Freudian slip or Public Health Gamble: Bridging Expertise and Ethics in Psychological Specializations

Dubai Mental Health 2027: Charting the Future of Psychological Care

Dr. Alexandre Machado *¹

*Correspondence to: Dr. Alexandre Machado, Clinical Neuropsychologist & Clinical Psychologist, Dubai, United Arab Emirates.

Copyright

© 2025 Dr. Alexandre Machado, This is an open access article distributed under the Creative Commons Attribution  License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 14 Aug 2025

Published: 20 Aug 2025

DOI: https://doi.org/10.5281/zenodo.17043276

Abstract

The field of psychology is vast and multifaceted, with numerous specializations requiring distinct academic foundations, clinical training, and supervised practice. However, the blurring of professional roles often leads to non-specialized professionals overstepping their boundaries, resulting in ethical violations and significant public health risks. This article delves into the ethical and public health implications of such role confusion and offers practical solutions to ensure accurate diagnoses and effective treatments.

Keywords: Neuropsychology, Psychology, Ethical Dilemmas, Public Health, Professional Practice, Specialties.

Introduction

Psychology, much like medicine, is a discipline with diverse specializations, each demanding rigorous academic training, supervised internships, and extensive clinical practice. Yet, the overlap in professional roles often creates confusion, leading to non-specialized professionals taking on tasks beyond their expertise. This not only raises ethical concerns but also poses serious public health risks, as misdiagnoses and inappropriate treatments can harm patients and delay proper care.

This article seeks to clarify the roles, training, and areas of practice for Clinical Neuropsychologists, while examining the ethical and public health implications of role confusion. It also proposes actionable solutions to address these challenges effectively.

Clarifying Roles, Training, and Areas of Practice

1. Clinical Neuropsychologists

Clinical Neuropsychologists specialize in understanding the intricate relationship between the brain and behavior. Their training includes:

- A minimum of a two-year Master’s and or minimum three-year Doctoral degree in Clinical Neuropsychology.

-  One year of academic supervised clinical neuropsychology training.

-   Two years of senior supervised clinical neuropsychology internship.

They diagnose and treat conditions such as neurodevelopmental disorders like ADHD or Autism, brain injuries, and neurodegenerative diseases like dementias. In some cases, Neuropsychologists are integrated into neurosurgery teams, where they perform perioperative neurocognitive and behavioral assessments, conduct brain mappings for neuro-oncological and epilepsy surgeries, and perform the world-famous awake assessments during neurosurgery. The inclusion of Neuropsychologists in these teams has substantially improved the quality of resections and patient recovery.

In contrast, Clinical Psychologists focus on emotional and behavioral issues, providing psychotherapy for conditions like anxiety, depression, and trauma. Their training does not involve deep knowledge of the functional neuroanatomy of the brain, its vascular system, neurocognitive functioning, pharmacology beyond psychopharmacology, image interpretation, or knowledge of neurological pathology, including the behavioral, morphological, organic, or metabolic causes of various clinical conditions, from neurodevelopmental to neurodegenerative disorders.

To be a Clinical Psychologist, one requires a Master’s degree in Clinical Psychology and or a minimum of three years in a Doctorate in Clinical Psychology. The emphasis is on psychotherapy and mental health treatment. While Clinical Psychologists play a vital role in mental health care, they are not qualified to diagnose or treat neuropsychological conditions, underscoring the importance of respecting professional boundaries.

2. Other Health Professionals

Like Clinical Psychologists, Speech Therapists and Occupational Therapists provide valuable support in their respective fields, but their training does not encompass neuropsychological expertise. As such, they are not equipped to diagnose or treat neuropsychological conditions, further highlighting the need for clear professional boundaries. Often, confusion arises because some of these specialists attend courses and postgraduate programs in Neuropsychology.

For example, most Clinical Neuropsychologists extensively attend university and professional postgraduate programs in Forensic Psychology or Radiology and Image Interpretation to enhance their knowledge in the field, improve clinical reasoning, and foster interaction with colleagues. However, this additional knowledge does not make them specialists in Forensic Psychology or Radiology.

Ethical and Public Health Implications

The overstepping of neuropsychological functions by non-specialized professionals has severe consequences:

•  Misdiagnoses can lead to inappropriate treatments, harming patients and delaying necessary care.

•  False positives create unnecessary stress and stigma for individuals incorrectly labeled with conditions they do not have.

•  Ineffective therapies fail to address the actual needs of patients, worsening their conditions and undermining the effectiveness of mental health care.

Proposed Solutions

To address the ethical and public health concerns arising from role confusion in psychology, a multi-faceted approach is essential. The following strategies are proposed to ensure that only qualified professionals perform specialized roles, safeguarding patient well-being and maintaining the integrity of the profession.

1. Recognition of Specializations

Formally recognizing specializations within psychology is crucial. Implementing cross-regulatory body/government-level criteria and regulations for accrediting specialized roles, such as Clinical Neuropsychologists or Clinical Psychologists, ensures clarity in professional boundaries. Regulatory bodies/governments must collaborate to monitor and sanction clinicians who overstep their qualifications. Given the public health implications, there should be legal and criminal sanctions for such actions.

For example, the EuroPsy Certificate provides a benchmark for psychological practice across Europe, ensuring professionals meet rigorous standards of competence. Similarly, the British Psychological Society (BPS) or the Order of Portuguese Psychologists (OPP) outlines specific requirements for specialization. By adopting such frameworks globally, we can ensure that only those with the requisite expertise perform specialized functions.

2. Monitoring and Oversight

Effective regulation of professional practice requires robust monitoring and oversight mechanisms. Regulatory bodies must establish systems to audit practitioners' qualifications and activities, ensuring compliance with defined scopes of practice. The Dubai Health Authority’s Mental Health Strategy 2027 introduces Standard Operating Procedures (SOPs) outlining the roles, responsibilities, and limitations of each specialization, including provisions for supervision and the prohibition of practices outside one’s area of competence.

Additionally, periodic evaluations and mandatory continuing professional development (CPD) programs help maintain high standards of practice. By holding professionals accountable, these mechanisms can prevent the usurpation of functions and protect public health.

3. Public Awareness

Public education plays a critical role in addressing role confusion. Many individuals are unaware of the distinctions between various psychological specializations, leading them to seek care from unqualified practitioners. Public service announcements, informational websites, and collaborations with educational institutions can help disseminate knowledge about the roles and qualifications of Clinical Neuropsychologists, Clinical Psychologists, and other mental health professionals. By educating the public, we reduce the demand for services from unqualified practitioners and encourage the use of evidence-based treatments.

4. Interdisciplinary Collaboration

Interdisciplinary collaboration is essential to address the complex needs of patients with psychological and neurological conditions. Clinical Neuropsychologists and Clinical Psychologists often work alongside neurologists, psychiatrists, and other healthcare professionals to provide comprehensive care.

Establishing clear guidelines for collaboration, such as those proposed by the International Neuropsychology Society (INS), ensures that each professional operates within their area of expertise while contributing to a holistic treatment plan. By fostering collaboration among various mental health specialists, we minimize the risks associated with role confusion and improve patient outcomes.

Regulating Professional Practice: The Dubai Health Authority’s Approach

The Dubai Health Authority’s Mental Health Strategy 2027 presents an exemplary framework for regulating professional practice through Standard Operating Procedures (SOPs). Each SOP is designed to address the various challenges faced in the mental health sector, improving the quality of services in the Emirate of Dubai.

Key components include:

• Definition: Providing a standardized understanding of the profession to ensure consistency across roles and expectations.

• Roles and Responsibilities: Clarifying the specific duties associated with each profession, clearly delineating the scope of activities professionals are authorized to undertake.

• Core Competencies: Identifying essential skills and knowledge required for safe and effective practice.

• Limitations and Boundaries of Practice: For example, psychologists are obliged to provide services, assessments, and interventions only within their areas of education, training, experience, and competence. Engaging in activities beyond these competencies, such as specialized assessments for which they lack training, is strictly prohibited. Furthermore, psychologists are not permitted to prescribe medications or provide medical diagnoses, necessitating collaboration with medical professionals when patients’ needs intersect with the medical domain.

• Supervision and Delegation: Practitioners must ensure that any delegation of tasks is appropriate, supervised, and within the capabilities of the training provided to assistant psychologists, psychometricians, or other support staff.

The meticulous SOP framework also includes licensing titles within specialties and sub-specialties and defines the specializations and boundaries in the field of Psychology for each specialty in the Emirate of Dubai: Neuropsychology, Child Psychology, Clinical Psychology, Forensic Psychology, Addictions, Health Psychology, Assistant Psychologist, and Psychometrician are the recognized specialties with specific frames of work. This structured approach guarantees that professionals operate within their areas of expertise, mitigating the risks of ethical violations and protecting public health.

Concluding Remarks

In conclusion, the complexities and demands of today’s mental health landscape necessitate a clear understanding of the specializations within psychology. By recognizing and delineating the roles of various professionals, implementing robust regulatory frameworks, fostering public awareness, and encouraging interdisciplinary collaboration, we can significantly enhance the quality of care provided to individuals with mental health issues.

The Dubai Mental Health Strategy 2027 serves as a pioneering model for addressing these challenges, offering a structured and comprehensive approach to professional practice. Through these steps, we can ensure that the integrity of the profession is maintained while prioritizing the health and well-being of patients. By continuing to refine and expand these strategies, we can pave the way for a future where psychological care is both effective and ethically sound.

References

1. American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct.

2. Bilder, R. M., et al. (2020). Neuropsychological Assessment in the Age of Evidence-Based Practice: A Critical Review. Neuropsychology Review.

3. British Psychological Society. (2018). Standards for the Accreditation of Doctoral Programmes in Clinical Psychology.

4. Dubai Health Authority. (2024). Mental Health Strategies and Professional Practice Regulations.

5. Dubai Health Authority. (2024). Mental Health Strategy 2027: Standard Operating Procedures (SOPs) for Professional Practice.

6. International Neuropsychology Society (INS). (2023). Guidelines for Interdisciplinary Collaboration in Neuropsychology.

7. Lezak, M. D., Howieson, D. B., & Loring, D. W. (2012). Neuropsychological Assessment (5th ed.). Oxford University Press.

8. World Health Organization. (2019). Global Health and the Role of Specialized Professionals.

9. Royal College of Psychiatrists. (2019). Standards for Specialist Training in Psychiatry.

10. Order of Portuguese Psychologists (OPP). (2021). Standards for    Professional Practice in Psychology.