better
ways of discerning the EEG than with galvanometers, and it would
not have taken him so many years to finally observe the signal
he was looking for. Also his inspiration might have been transplanted
to a new generation of researchers.
As it was, when Joe Kamiya set a similar objective some fifty
years later, the world was not particularly more hospitable to
such inquiries. Kamiya was almost as much off on a tangent as
Hans Berger had been. And when Sterman published his results,
there was simply no context within science that allowed that work
to be appraised. The EEG had found only a minimal role within
medicine, a role where profound new insights were not to be expected.
Tying the world of behavior~even sleep behavior~and the waking
EEG together was a novelty.
So would the establishment of a licensed profession around psychophysiology
finally yield a level playing field, correcting an imbalance that
has existed for more than 100 years? Is licensure needed to give
cohesion and focus to a discipline in which nearly all participants
have their primary loyalties elsewhere? Or is this proposal late
to the party, as the world is already on the threshold of accepting
the objective of ~integrated medicine,~ of functional medicine,
of ~electromedicine~? Does the ~Self-Regulation Remedy~ require
the status of sponsorship by a licensed profession to carry the
flag, or is the Disregulation Model something that will simply
marble through all of the health professions, and influence all
of them? Is the knowledge we have gained something that can remain
the unique province of a certain cadre of professionals, or must
it become the universal knowledge base of all health professionals?
And even if the latter is the case, is there at least a transient
role for a dedicated, trained group of professionals with psychophysiology
as their primary distinguishing expertise, before the nirvana
of universal acceptance can be reached? On the downside, would
the establishment of a profession give this field a ~procedure-focus~
or technical preoccupation that simply sells short the complexity
of human behavior in yet another dimension? Would licensure promote
the very compartmentalization that the Disregulation Model leads
us to break down?
In all of these speculations, we should not delude ourselves into
thinking that this issue is actually under our control. But we
should at least have the issue in mind. A movement toward licensure
would mobilize opposition by the existing licensed professions,
and it would also further disadvantage unlicensed professionals.
There would have to be a rather substantial thrust toward licensure,
and the existing body of professionals does not give any sign
of being capable of such organized behavior. Most likely such
a movement would arise only out of reaction to an attempt by mainstream
professionals of one stripe or another to appropriate this discipline
as their own. Up to now we have had principally intra-mural regulatory
issues~psychologists and MDs accused of acting unprofessionally
by their own boards for offering neurofeedback. Recently, we have
had a case in which a non-psychologist has been accused of practicing
psychology without a license because he was doing neurofeedback.
This may be the beginning of a trend.
On the positive side, licensure would establish a pathway into
this field with a more assured outcome. Academic programs would
organize to serve this community, and reimbursement issues would
clarify. Conceptual unification would be more likely to occur
among the disparate thrusts in the field. On the downside, the
regulatory mechanisms that would build up around the new licensure
would also work to enforce a clinical uniformity, and such uniformity
could be detrimental to the most creative forces currently operative
in the field. We would have the BCIA with real teeth. On the other
hand, the movement toward licensure would likely take some time
to bear fruit, and by that time the essential new departures that
need to be nurtured will all have taken root.
The most likely outcome is that the existing professions will
adopt the insights from psychophysiology. We have just had an
example of this in psychiatry, which moved from a totally psychodynamic
perspective to a thorough-going biological model without changing
the sign on the door.
Accreting the bioelectrical modalities is not that big a leap,
and psychiatrists would do so adroitly if the reimbursement environment
were more favorable. Psychology has in store for it a similar
kind of revolution, irrespective of any licensure in biofeedback.
Neurofeedback is simply too effective to be ignored by psychologists
for very long. The market will more and more shift our way, and
at some point that will begin to bite.
There is an obvious coupling between the issues of licensure and
reimbursement.
In the case of chiropractic, naturopathy, and acupuncture, licensure
came before reimbursement ramped up significantly. In the case
of biofeedback, the world is already full of professions who stand
ready to lunch off any improvement in the reimbursement environment.
It would seem that if reimbursement rates ramp up in the near
term, any movement toward an independent licensure would meet
headlong opposition. Licensure may only have a chance if reimbursement
rates remain uninviting for some time to come. In other words,
licensure can only happen if nobody else really cares very much.
Ironically, then, both those who wish to see the field move in
the direction of licensure and those who want to maintain its
status as an unlicensed discipline should be united in the objective
of promoting growth outside of the reimbursement environment.
With reimbursement inevitably comes a slide of the field into
strong hands, which would be those of the existing licensed professions.
Such a trend can be resisted only if a counterforce of licensure
already exists. It would be too late at that point to get it started.
If the space, time, and opportunity in which licensure could get
started is limited, one needs to ask why this hasn~t happened
already. As one looks at the history of the field, one sees it
curiously dominated by an atmosphere of stasis. Even by some of
its most devoted leading practitioners, biofeedback and neurofeedback
seem to be treated as something of grace note in the mental health
field rather than as a core truth and as an organizing principle
through which all of mental health should be viewed. The field
is already dominated by folks whose primary professional identification
is elsewhere. In sum, then, there doesn~t seem to be the environment
suitable for the kindling of a new thrust toward licensure, one
that would take the energy of a whole lot of people. And if the
movement toward licensure does not take place soon, then it is
unlikely to happen at all. I will report again after the meeting
on Friday.
Dr. Siegfried Othmer |
