who comes to him with some problem, some serious difficulty, some type of unhappiness, some type of behavior that he wishes changed to relinquish, some type of suffering that he no longer wants that he wishes to relinquish. The approach then is one of trying to help the person, every often through talk, to understand himself, to understand the causes and the purposes of his behavior and helping him then to see other words of acting, of behavior of relinquishing that way of behavior. A very psychological procedure.

Mr. JACOBS. If I retained properly the definition that you read. you included the phrase "the curing of psychological disorders." The curing of psychological disorder could clearly include the treatment of organic disorder which manifested itself in a psychological disorder, could it not?

Dr. MELTZER. Would you repeat that?

Mr. JACOBS. Please read back the question.

(The question was read by the reporter.)

Dr. MELTZER. I do not think I can answer that, in that manner.

Mr. JACOBS. I will rephrase the question, then. I am simply saying that when a psychiatrist treats an organic disease or an organic disorder which manifests itself as a psychological disorder, it could be accurately said that that he is attempting to cure a psychological disorder; is that not correct?

Dr. MELTZER. Yes, sir.

Mr. JACOBS. Therefore, I am asking whether the term "psychotherapy" perhaps does not include at least the psychiatrist discipline as well as the psychologist discipline?

Dr. MELTZER. Are you asking as to the psychiatrist in pyschotherapy?

Mr. JACOBS. I am asking if the term is not broader than the specific discipline of a psychologist, that is, the term "psychotherapy"?

Dr. MELTZER. Yes, and that is why we are not attempting to restrict it in this bill. We recognize that a large number of other things exist. Mr. JACOBS. That is fine. Then you are saying that the practice of psychology includes psychotherapy without then qualifying the term "psychotherapy" as applied to the practice of psychology, and, perhaps you overshoot the runway.

Dr. MELTZER. If we have, I think we have helped the situation later in the bill when we point out that there is no intention to restrict the activities of other professions.

Mr. JACOBS. Then, you would have no objection to helping the situation immediately following the word "psychotherapy" if, indeed, it is included to restrict its meaning to the sphere of competence or the sphere of attempted competence of the psychologist?

Dr. MELTZER. The bill states that very clearly. It already says that. Mr. JACOBS. Just as I read the definition?

Dr. MELTZER. It is not exactly in that part, but it has to do with the practice of psychology that he must practice within his competency or he will lose his license if he does not.

Mr. JACOBS. When you go to the definition section, you will agree with me then that the term "psychotherapy" could imply more than you are advocating that the psychologist be licensed to perform? Dr. MELTZER. That was the intent.

Mr. JACOBS. Well, sir, I am not referring to your proviso.

Dr. MELTZER. It is in the context of it. One would not know where, if you said "psychotherapy," but if one takes it in the context

Mr. JACOBS. But in the definition section, you do not have any definition to that point.

Dr. MELTZER. I would like to have it.

Mr. JACOBS. If you have objection to striking "psychotherapy," do you recognize a need for further wording?

Dr. MELTZER. Frankly, I do not. I think that the context qualifies the meaning of that term tremendously. The context points out that people have their problems of adjustment, that it is not to be the practice of medicine. I think the word is qualified within the context. Mr. JACOBS. And you have some objection to qualifying it within the context of the definition section of the bill; do you?

Dr. MELTZER. No, you ask me now

Mr. JACOBS. You said you would object to seeing it?

Dr. MELTZER. You did not ask me that. You asked me if I felt it needed to be.

Mr. JACOBS. Then, you would not object?

Dr. MELTZER. I do not feel it needs to be.

Mr. JACOBS. You do not object?

Dr. MELTZER. I would be happy to see the word in there.

Mr. JACOBS. O.K.

Dr. CUMMINGS. I think that you raised one definition, and I think that is very clearly covered. I hope that this will straighten this up. Three different times in the past decade the question that you have asked us this morning has come up in the legislative or legal kind of question. In California, in Michigan, and in one other state where they have passed upon it. In each case, it went to the state attorney general's office for a decision. And in each of the three decisions by the state attorney general, in the states of New York, Michigan, and California, the ruling was that psychotherapy is not limited to medical practice. Psychotherapy as they studied the definition of their various acts is a form of activity which is just as much engaged in by others as by physicians. I have the full text here.

Mr. JACOBS. I think I understand it. I think that belongs in the record at this point. However, I call your attention to the fact that the matter, about which we are talking, is a definition of the practice of psychology, because the term "psychotherapy" is not restricted only to the practice of psychology, but I believe it needs further definition, further clarification within the definition of the practice of psychology, because if it is left naked as a term within a series, then there is some ambiguity that the practice of psychology could possibly include the treatment of organic disorder relating to mental disorder. That is my point. I do not know if anybody cares to comment upon that further, or not.

Dr. MELTZER. I would disagree.

Mr. JACOBS. Excuse me. You are saying that you disagree that the term "psychotherapy" includes more than the practice of psychology? Dr. MELTZER. Pyschotherapy is a technique, and it is not restricted to any particular discipline.

Mr. JACOBS. You have not answered. If it is not restricted to your discipline, it can hardly be an unqualified term to describe your discipline.

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Dr. MELTZER. The problem is not with the technique. It is by whom the technique is employed. This is what differentiates the psychologist from the psychiatrist.

Mr. JACOBS. I shall not belabour the point, but I think the record is amply clear for our consideration in executive session.

I want to ask one further question which is with reference to the bill that is before us, S. 1864.

Mr. SISK. I might say that we have two bills. The House bill is H.R. 10407, and S. 1864 which is identical-or was at the time it was originally introduced-is the Senate bill. It has had some amendments as has been pointed out earlier.

Mr. JACOBS. I am talking about Section 6 (B). What did you say, as in Beethoven?

Dr. MELTZER. In Beethoven, yes.

Mr. JACOBS. I see in the bill that it is permissive. I am just wondering whether it should be permissive to appoint a Board of Psychologist Examiners if they have specific duties to perform?

Why would it be a permissive provision?

Dr. MELTZER. Would you explain what you mean by that?

Mr. JACOBS. It says that the Commissioner may appoint a board of psychologist examiners, and, then, as I understand it, the bill goes ahead and requires specific performances from that board which may or may not exist. Can you enlighten me as to why it was "may" and not "shall" as to its appontment?

Dr. MELTZER. I believe that when we discussed this with the city government, we were told that we could not tell the Commissioners that they had to do so; that one "allowed" them to do so. Now, whether or not that is correct, I do not know.

Mr. JACOBS. I think I have something to learn.

Just one final question. This is purely a matter of first impression with me. I have had very little correspondence about it, and very little information about it, although questions have been raised to me. Has there been cooperation between the Association of Psychiatrists and the psychologists in this jurisdiction in the preparation of this legislation?

Dr. MELTZER. I am sorry to have to talk to this point. We began work on this in January 1965, trying to decide whether or not to have a bill.

In February 1965, we wrote to the Washington Psychiatric Association and asked if they would join with us in writing such a bill. We got an aswer saying "No, we are against such legislation.” Mr. JACOBS. Can you submit that for the record?

Dr. MELTZER. Yes, sir, I can.

(The correspondence referred to appears at p. 108.)

BACKGROUND OF LEGISLATION

Mr. MELTZER. For two years we have attempted to have some type of communication, and it was not until last May, one year ago or over two years after our first contact with them, that we started to have discussions. This came at the time when the bill was submitted to the Senate. They wanted to modify the bill in some way. The suggestions that were made by the psychiatrists made it totally unacceptable. They

had it where psychotherapy would be defined as the practice of medicine. They would have added a section which would have said that a psychologist may do psychotherapy only as an exception to the medical practice arts.

As Dr. Cummings has pointed out, three states have ruled on this question-ruled that it was not an exclusive medical practice, but their suggestion was to give us an exception to the act so that we could do so. They would have, in effect, asked this Congress to act, as no state has ever acted, to define "psychotherapy" as medicine.

Secondly, they suggested that the Board of the Examiners of Psychologists contain several psychiatrists. Well, this is totally impossible. First of all, psychology is a much broader field than psychiatry. As they themselves point out, only a fraction of the psychologists do psychotherapy. They have familiarity as to the competency of the broad field to sit in judgment on psychology. Certainly, psychologists clearly say that they are not psychiatrists. I wish that the psychiatrists would admit that they are not psychologists. But could not have been determining the fate of an independent profession.

Finally, one of the other major suggestions had to do with the practice of psychology, the practice of counseling and psychotherapy. Now, there is a lot to this. It has all kinds of implications.

Mr. JACOBS. May I ask at this point: Did you say at one point that the Psychiatry Association wanted to rule out the concept of psychotherapy altogether and at this point that they suggested that there be a separate license for psychologists?

Dr. MELTZER. Yes, sir. Now, in the separate licenses, these are the problems that are involved. First of all, the psychiatrists point out that the reason they suggested that we have an omnibus bill that included all fields and that this would strengthen it, I think they are talking about their own field. There is nothing that contains more diverse activity than the healing arts practice act. There is nothing more diverse than surgery and psychotherapy. The conflicts of techniques and learnings are totally different. What would happen if they got out to do this?

Incidentally, none of the 37 states have a separate licensing of this nature. It specifies that. It would be the first time that that would be.

First of all, I think it would bring to a halt much of counseling work that is done in this city by the legal profession, by ministers, by social workers, because what they said then is that this counseling and psychotherapy is a medical practice, that no one is allowed to do this except a physician. And those psychologists would have a license and it would be disastrous.

In addition, this room today would be overwhelming with social workers, ministers, and lawyers. It has tremendous other ramifications. Mr. JACOBS. I think that responds fully to my question.

Thank you very much, Mr. Chairman.

Mr. SISK. The gentleman from Maryland, Mr. Gude.

TRAINING

Mr. GUDE. Thank you, Mr. Sisk.

In section 7(B), on page 6, it would appear to me that it includes any type of training, for example, (B) (1).

Dr. MELTZER. That is a very specific reference. You refer to the internship that refers to the psychological internship which the graduate student might take while he is a graduate student. What the section does, it says that the psychologist cannot count that experience towards the two years postgraduate experience that he must have before he can apply for a license.

Mr. GUDE. Section 3 (D) speaks of the use of counseling and psychotherapy with individuals having problems in the area of work, et cetera. Is it not necessary for a person working in this area to have some knowledge of medicine, for example, for a person to have some knowledge of physical or organic change?

Dr. MELTZER. You are talking as to the training of the clinical psychologists?

Mr. GUDE. Yes, sir.

Dr. MELTZER. This is the pattern of training, to have the psychologist in training work closely in various medical fields. For example, in the five or six years, two and one-half years in the Veterans Administration working in the hospitals, in the out-patient clinics such as here in Baltimore and in Washington. This is one of the reasons, too, that we say to the psychologists, "You cannot offer yourselves to the public for a fee until three years after your degree, because you have to work in a setting which will prepare you for what you are trained to do under the supervision of other disciplines," and so forth. In the training of a psychologist, he must do an internship. And these internships, invariably, are in medical institutions, in clinics, or in hospitals. Many of the courses are related to the same types. And for two years after the degree, the psychologist would not be able to practice independently. If this were the law, he would have to work under supervision.

Mr. GUDE. Do you think that this educational program, carried forward in a medical environment, is a guarantee under the terms of this requirement to have a degree in psychology?

Dr. MELTZER. I am talking about the specific parts of it, that is, the practical training, in addition to the work in the universities. Other types of psychologists, counseling psychologists, industrial psychologists very rarely see the medical part. The clinic psychologists, yes.

Mr. GUDE. Would this bill provide for the licensing of industrial psychologists?

Dr. MELTZER. Yes, it would.

Mr. GUDE. He would be able to engage in psychotherapy?

Dr. MELTZER. No, that is the situation. Right now at this moment, an industrial psychologist could practive psychotherapy in this city. He is not in violation of the law. He can be thrown out of the D.Č. Psychological Society and be sued for malpractice, but he cannot be stopped. What this bill would do is to say that a psychological must practice within the purview of this authority, within the confines of the training in the areas of his competence, and if he steps over that line then we would remove his license and we could stop him. This makes sure that the industrial psychologist would not do so. He would be thrown out of the organization, which is all we can do now. And he is going to be unprincipled. If he is that will not mater.

Mr. GUDE. Where would this guarantee be?