Psychology’s Clouded Vision

February 27, 2008

Instead of directing their sexuality towards a more conventional object, individuals with perversions deflect their desire elsewhere, be it towards special clothing, shoes or. more dangerously. children or even animals. Professional psychology, on a state and nationwide level, displays a similarly perverse distortion of objectives. Rather than focusing on the true threats to applied psychology. attention has instead been paid to educating psychologists to work with managed care companies, to allowing the proliferation of new doctoral programs and expansions in existing doctoral programs (such as CSPP’s rumored-to-be-soon doubling of their enrollment), and to pursuing the gravest perverse aim of professional psychology–the quest for prescription privileges. The real threats to applied psychology lie in its participation in managed care, the (much less widely publicized) plethora of inadequately-trained psychology graduates from accredited and unaccredited graduate schools. and the waste of time and energy spent pursuing prescription privileges.

So why has psychology’s vision become so clouded? The answer lies in its short history. Beginning during World War II, with the need for mental health practitioners to treat psychologically traumatized soldiers, clinical psychology emerged as the bastard child of medicine, essentially unwanted, relegated to a second-class position, but tolerated due to need.

During the ensuing three decades, with much sweat and toil on the part of its leaders, psychology emerged as a distinct discipline. By the 1970s, it had gained considerable respectability. Psychologists’ expertise in provision of psychotherapy, and psychological and neuropsychological assessments, was well-established. Many psychologists practiced independently. Graduate schools excelled in training psychologists in these basic tasks.

Enter the malignant spread of health maintenance organizations, preferred provider organizations, and the like, commonly referred to as the “industrialization of medicine.” The face of psychology gradually changed. In retrospect, it seems that almost overnight psychology as a profession became influenced by economics rather than ethics. Issues of confidentiality and privacy took the back seat to concerns about cost cutting. By the late 19805, some psychologists began seeking prescription privileges as a way of competing with medicine and working within this time-limited, cost-controlled system. It was then only a short trip to the dark collection of various recently published. particularly nauseating articles in the APA Monitor and The California Psychologist such as one gem which described a psychologist’s discovery of how working for a managed care company, which she had previously viewed. as “the enemy,” proved. to be a rewarding, fulfilling experience.

Because it has been responding to market pressures rather than striving to perfect its services, professional psychology now risks complete destruction. The continued capitulation to managed care forces threaten to destroy the privacy which is ultimately the basic foundation of any psychotherapeutic approach. The inevitable failure of the prescription privileges effort will drain limited financial resources for political lobbying and weaken the profession in the eyes of other professional colleagues, not to mention the public. A final issue, which receives far too little attention, concerns the excessive number of psychology graduates being produced, particularly in California, One recent psychology graduate appeared in Playboy magazine. How many more will be driving taxicabs, working as waiters. or functioning in other businesses? These trends will ultimately diminish the credibility of the entire field, For those who find work in psychology, their fees or salary will be greatly reduced, as will respectability. because supply will exceed demand and the many swollen training programs will inadequately screen or train their graduates.

Perversions typically prove difficult to treat because of the gratification individuals find in the distorted object of desire. A compulsive, self-reinforcing pattern usually develops which ensures the continuation of the behavior. This is just the sort of pattern that has emerged in professional psychology. It has become entrenched in certain paths: Lobbying for prescription privileges when many psychologists are inadequately trained in their basic skills; training psychologists to work within a managed care system which destroys the provision of meaningful psychotherapy with its third party intrusions; and allowing graduate training programs in psychology to proliferate when higher standards for screening and training should be developed instead.

In cases of severe perversions, behavioral changes typically only follow major consequences, i.e. arrest or public exposure. If there is any hope for the future of psychology, it sadly lies on a similar path. As the profession’s credibility with the public plummets, the prescription privileges effort fails, and the number of unemployed psychologists reaches into the hundreds or thousands, perhaps only then our profession’s leadership will focus its attention on these three focal tasks: eliminating managed care in professional psychology, relinquishing the absurd push for prescription privileges, and greatly increasing the standards for professional training through better screening, training, and the elimination of unaccredited schooling. And since, as Tolstoy argued in War and Peace. leadership emerges from the will of the people, the responsibility for ensuring such a movement toward ethics and integrity in our field rests with all of us.

(Dr. Karbelnig, a past Member of the CPA Board of Directors and current Chair of the Ethics Committee of the San Gabriel Valley Psychological Association, practices psychoanalytic psychotherapy and forensic psychology in South Pasadena, California.)

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