A Changing Profession - Psychology's Evolution

A Changing Profession 1) The Boulder Model and its Discontents 2) Humanistic Psychology and the Counterculture 3) Rational Living and Thinking Straight 4) Prescription Privileges 5) The APA and Enhanced Interrogation  New York Times, September 3, 1946 First(?) classified ad for of...

A Changing Profession 1) The Boulder Model and its Discontents 2) Humanistic Psychology and the Counterculture 3) Rational Living and Thinking Straight 4) Prescription Privileges 5) The APA and Enhanced Interrogation  New York Times, September 3, 1946 First(?) classified ad for office rental which lists “psychologists” along with other medical professions as possible tenants What might its appearance tell us about changes to psychology as a profession? “The Veterans Administration practically created a new mental health specialty by providing training funds as well as hospital internships and permanent jobs for clinical psychologists. The massive infusion of funds for research and training transformed university psychology departments, causing a rapid rise in the number of faculty members, students, and support staff as well as major changes in curriculum” - James Capshew, 1999 In 1942, the United States Public Health Service (USPHS) and the Veterans Administration (VA) worked to expand pool of mental health professionals Insufficient number of psychiatrists to cope with returning soldiers USPHS provided funds to psychology departments for clinical training and the VA established funded practicum and internship experiences 1946: 200 trainees at 22 universities 1949: 1500 trainees at 50 universities Boulder Conference (1949) Scientist-practitioner model - Academic instruction in experimental psychology in existing departments - Practicum (often done in university counseling centers) - Internship (often done in medical/psychiatric setting, e.g. VA hospitals) - Complete research dissertation Total Psychology PhDs awarded in the United States (per 5 yrs) 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 0 4 09 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89 94 99 04 10 14 1 9 19 19 19 19 19 19 19 19 19 19 19 0– 5– 0– 5– 0– 5– 0– 5– 20 20 20 0- 5- 0- 5- 0- 5- 0- 5- 0- 5- 0- 5- 6 6 7 7 8 8 9 9 0- 5- 0- 0 0 1 1 2 2 3 3 4 4 5 5 1 9 19 19 19 19 19 19 19 0 0 1 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20  Psychology PhDs in the USA, 1960-1999 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 1960–64 1965–69 1970–74 1975–79 1980–84 1985–89 1990–94 1995–99 Clinical + Developmental + Experimental + SP I/O  Gender breakdown of Psychology PhDs awarded in the USA 3,000 2,500 2,000 1,500 1,000 500 0 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 10 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 male female What trends did you notice in these demographics? Who is a psychologist? How has this changed over time? What has remained the same? - Originally clinical psychologists charged with assessment. The administration of intelligence and personality tests (both objective and projective) - Organized psychiatry opposed psychologists offering psychotherapy - However, the VA hospitals allowed psychologists to administer psychotherapy under the (often minimal) supervision of an MD - In 1955, APA drafted model legislation to have psychology recognized as a regulated profession. In 1977, Missouri became the last state or province to license psychologists Carl Rogers (1902–1987) - Prewar background in child guidance - In 1945, he established a counselling center at the University of Chicago - As president of APA in 1947, he commissioned David Shakow to develop scientist-practitioner model at the Boulder Conference “There has, of course, been lip service paid to the strength of the client, and the need of utilizing the urge toward independence which exists in the client. Psychiatrists, analysts, and especially social case workers have stressed this point…. this confidence is a very limited confidence. It is a confidence that the client can take over, if guided by the expert, a confidence that the client can assimilate insight if it is first given to him by the expert, can make choices providing guidance is given at crucial points. It is, in short, the same sort of attitude which the mother has toward the adolescent, that she believes in his capacity to make his own decisions and guide his own life, providing he takes the directions of which she approves.” - Rogers, 1946 Client-Centered Therapy - nondirective psychotherapeutic approach, emphasizing the centrality of the client’s point of view, avoiding interpretation by the therapist’s preconceived theories - Unconditional positive regard, congruence, warm and permissive atmosphere - Counseling as a “democratic” technique for self-realization - Third Force: humanistic psychology as an alternative to behaviorism and psychoanalysis Hans Eysenck (1916-1997) - Leader of clinical psychology in Britain - Based out of the Institute of Psychiatry, Maudsley Hospital and King’s College, London - Comes out of the Galtonian tradition of testing and psychometrics “The Effects of Psychotherapy: An Evaluation” (1952) “A survey was made of reports on the improvement of neurotic patients after psychotherapy, and the results compared with the best available estimates of recovery without benefit of such therapy. The figures fail to support the hypothesis that psychotherapy facilitates recovery from neurotic disorder.” Behavio(u)r Therapy - First formulated by South African psychiatrist Joseph Wolpe in 1950s (based on principles of Clark Hull’s learning theory and Ivan Pavlov’s conditioned response) - Instead of unravelling hidden, underlying “complexes,” directly targeting the symptoms of maladaptive behavior - Initially popular for treating phobias, addictions, and “sexual disorders” “According to psychoanalytic doctrine, there is a psychological complex, situated in the unconscious mind, underlying all the manifest symptoms of neurotic disorder. Hence the necessity of therapy for the psyche. According to learning theory, we are dealing with unadaptive behaviour conditioned to certain classes of stimuli; no reference is made to any underlying disorders or complexes in the psyche. Following on this analysis, it is not surprising that psychoanalysts show a preoccupation with psychological methods involving mainly speech while behaviour therapy concentrates on actual behaviour as most likely to lead to the extinction of the unadaptive conditioned responses.” - Eysenck, 1959 - Wolpe and Eysenck grounded in the world of psychiatry and medicine and the more class-based, deferential culture of the United Kingdom and British Commonwealth - Patients assigned to the psychiatrist by the state (as an alternative to prison or civil commitment) as opposed to the customer-oriented counseling of client-centered therapy - Therapeutic relationship as teacher-pupil How are the approaches of Rogers and Eysenck different? Why was client-center therapy understood as a “democratic” approach? Why was behavior therapy understood as an “authoritarian” one? How fair are such assessments? Medical Model of Mental Illness: A model of mental illness in which individual diagnosis and treatment are emphasized rather than social-learning approaches and prevention. Community Psychology: A field that studies the social and environmental determinants of mental health and illness in communities with emphasis on empowerment and prevention as anti-oppression interventions The Association of Black Psychologists (ABPsi) founded at 1968 meeting of the APA - informed by the Black Power movement - social and clinical psychologists who felt the establishment ignored their community’s needs Reform psychological training to make it more responsive to community needs - Advocated for greater inclusivity through new methods of recruiting and retaining Black students and faculty to lessen the shortage of Black mental health professionals - cultural competence as an aspect of professional training - embed training in practical community experiences - multiply roles as mental health workers at all levels of training George Albee (1921-2006) - “first” clinical psychologist, part of 1946 VA cohort and last name begins with “A” - Early research on the “manpower” problem in postwar mental health - Became increasingly critical of the medical orientation of the scientist-practitioner model of clinical training “clinical psychology began as a small offshoot of academic, scientific psychology, growing within the confines of the graduate school where professional education was unfamiliar…. clinical psychology has owned no captive practicum training facility of its own, and so, like the cuckoo, it has had to place its eggs in other birds' nests.” “Perhaps the most serious consequence for clinical psychology deriving from its near-total immersion in the psychiatric setting is that clinical psychologists and their students have been exposed to a very narrow range of human problems and without any real opportunity to think about the matter, have accepted the psychiatric definition, confused as it is, of who is to receive our intervention.” - Albee, 1970 “our selected treatment population is largely restricted to the two groups traditionally served in psychiatric settings. The first of these groups, usually found in the general hospital, especially the university hospital, is the white middle class neurotic who seeks prolonged psychotherapeutic relationships—people whom Schofield has described as having the YAVIS syndrome (young, attractive, verbal, intelligent, and successful). The second group clinical psychology has learned to work with is the seriously disturbed poor who are incarcerated in tax- supported state and Veterans Administration hospitals.” - Albee, 1970 “people have emotional problems in living that are produced by the problems inherent in an industrial civilization and that these problems should not be regarded as illnesses and should not be covered under a national health scheme. I would favor no coverage for any outpatient therapy except in cases of genuine organic illness.” - Albee, 1977 Berkeley Barb, Volume 2, issue 4, 1/28/1966 Albert Ellis (1913-2007) - PhD in psychology, underwent psychoanalysis with neo-Freudians - In late 1940s, he serves as the chief psychologist at the New Jersey Department of Institutions and Agencies (e.g. sex offenders) - Enters private practice in New York City - In 1954, formally breaks with psychoanalysis - As a sexologist, Ellis’s practice focused on marital, courtship, and family problems - Rational living and sexual liberation - Group psychotherapy, encounter groups, marathon weekends - Rational Emotive Behavior Therapy Paul Bindrim (1920-1997) - In 1967, he began promoting “nude psychotherapy” in his marathon weekend retreats - guide clients to their authentic selves through the systematic removal of clothing - Blurry line between humanistic psychology and unchurched spirituality “Paul Bindrim is not to be trust very far in regard to sexual freedom…. he insists very clearly, that a nudist marathon means that the individuals are only allowed to look and touch lightly and not at all to have sex relations of any kind. Secondly, he over-emphasizes the love bit as against the sex bit in a very typical meely-mouthed ministerial manner. His old background as a preacher comes out very clearly in what he says and the net result is quite puritanical and even hypocritically so, since on the surface he seems to be liberal.” - Albert Ellis, 1968 “We six girls (in a large co-ed university) would like to know whether your book The Art of Erotic Seduction was addressed with sincerity to American males. We were unable to believe that a supposedly well-educated doctor could have the idea that a male should get as much sex as he possibly can without the growth of emotional love. Our only conclusion is that you wrote the book for financial gain.” - “Fan” letter to Ellis, 1967 “We homosexuals are increasingly aware of the racket in which you and many other counsellors are engaged in your expounding the various concepts of the homosexual sickness myth. You are surely aware by now that the new trend in our movement is to reject participation of persons like yourself who obviously use our movement for the ulterior purpose of financial gain. The fact remains that by no means a ‘few’ but many homosexuals do go to counsellors of the sickness schools and we are becoming increasingly aware of the impracticality of many counsellors’ advice and their tremendous bleeding of our financial resources.” - Elver A. Barker to Ellis, February 15, 1968 Behavior modification: "the direct and systematic manipulation by one individual of the personality of another through the use of consciously applied psychological, medical, and other technological methods" "Because it is not based upon the reasoned exchange of information, behavior modification is not a traditional learning process" “Our general assessment of the field of psychotherapy is that we are entering a period of "psychological detente." Therapists of different persuasions are beginning to highlight their operational and theoretical similarities with concern for the mediating psychological and environmental processes that contribute to change in both therapy and nontherapy settings.” - Michael J. Mahoney, Aaron T. Beck, Marvin R. Goldfried, and Donald Meichenbaum Aaron T. Beck (1921-2021) - American psychiatrist who developed Cognitive Therapy, later Cognitve Behavioral Therapy (CBT) - focuses on correcting the distorted thinking and irrational thoughts that are presumed to underlie psychological problems such as depression. Martin Seligman (1942-) Learned Helplessness - Behavioral theory of depression - After experiencing the inability to avoid an adverse situation (like an electric shock), the organism learns to act or behave helplessly in a particular situation - Attributional style “It has not been easy for psychology, which struggled for many years to attain autonomy only to see the rules of the game change just as it became the preeminent psychotherapy profession” - Nicholas Cummings, 1995 “Any assertion that a physician must actually supervise the psychologist to assure the quality of psychotherapy treatment administered is refuted by the policy itself. The Blue Shield policy provides for payment to psychologists for psychotherapy if billed through any physician—not just those who regularly treat mental and nervous disorders. It defies logic to assume that the average family practitioner can supervise a licensed psychologist in psychotherapy, and there is no basis in the record for such an assumption.” - Virginia Academy of Clinical Psychologists and Robert J. Resnick v. Blue Shield of Virginia, 624 F.2d 476 (4th Cir. 1980) Tensions between practitioners and scientists within APA structure - Rapid growth of practitioners in independent practice as an interest group - Practitioners felt academic scientists indifferent to their concerns about insurance and managed care - New lobbying and activism by the organization - Psychology Today fiasco In 1988, mass exodus of academic (cognitive) scientists from APA after a failed reorganization They create the Association for Psychological Science (APS) with narrow focus “to promote, protect, and advance the interests of scientifically oriented psychology in research, application, teaching, and the improvement of human welfare” In 1987, the antidepressant fluoxetine (Prozac) was introduced - First commercially available Selective Serotonin Reuptake Inhibitor (SSRI) - By 1989, 65,000 Prozac prescriptions per month in the United States - By 1992, 4.5 million Americans had taken it. - Psychologists gained legal recognition to deliver psychotherapy amid the psychopharmacological revolution - Physicians and psychiatrists have resisted extending prescription privileges to psychologists - Currently, psychologists only hold prescription privileges in 5 U.S. states (New Mexico, Louisiana, Illinois, Iowa, and Idaho) and the territory of Guam  Patrick DeLeon (1943-) In 1991, the United States Department of Defense (DoD) started a program designed to Senator Daniel train doctoral-level Inouye (1924- psychologists to 2012) prescribe psychotropic medications Presidential Taskforce on Psychological Ethics and National Security (PENS) - Established by APA in 2005 after revelations about Abu Ghraib prison in Iraq and media concerns about health professionals’ roles at extrajudicial “dark sites” as members of Behavioral Science Consultation Teams - Charged with determining whether and under what circumstances psychologists who are APA members could, without violating the ethics regulations of the association, participate in national security “interrogations” "Ethical Principle B in the APA Ethics Code, Fidelity and Responsibility, states that psychologists “are aware of their professional and scientific responsibilities to society.” Psychologists have a valuable and ethical role to assist in protecting our nation, other nations, and civilians from harm. This role will sometimes entail gathering information that can be used in our nation’s and other nations’ defense, which is appropriate when psychologists act in accordance with the PENS Task Force statements. Psychologists working in the area of national security-related investigations are in a unique position to assist in ensuring that processes are safe, legal, ethical, and effective for all participants." - Stephen Behnke, APA Ethics Director, 2006 “Conducting an interrogation is inherently a psychological endeavor. Forming a relationship and building rapport have proven to be effective means of eliciting information. Psychology is central to this process because an understanding of an individual’s belief systems, desires, motivations, culture and religion likely will be essential in assessing how best to form a connection and facilitate educing accurate, reliable and actionable intelligence. Psychologists have expertise in human behavior, motivations and relationships. The background, training, and experience offered in psychology are therefore highly relevant to the process of creating and nurturing conditions that will maximize the likelihood of obtaining good and useful information. Psychologists have valuable contributions to make toward the goals of preventing violence and protecting our nation’s security through interrogation processes” - APA Statement submitted to the United States Senate Select Committee on Intelligence, 2007 What is the context of this quotation? To whom is this testimony being delivered? Why? What claims does it make about the psychologist’s role in interrogations? Who is the client in these situations? How is this description of an interrogation like Rogers’s description of the ideal therapy session? American Medical Association Code of Ethics (2006): “(b) Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession. “(c) Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.” Hoffman report (2015): “key APA officials, principally the APA Ethics Director joined and supported at times by other APA officials, colluded with important DoD [U.S. Department of Defense] officials to have APA issue loose, high-level ethical guidelines that did not constrain DoD in any greater fashion than existing DoD interrogation guidelines.” “I was asked by the Central Intelligence Agency in the spring of 2002 about how the research on learned helplessness could help captured Americans resist and evade torture and interrogation. There was no discussion of how learned helplessness could be used with detainees nor any mention of the interrogation of detainees. James Mitchell and Bruce Jessen later created a program of “enhanced interrogation” of detainees and it was incorrectly reported that they based it on the theory of learned helplessness…. The unfounded attacks on me and others, however, may have been intended to discourage young psychologists from working with the Department of Defense, and I urge American Psychological Association not to waver in its long-standing commitment to serve the nation.” - Martin Seligman, 2018 Hoffman Report (2015): “We think it would have been difficult not to suspect that one reason for the CIA’s interest in learned helplessness was to consider how it could be used in the interrogation of others.”  Conclusion To what extent has the professionalization of psychology been a success? What have been some of the costs or compromises in pursuing psychology’s professional ambitions? - Successes in establishing training programs, accreditation processes, and licensure from the state - Expansion of psychologist’s authority from assessment to include psychotherapy and other services - Limits of psychotherapy as a technology to heal society - Tension between care for individuals and embeddedness in large social structures and systems Psychology continues to face competition from: - Psychiatry - Psychopharmacology - MA-level psychotherapists - Self-help “People seem to feel acutely ambivalent about giving the analysis of their private experience over to outsiders, alternately seeking and rejecting the opinions of these "experts." For psychology to succeed in garnering for itself hegemony over the psychological realm, it would have to persuade people that they were entirely incapable of understanding the conduct and meaning of their own lives. That the public resists such attempts is unsurprising. And yet the very complexity of contemporary life makes people aware that they do not in fact know how to cope with many of the situations facing them and, in this sense, they desire advice. The problem for psychologists is that the public is willing to be eclectic, to take any advice that seems to make sense, whether it arises from science, common sense, or divine revelation.” - Morawski & Hornstein, 1991 References Benjamin Jr., L. T. (2005). A history of clinical psychology as a profession in America (and a glimpse at its future). Annual Review Clinical Psychology, 1, 1-30. Capshew, J. H. (1999). Psychologists on the march: Science, practice, and professional identity in America, 1929-1969. New York: Cambridge University Press. Green, C. D., & Cautin, R. L. (2017). 125 Years of the American Psychological Association. American Psychologist, 72(8), 722-736. Morawski, J. G., & Hornstein, G. A. (1991). Quandary of the quacks: The struggle for expert knowledge in American psychology, 1890-1940. In J. Brown & D.K. van Keuren (Eds.), The estate of social knowledge (pp. 106-133). Baltimore: Johns Hopkins University Press. Pope, K. S. (2016). The code not taken: The path from guild ethics to torture and our continuing choices. Canadian Psychology/Psychologie canadienne, 57(1), 51. Rosner, R. I. (2014). The “splendid isolation” of Aaron T. Beck. Isis, 105(4), 734-758.