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An Alphabet of Good Health in a Sick World by Martha M. Grout MD, MD(H) and Mary Budinger
An Alphabet Of Good Health
In A Sick World

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Credentials for Neurotherapy

What follows is an argument made for licensure, which would provide minimal standards to adhere to for members of this field and promote colleague consultations between therapists.

By Margaret MacDonald, MD and Cynthia Kerson, PhD; edited by David A. Kaiser, Ph.D.

We want to continue our discussion on the pros and cons of licensure for the clinical practice of applied psychophysiology in the state of California, a discussion first started at the BSC meeting in Asilomar this year. Applied psychophysiology refers to autonomic and central nervous system (ANS & CNS) operant conditioning, peak performance training using neurophysiology, and quantitative EEG assessment. We want to make clear to this group how we all can gain from attaining formal licensure. We are well aware that most clinicians do not have the time nor energy to spend on additional efforts to maintain the scope of their current practice; but none of us want to see our field's reputation degraded by non-credentialed practitioners, those who practice "neurofeedback" with little training or education about physiology, biofeedback or the professional and ethical considerations of how clinical operations should run.

As biofeedback clinicians we believe we need to elevate our standing in the care community. We are medical and psychological practitioners who work with individuals who have serious mental and physical ailments. It is our hope that, by having licensure status in applied psychophysiology, we will be able to provide the public a guaranteed level of care, one which is respected by members of other medical, psychological, and therapeutic communities as well as by third-party payers. To do this, we must standardize significant aspects of our clinical practice and address current sub-optimal practices. ... Neurotherapists need to work in collaboration with medical practitioners in many cases, especially when working with clinical conditions that are complex and require extensive experience. ...

If we claim to care for and improve the health and wellbeing of our clients, we must have a scientific or clinical model of efficacy that addresses each individual's complaints. We cannot proceed blindly into altering the function of the most complex organ in existence and assume all will work out well without an appropriate base of knowledge. We must be clear about what our equipment and software are capable of doing in terms of stimulation or operant conditioning and we must be clear about what our assessments mean in the context of applied psychophysiology. ...

By having a separate designation for what we do, we can avoid some of the overlap with other specialties, and can thus respond as needed to symptoms and sources, rather than only to diagnostic or medical labels. For example,if a client comes in with the diagnoses of multiple sclerosis, anxiety, and marital problems and a quantitative EEG assessment reveals a frontal disconnection in the brain and all three problems are alleviated through frontal connectivity training, the current climate would dictate that we would need to be a neurologist, a psychiatrist, as well as a licensed family therapist else be vulnerable for treating outside our expertise. As long as it can be understood that these symptoms are the result of an ongoing but temporary dysfunction of the central nervous system (CNS), it is more appropriate for such a client to be handled by someone with recognized expertise in manipulating the functionality of the CNS.

Establishing educational standards and licensing procedures for practitioners requires introduction and successful passage of new legislation at the state level. The process is tedious and can span one or more two-year legislative sessions, depending upon the level of support. ... Grandfathering of existing practitioners will require clear and rigorous guidelines. Proof of years in practice, an applied psychophysiology exam requirement, and/or proof of a minimum level of training beyond what is currently required by BCIA may be in order.

For more information about the Biofeedback Society of California, see: www.biofeedbackcalifornia.org

For more information about the International Society for Neurofeedback and Research, see: www.isnr.org

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