Angst

Last Saturday I re-took the oral exam for licensure. Texas is one of only a handful of states, including Georgia, Louisiana, Oklahoma, West Virginia, New Jersey, Colorado & California, that still engages in this outdated, highly subjective final hoop to private practice. I passed the national written exam (EPPP) and the state jurisprudence (ethics) exam over four years ago at the Doctoral level within a few months of receiving my Master's degree. Then I finished my internship, and that pesky dissertation thingy to earn my PhD (the highest possible degree) and the last year I've been in postdoc. In most states that would be sufficient. Instead, I got to sit in front of the Inquisition and give answers to questions about an imaginary case off the top of my head instead of being able to consider all the aspects of the case beforehand - like I do every other day of my professional existence, during which I typically have a minimum of a week to mentally prepare for the the person who will spend time under my care. Neuropsychology a specialization that usually requires a referral. It's not 7-11. We just don't get walk-in traffic.

This time, I was able to manage my anxiety up front a lot better. Knowing what to expect going in went a long way toward not elevating that anxiety to the point where I was having panic attacks or feeling like I was going to vomit on the examiners (okay there were a few minutes at the beginning that I thought I might release the contents of my stomach onto the examination table but once we got underway, it wasn't so bad). I was able to conceptualize the case and articulate my considerations in a cogent manner and nailed the diagnosis (multiple sclerosis) right off the bat even though I'd been studying TBI (traumatic brain injury) because it comprises well over half of all neuropsychological issues. Then they started asking me about psychotherapy, which I don't do and I told them I would refer the patient and her boyfriend to someone else if they wanted couples' counseling. Still they insisted that I assume I had agreed to see them - together - for counseling - which I don't do. Ever. Psychoeducation...maybe a little crisis management with an appropriate referral, yes - but ongoing psychotherapy? Fuggedaboutit. Ain't happenin', pal. So I did the best I could to talk about an area that does not lie within my area of expertise. yippee.

I was able to tell them what I've done to enhance my professional skills without any trouble. In addition to telling them about keeping up with my continuing education as required, I talked about all the major assessment standardizations I worked on (WAIS-IV, WMS-IV, NEPSY-2, WNV, et cetera - my name's even in the manuals), talked about the continuing education module I wrote for NAPPP on cognitive care of the elderly, and about the presentation I did at our state psych association's convention on cognition and affect in the elderly. The older of the two nodded his head and got a look of "aha" recognition on his face. I think "Aha" guy was there - and I did seriously kick ass on that talk.

So I have to say that, also unlike last time, the two examiners were genuinely nice, friendly guys. There wasn't a Blackberry in sight. Nobody checked the two-way mirror for stray hairs or boogers and they appeared to be interested in what I had to say. When I got stuck, they tried to guide without giving the answer away. There were even several times when they said, "Good." I appreciated the positive feedback. Once when my answer was very succinct but to the point, they were looking at me kind of weird so I asked if they wanted further elaboration, "Aha" guy said, "No. Actually, that was exactly what we were looking for." I could see his score sheet and noticed several 8-point scores, so all that was good. Granted, there were some weak answers in there too, but they can't all be winners, and I just need 64 points to pass. After being escorted back to the holding room, I was dismissed within a few minutes, meaning that once again, I either failed miserably or I passed. I'll know in another 3 weeks or so when I get my notification letter.

It's that wait time that's killing me. I have a constant nagging in the pit of my stomach and every time I think of opening my results letter on the day that it arrives in the mail, I feel my blood pressure go up along with a wave of nausea that I haven't experienced since the early days of my pregnancy with The Girl. I'm having nightmares, waking up sweaty and in a panic, and am on the verge of tears at any given moment. These folks have the key to my professional future and all these years later I'm still whining and scratching at the door like a dog wanting to come in from the cold and be fed.

I've said repeatedly that Psychology is a field that eats its young. Had I known going in how treacherous the path would be, I'd have become a physician and would already have my training wheels off. The licensing process in psychology seems to be more about keeping new practitioners in a one-down position for as long as possible than anything else, and I wonder if they're really concerned with ensuring that there are enough practitioners available to serve our communities, especially in a state that is as grossly underserved as Texas. I've been formally studying psychology with the intent of becoming a psychologist since returning to college in the spring of 1997 and I cranked out 4 degrees in the next ten years. My doctoral program began in the fall of 2000. My training with actual patients began a year later. I graduated with 96 credits more than I needed for the PhD, including a concentration in neuropsychology and a 3.76 gpa to boot. That said, how much is enough?