The cat is out of the bag.

After many months, I've finally been pushed to finish this article on questionable credentialing in hypnosis and "psychotherapy." A reporter from a major magazine wrote to "Dr. Zoe D. Katze" for input on an article she was writing on hypnosis for childbirthing. She had stumbled across Dr. Zoe's name on the American Association of Professional Hypnotherapists' website. I had to tell her the truth.

Dr. Zoe D. Katze, Ph.D., C.Ht. is a cat. In fact, she is my cat. Those familiar with basic German have probably already enjoyed a laugh. "Zoe Die Katze" literally translates to "Zoe the cat."

Dr. Katze's credentials look impressive. She is certified by three major hypnotherapy associations, having met their "strict training requirements" and having had her background thoroughly reviewed.

I was motivated to credential my cat by two circumstances. First, I have become increasingly heedful of all the questionable credentials out there, and I've grown tired of sounding defensive to therapist-shopping clients who confront me with something along the order of: "I found somebody with all these certifications and diplomas and he/she charges half of what you psychologists charge."

The last straw (and my moment of inspiration) came during an internet search for a colleague. I accidentally came upon the website of another "psychotherapist" who listed a doctoral degree from an infamous diploma mill. Along with his degrees, he listed a veritable alphabet soup of impressive-looking letters after his name, corresponding to various "board certifications" and his status as a "Diplomat [sic] and Fellow" of the "largest professional hypnosis association in the world."

I decided to credential my cat.

This was a surprisingly easy thing to do. First, since so many financial transactions are conducted by credit card, I had to get Zoe some credit. No problem; I just added her as an "authorized user" of one of my own credit cards. (The credit card agent asked for Zoe's social security number, but then cheerfully relented when I told him it would take me some time to search for it.)

The rest was equally as easy. In the nefarious world of quasi-credentialing and diploma scams, money talks. Or at least it meows. All I had to do was get Zoe her first credential, which I did by filling out an "application for certification" on a lay hypnosis association's website. I charged her application fee, and within a few weeks, Zoe had her first piece of paper. Since most lay hypnosis associations have a reciprocity agreement respecting each others' certifications, it was a snap to obtain additional (and very impressive sounding) certificates.

Zoe is (or was, since I doubt I will pay certification maintenance fees) certified by the National Guild of Hypnotists, the American Board of Hypnotherapy, and the International Medical & Dental Hypnotherapy Association. She is a Professional Member of the American Association of Professional Hypnotherapists.

Not bad for a cat who's not even purebred.

What do credentials mean, really? In most health professions, the basic credential is a license. Psychotherapy and hypnotherapy are activities that are difficult to regulate. With few possible exceptions--psychological testing may be the only one--they do not require an ability to utilize a clearly-defined or unique technology (like surgery) or a tangible asset (like pharmaceuticals). Instead, they rely primarily or exclusively on communication and human interaction. Ultimately, then, we are up against a seemingly impossible proposition: How does one "license" a form of human interaction? Licensing boards have taken on this improbable task, but they typically do not attempt to define or enforce any set of behaviors except upon those who submit to licensing. Of course, there are strong incentives to being licensed, like the ability to qualify for insurance reimbursement or for certain agency, healthcare service or government positions. But by and large one can get by without a license to practice, especially if one has other sources of income. Some unlicensed practitioners have succeeded quite handsomely, thank you; unlicensed therapist-cum-author John Gray is one of the prime examples, neurolinguistic programmer and motivational speaker Anthony Robbins is another.

And for the thousands of private practice "counselors" and "therapists" who are engaged in what is essentially a small part-time business or even a hobby (they do not need this income to survive), licensing is largely superfluous and--with its rigid experience requirements, laborious application and examination procedures, and continuing education requirements--perhaps even an irritant.

In psychology and mental health, research on whether licensing actually assures competence has yielded inconclusive results. Nevertheless, licensing and certification are minimally capable of doing two things: (1) guaranteeing that an individual possesses a journeyman's fund of basic information (at least at the time of the examination) and shares a somewhat common educational/training experience; (2) providing a system of accountability to the public.

Compared with the conservative, rigidly regulated and highly structured world of medicine, psychotherapy is the wild west of credentialing. When a physician claims board certification, her patients can be reasonably assured that their doctor has completed a fairly uniform course of training and has passed a tough examination. In mental health, credentialing is a far more varied and amorphous affair. Until relatively recently, "board certification" meant one was either Diplomated by the American Board of Professional Psychology (ABPP) or, if a social worker, by the American Board of Examiners in Clinical Social Work. There were also a small number of proficiency certifications available (e.g., rehabilitation counseling, career counseling) to those who completed substantial training requirements (and usually an examination) in that area.

But, in my opinion, something happened in the 1980s and '90s that led directly to the proliferation of credentialing (and pseudocredentialing) in mental health. First, the advent of managed care, coinciding with the proliferation of graduate school programs in mental health (especially at the masters degree level), led to uncontrolled growth in the supply of practitioners while demand became increasingly restricted. As a result, many mental health practitioners began to scramble for a means (any means) to distinguish themselves, to be perceived as above the common horde, to be singled out.

Second, the last 20 years have seen a proliferation of specialties and "techniques," some valid, others a bit dubious, and still others the peculiar invention of their creators. In some cases, like trauma treatment, neuropsychology and forensic psychology, specialties were essentially invented where none existed before, due primarily to advances in the science as well as the practice of psychology. However, other more arguably dubious credentials also came into existence, leading to the development of "certified specialists" from "energy therapist" to "alien abduction therapist" to "past life regression therapist."

How confusing this must be to clients and consumers of our services. And how frustrating this is to the legitimate clinician who might be left feeling "credential challenged" or even intimidated by the therapist who advertises him/herself with multiple impressive-sounding credentials.

Would additional laws help? In my opinion, probably not. In fact, l can not think of a legal or legislative solution that would positively impact credentialing without creating even worse problems. Unlike medicine, which often involves immediate life and death issues, mental health clinicians typically treat more subtle and (with the exception of a relatively small percentage of critical emergencies) less immediately dangerous situations. As a result, the public and our lawmakers are less likely to worry about the inflated or even implausible claims made by some therapists. In addition, we clinicians have traditionally operated under a kind of libertarian tradition. By and large we loathe guidelines, treatment manuals, or any external agent claiming to be able to judge or measure our competence. Nor do we want anything beyond broad and inclusive suggestions when it comes to external agents telling us what constitutes "good" vs. "bad" therapy. And for good reason. Human behavior and the "mind" are just more complicated than, say, the liver or a broken bone. What is "good" and "bad" for the psyche is not as easily defined as what is good for the liver or bad for the fibula. We psychotherapists continue to argue and debate these issues, and I for one value our disagreements. I hope we never come to completely understand the mind and what is "right" for it. (If we ever did, we would be a short skip and a jump away from a form of psychologically-sanctioned fascism that would make Orwell's 1984 seem like a hippie utopia.) Those who claim to know the absolute truth about the human psyche are more likely to be psycho-demagogues and therapy cult leaders than benevolent role models.

So it seems that, with the possible exception of the most outrageous forms of "certified therapies," we are doomed to tolerate an extremely broad array of credentialing bodies, from the legitimate to the questionable to those that are outright shams. It is up to each of us to examine our own motivations for obtaining credentials (both legitimate and dubious), to police ourselves and our own professions, and to do our best to educate the public.

Still, one has to ask: What value can a credential hold when it can be so easily obtained for a common household pet? I expect the unmasking of Dr. Zoe D. Katze, Certified Hypnotherapist, will make some people very, very angry. I hope they will find it within the purview of their anger to demand serious changes in the credentialing process employed by these associations.