What is psycholgy??

[50960]

As MOD of this forum, I choose to remain silent on alot of topics I know alot about as licensed psychologist. I do this because I believe it is very important for students of psych to get proper feedback about the field, get some helpful tips from those who have been there before them, and learn how to navigate some things on their own.
I have recently become very disheartened by some discussions on this forum and elsewhere, and wish to speak my mind. What is psychology? Are we trumped up therapists with a big title; are we scientists who belong back in the lab; are we primary care mental health providers who need to know about bio-psych- and social aspects of health care? Unfortunately I see that too many students and ancillary health providers view psychology as basically psychotherapists who feel the need to be called Dr. I see psychologists in medical settings calling themselves therapists, and their patients "clients". I see students (such as recent posts have shown) who only view their potential role as a psychologist as some kind of over-educated therapist. Where is this all coming from?? Where is the APA and other national organizations?? I find this whole dummying-down of psychology very pathetic, and not in any way in line with what other fields (medicine etc.) are expecting of us. If you plan to be a psychologist be ready to be a doctor who can diagnose, treat, and refer on a very high level, or go to counselling school. Rant over

[Therapist4Chnge]

Originally Posted by psisci

Are we trumped up therapists with a big title; are we scientists who belong back in the lab; are we primary care mental health providers who need to know about bio-psych- and social aspects of health care?

I think our flexibility is a help and and a hinderance. I think of psychology like engineering.....people know very basically what an engineer does, but doesn't understand (nor feel the need to understand) the difference between a mechanical engineer and a chemical engineer. If you look at the actual work, it is apples and oranges...much like sub-fields in psychology. We need to educate the general public, and our policy makers.

This goes back to my assertion that the APA needs to look at investing in EFFECTIVE lobbyists for the hill, and also a major PR firm. I use to work in the DC area, and PACs (political action committees) from the medical side were VERY visible. (AMA, healthcare companies, biotech, drug companies, etc) I was most familiar with biotech, and they took a niche industry and were able to wield a large amount of clout. Psychology is a MUCH larger field, and collectively has the funding to do it, but I've noticed that we are CHEAP!

The RxP issue has shown Psychologists how far behind we are with PACs, political affiliations, and influencing public policy. We could be doing so much better if we had a more collective approach ("insert APA here"), which then can be pushed down to the state level, with structured plans.....and not 'reinventing the wheel 20 years too late' that we are experiencing now. The only way to catch up now is to have an organized plan and MORE money. Legislative Change = Political Connections + Time + Money. Any loss of one (or more of these areas) will torpedo ANY chance of legislative change. Right now psychology as a whole is going 0/3.

Political Connections are made by Educating (About your issue), Delegating ($$ + voting support), and Regulating (Drawing up policy). The legislative cyle is tricky, but if you can do each of the above areas well, you can sometimes deal with issues of the legislative calendar by getting support more quickly, and advancing your policy through the stages of review.

Originally Posted by psisci

Unfortunately I see that too many students and ancillary health providers view psychology as basically psychotherapists who feel the need to be called Dr. I see psychologists in medical settings calling themselves therapists, and their patients "clients". I see students (such as recent posts have shown) who only view their potential role as a psychologist as some kind of over-educated therapist. Where is this all coming from?? Where is the APA and other national organizations??

Ironically my username has therapist in it (based on a username I had at another place a couple years ago). This was brought up in another thread, and it boils down to what a person expects of themselves, and expects of others. I don't dilute my education, but many others are deferential in this area.

Originally Posted by psisci

I find this whole dummying-down of psychology very pathetic, and not in any way in line with what other fields (medicine etc.) are expecting of us. If you plan to be a psychologist be ready to be a doctor who can diagnose, treat, and refer on a very high level, or go to counselling school. Rant over

I totally agree. Psychologists are getting lumped together, and we need to differentiate ourselves, instead of taking on the assigned roles, which is largely based on misinformation. (Goes back to the education of the general public and policy makers).

I currently work in a medical setting, and plan on staying in this arena. It is very much indicative of what psisci is talking about. I am going the 'medical psychologist' route, and I envision the 'doctor vs therapist' issue will come up again. If you assert yourself, set the expectation, and support the expectation.....others should follow.

-t

[50960]

I hope you do not think I was targeting you and your name; I wasn't at all. Thank you for your well thought out and informative response, I very much appreciate it. I see the lack of response to this thread another sign of the general apathy in our field. I was having an online conversation with apsychiatrist lately who basically asked me why I am in the field I am in when I see so much wrong with how it is going? Sometimes I wonder..

[Therapist4Chnge]

I didn't think you were targeting me; no worries.

I would like to get a variety of input on this topic, which is an important one.

-t

[Pterion]

Originally Posted by psisci

As MOD of this forum, I choose to remain silent on alot of topics I know alot about as licensed psychologist. I do this because I believe it is very important for students of psych to get proper feedback about the field, get some helpful tips from those who have been there before them, and learn how to navigate some things on their own.
I have recently become very disheartened by some discussions on this forum and elsewhere, and wish to speak my mind. What is psychology? Are we trumped up therapists with a big title; are we scientists who belong back in the lab; are we primary care mental health providers who need to know about bio-psych- and social aspects of health care? Unfortunately I see that too many students and ancillary health providers view psychology as basically psychotherapists who feel the need to be called Dr. I see psychologists in medical settings calling themselves therapists, and their patients "clients". I see students (such as recent posts have shown) who only view their potential role as a psychologist as some kind of over-educated therapist. Where is this all coming from?? Where is the APA and other national organizations?? I find this whole dummying-down of psychology very pathetic, and not in any way in line with what other fields (medicine etc.) are expecting of us. If you plan to be a psychologist be ready to be a doctor who can diagnose, treat, and refer on a very high level, or go to counselling school. Rant over

I feel your pain. Or I did until about two years ago My response to your thread title is more aspirational than real. With that caveat, psychology is:
• THE science of human behavior, from the neuro-molecular level to the cross-social level.
• It is the highest level of understanding human functioning, as it encompasses several offspring specialties that may have divested themselves of overt relation to their parent: including psychiatry, psychoneuroimmunology, communications, diplomacy, marketing, to name very few.
• An experimental science that continues to seek answers to the most amorphous of human problems: those manifest in behavior and relationships.
• An evaluative science that seeks to link current and future understanding of the biochemical with the psychosocial.
• A clinical science that employs understanding of all of the above to address very complex health issues (whether or not there is concomitant “medical” pathology) so as to affect significant, lasting improvements in social, emotional and occupational and yes, biological functioning.

I agree with the points you listed in the original rant. I am disheartened by those within the field who see no need to study all the above listed aspects of the field. I am also disappointed by those who will see that list and only notice the lack of a single possible practice opportunity. I hope the future sees significant changes in the discipline. As you know by now, I have little faith that this will come to pass.

[Jon Snow]

As I see it, the erosion of responsibilities by masters level practitioners (due to our weak political presence) including social workers and licensed counselors of various types, along with professional school graduates masquearading as legitimately trained psychologists are the likely undoing of this field. I wish I did something else.

[Therapist4Chnge]

Originally Posted by Jon Snow

I wish I did something else.

It is never to late to do something new. Test the waters out at first (moonlighting, etc). I know people who have had some great 2nd, 3rd...etc careers that they started moonlighting.

-t

[Jon Snow]

It is never to late to do something new. Test the waters out at first (moonlighting, etc). I know people who have had some great 2nd, 3rd...etc careers that they started moonlighting.

-t

True, and I have been. . .mostly in a way that uses the time I've invested in this field. I also have been focused on increasing my uniqueness to the research/clinical community. I am very put off by how things have developed over time regarding our field.

[Therapist4Chnge]

Originally Posted by Jon Snow

True, and I have been. . .mostly in a way that uses the time I've invested in this field. I also have been focused on increasing my uniqueness to the research/clinical community. I am very put off by how things have developed over time regarding our field.

As someone who changed careers (and on the front end of this one), I am definitely concerned with the path psychology is going down, but I am going in with open eyes and an understanding that I need to be pro-active and not just reactive.

-t

[doctorpegasus]

Originally Posted by psisci

As MOD of this forum, I choose to remain silent on alot of topics I know alot about as licensed psychologist. I do this because I believe it is very important for students of psych to get proper feedback about the field, get some helpful tips from those who have been there before them, and learn how to navigate some things on their own.
I have recently become very disheartened by some discussions on this forum and elsewhere, and wish to speak my mind. What is psychology? Are we trumped up therapists with a big title; are we scientists who belong back in the lab; are we primary care mental health providers who need to know about bio-psych- and social aspects of health care? Unfortunately I see that too many students and ancillary health providers view psychology as basically psychotherapists who feel the need to be called Dr. I see psychologists in medical settings calling themselves therapists, and their patients "clients". I see students (such as recent posts have shown) who only view their potential role as a psychologist as some kind of over-educated therapist. Where is this all coming from?? Where is the APA and other national organizations?? I find this whole dummying-down of psychology very pathetic, and not in any way in line with what other fields (medicine etc.) are expecting of us. If you plan to be a psychologist be ready to be a doctor who can diagnose, treat, and refer on a very high level, or go to counselling school. Rant over

Interesting post!

We are ALL human beings. ................and hooray! for that!

[50960]

What is your point?

[doctorpegasus]

Hi! psisci,

Well, all I meant was that we are ALL on this planet trying to figure out what's going on and hopefully trying to support/help one another in the process.

In my opinion- Whether you are a support worker or the principle psychologist, we are continually learning and experiencing form each other and not necessarily getting all information out of a text book!

To me - Psychology is a passion and a need! Maybe because I have an over-active and enquiring mind!

Regards.

[amy203]

psisci - I would first like to comment on your statement that the "lack of response to this thread [is] another sign of the general apathy in our field." I actually think it is a sign that a lot of us have applications due in a month, and we are a little too overwhelmed to write a coherent answer to such an important, complex question.

Unfortunately, I am one of the overwhelmed and I don't have time to really think out the question, except to say that I love Pterion's response - the fact that psychology has a biopsychosocial emphasis and addresses human behavior across a lifespan is what truly makes it a unique science.

Back to psisci - your comment seems to have more to do with psychologists' role as clinicians. Frankly, I don't think you've done a very good job answering your own question. Psychologists should "diagnose, treat, and refer on a very high level" is a pretty vague statement. What is a "very high level?"

I am especially referring to treatment. As I have mentioned in other posts, I think psychologists are starting to be cast in more of a managerial or referral role - they diagnosis a patient and refer them to another clinician (possibly not an M.D./Ph.D. - definitely someone who is payed less) who has specialized in the appropriate type of treatment (often a form of therapy). What do you think of this?

One final note - therapists often refer to their patients as clients because it is more respectful and reduces the stigma associated with treatment. This language has been adopted by many M.D.'s in the medical arena as well.

[phd2006]

Might be better thought of as: Why is psychology? If you don't have a purpose or a 'niche,' then why be? In other words, focus on what we can contribute that is above and beyond what other fields can contribute.

[MeghanHF]

What is psychology? Hmmm... Well there's definitely some psychology in psisci's original post that provokes folks to argue emotionally against the condemnation of psych students while essentially (and unwittingly) agreeing with the main points of the post. Psychology is not a niche but it does have a purpose. It should be difficult to get a PhD or PsyD, hence the overwhelm. Calling patients "clients" is not more respectful; it blurs the boudaries and is like trying to sweep the stigma under the carpet insetad of actually addressing it. Pterion has made a good list of defining points and Therapist4Change seems to have her/his finger on the pulse. Psychology is what we practice and supporting eachother does not mean mushy acceptance of different opinions. It means lively debates through evdience based research, diagnosing, treating, and refering "on a very high level", and demonstrating the merrits of our profession to our colleagues in other fields, our patients, and apparently...ourselves.

[50960]

Indeed......well said.

[amy203]

Bob’s adventures in the mental health system
by amy203

Scene 1

Bob: So I’ve been feeling really depressed lately. I think I need to see a doctor so I can figure out what’s wrong with me and get some help.

Psychologist: You should see me. I diagnose and refer at a very high level.

Bob: You know, I was actually thinking of just seeing my primary care physician. It’s easier with my insurance and I find her less intimidating.

Psychologist: Didn’t you hear what I just said? I diagnose and refer at a very high level!

Bob: So, what does that mean? Will your diagnosis be more accurate than my PCPs or…

Psychologist: It means it will be a very high level diagnosis.

Bob: But I don’t know what that mea…

Psychologist: A very high level, I tell you!! VERY HIGH!!!

Bob: Right – um, I think I’ll just try my PCP first. (backs away slowly)

Scene 2

Bob: So my PCP says I meet DSM-IV criteria for depression.

Psychologist: Based on what expertise? High level expertise?

Bob: Um, the DSM-IV – isn’t that, um, high level? She also said something about following the American Medical Association Guidelines, so I think she probably…

Psychologist: Sniff. Doesn’t sound high level to me.

Bob: Right. Well, anyway, she says I would probably benefit from cognitive therapy so…

Psychologist: Oooh! You should see me! I perform cognitive therapy at a very high level.

Bob: I thought you might say that, but, see, my PCP referred me to a therapist.

Psychologist: WHAT! Did you just say therapist?

Bob: Yeah. He’s a licensed cognitive therapist with a master degree…

Psychologist: Masters degree?!?!

Bob: so I wanted to ask you what the difference is. He’s definitely much cheaper than you are…

Psychologist: The difference is that I treat at a very high level!!!

Bob: But there’s evidence to suggest that there isn’t a difference in outcome, so…

Psychologist: Forget the evidence!! Do you KNOW how hard it was for me to even get into graduate school? Do you have ANY IDEA how many years I spent in school? And now you’re going to see some little pissant therapist!!!!

Bob: But if you can’t explain the difference….

Psychologist: I SAID IT’S AT A HIGHER LEVEL!!!

Bob: Right. Um, I think I’m going to go with the cheaper and, you know, maybe less arrogant option.

Insurance Company: No, we’re making you go with the cheaper and less arrogant option. Unless you want to pay 130 bucks an hour out of pocket.

Bob: Right.

Fin

[Therapist4Chnge]

(all tongue in cheek)


Scene 3

Bob: So I want to get a better idea of what's going on with me. Is there a way to measure the kind of problems I am having?

Therapist: Of course. There are assessments that you can do.

Bob: Great....can you give me some, and then can we talk about the results and what they mean?

Therapist: Uhm...sure. I mean, technically I never was trained on them, but how hard could they be? I mean, I think anyone can do therapy, so anyone can do assessments, right? I've seen them, and it seems easily enough. Let me just find...uhm...what was that called...I dunno, i'll look one up.

Bob: Uhm. You don't do testing?

Therapist: Well....no. Not technically. Well, we aren't suppose to....and who has time to learn all of that anyway?! I mean, our training was pretty much the same. Sure, less years, less experience, not as in depth, but I mean, who is going to take the time to really learn that stuff anyway? I learned a couple ways to do therapy, so that is more than ok to address everything out there.

Bob: Wow. I guess clinicians and therapists aren't the same. I wish someone told my insurance that.

Therapist: What do you mean?! They do CBT, I can do CBT. They talk, I talk. I mean.....it is the SAME!!!!

Scene 4

Bob: So I went to a clinician, s/he completed the assessment, and we talked about my results. They said I had MDD w/psychotic episodes and Anorexia. A lot of it fit and made sense, but I still haven't had enough time to really process everything; I'm having a hard time with this........can you help me?

Therapist: Sure! So lets talk about your depression.

Bob: Actually, I sorta want to talk about how the other stuff is effecting me.

Therapist: Oh....ok. Uhm, well....you are depressed right?

Bob: Yes.

Therapist: So let's work on that first, and then deal with the rest later.

Bob: Uhm...I guess.

Therapist: (Thinks to self: Once i'm done I'll start looking up books on psychosis and other books on Eating Disorders. They can't be that much different from what I learned, right? Maybe the next time a CE comes around, I'll take it in a speciality, so I can start seeing people with even more complex cases.)

-t

[Jon Snow]

nt

[psychwhy]

I understand and share psysci's sense of ... what exactly? Disillusionment? Disenfranchisement? Discontent?

As one who came to the profession later in life (after beginning years ago as a milieu counselor), I am left scratching my head just how the journey was worthwhile.

Yes, I know what I've done and why I've done it to arrive at my level of professional ability and, dare I say, stature.

But I don't know of any other profession where the practitioners ask this sort of soulsearching question.

I am about to go on a job interview where I was told that people with BAs/MAs/RNs have the exact same professional responsibilities. I was assured that I will be able to accrue appropriate clinical contact hours to satisfy my post-doctoral licensing requirements. But I am left wondering how that can be? I know they have not received the same sort of in-depth "higher level" training I have. So the question for me is the agency just making do because they are unable to recruit appropriately trained personnel in this rural setting? Or are these "lesser" practitioners truly just as good at doing the work?

I commented to a former intern colleague that the work I might be doing seems like the community-based version of the work we did during internship. And during that internship we often expressed concern that much of what we were doing was clinical "housekeeping" tasks that certainly did not require doctoral level training -- yet there it was as part of a doctoral internship.

It has often been said that, at least in the training/early post-graduate years, people tend to be unwilling to take a stand and assert their professional "rank" because they fear losing whatever position they have acquired at that point. That does not, of course, answer the question of why mid-career and/or senior psychologists are not more pro-active in "defending the turf."

Are we just too "touchy feely" to assert ourselves and our unique professional abilities?

[Logic Prevails]

Are we just too "touchy feely" to assert ourselves and our unique professional abilities?

bollocks!

I think we can be assertive and still slip on our "touch feely" pants when needed. However, I don't think many people are good at this. I think women may also have a harder time with this given our line of work and the many sexist stereotypes about how they are supposed to act (i.e. I recall some social psychology study some time ago where assertiveness was seen as a powerful attribute/quality when exerted by a man, but was seen as overbearing and disliking when exerted by a woman - sorry don't remember where I heard this).

[Jon Snow]

Oh, I agree. Women are a serious problem when they try to be professionals.

[MeghanHF]

This is nonsense! It feels more like kindergym with a bunch of whiny, snot-nosed todlers, a few kids with encopresis (of the mouth), role plays in the corner, & a dress up area with a box touchy-feely pants instead of a doctoral level clinical psychology forum. Would anyone like to discuss clinical issues, research ideas, and what psychology actually is?

[amy203]

I think psychologists are in trouble if they don't do a better job of determining where they are essential in the mental health system. We are competing with professionals that are 1) cheaper and 2) less intimidating (if a patient is nervous about being labeled as "mentally ill," it's much easier to see a therapist or a family physician than a psychologist). The APA can invest in lobbyist and educating the public, but it's not going to work very well if they don't have anything better to say than "psychologists go to school for a very long time and learn in-depth techniques." If a potential patient is going to have to do battle with their insurance company and their own fear of stigma in order to see a psychologist, we better come up with some pretty compelling reasons why they should bother.

I will grant that therapists probably shouldn't be doing a lot of assessments/diagnosis, but why shouldn't people see psychiatrists or other medical doctors for these services?

And then there's the question of treatment.... Are their patients who would be fine just seeing a therapist for one form of treatment? What kind of patients? For what disorders? Who needs to see a psychologist? People with comorbid disorders? Everyone? The medical system actually has a pretty good formula for deciding which patients should see, say, a gastroenterologist as opposed to a gastroenterology nurse. Should the mental health system be set up in a similar way? Or is there something unique about psychology - perhaps that it is more holistic? - that makes this type of arrangement inappropriate.

The posts that have actually addressed the difference in training for Ph.D.s (other than the fact that it's "high level") seem to have focused on the more quantitative aspects - psychologists learn more forms of assessments, they learn more forms of treatment - but are there any qualitative differences?

I know my posts have been kind of negative, but I would like to think that there is a good answer to psisci's question. Although I have studied the mental health system (I'm involved in services research), I haven't been to graduate school, so enlighten me! What is the difference?

But there I go being assertive again! I should probably go knit or make babies or something to calm myself down...

[amy203]

Originally Posted by MeghanHF

This is nonsense! It feels more like kindergym with a bunch of whiny, snot-nosed todlers, a few kids with encopresis (of the mouth), role plays in the corner, & a dress up area with a box touchy-feely pants instead of a doctoral level clinical psychology forum. Would anyone like to discuss clinical issues, research ideas, and what psychology actually is?

Ahhhhh - I see now. The difference is, doctoral training leaves you with no sense of humor whatsoever. That certainly answers my question!

[Jon Snow]

The posts that have actually addressed the difference in training for Ph.D.s (other than the fact that it's "high level") seem to have focused on the more quantitative aspects - psychologists learn more forms of assessments, they learn more forms of treatment - but are there any qualitative differences?

Are there quantitative differences between going to a nurse (with two years of training or so) to get prescriptions and a medical doctor? There are definitely qualitative differences, but those aren't measurable. Mostly people talk about safety in that regard, but what it comes down to is that kind of research is very challenging. Outcome research in general is just. . .difficult. But, I'd rather go to the MD, who has had to endure rigorous entry requirements into the field, in depth study of human biology, residency, and competition to get where they are, than a nurse or physician's assistant with minimal training. The same is true with psychology. If you're depressed, or whatever, you can choose to go to a masters or bachelors level therapist or a priest or whatever. If your child is having trouble in school, you can send them to a masters level school psychologist over a pediatric neuropsychologist. But, you're by definition dealing with people that have a lower bar to entry in to the field, less training, less supervision, and likely less general ability. You might be ok, but the most likely situation is that the doctoral level provider is more competent, more likely to keep abreast of the latest research, more likely to respond to subtle data, more likely to make appropriate referrals, more likely recognize unusual complications, etc. . . Just coming in and talking to anyone is likely to make most patients "better" in some way. Fostering expectancy of success is better still. This is true for medical conditions too. For example, look at almost any clinical control trial. Most of the variance in improvement is not from the drug. However, this doesn't tell the whole story. We are an evolving human science. By ceding treatment and control to lesser providers, we will stem that evolution. There will not be leaps forward. There will not be improvements over time. The field will stagnate. We need doctoral level psychology to be strong. We need MDs to be strong. The trend towards midlevel providers is an anathema.

[MeghanHF]

Originally Posted by amy203

Ahhhhh - I see now. The difference is, doctoral training leaves you with no sense of humor whatsoever. That certainly answers my question!

I'm sorry you aren't starting off with a sense of humour and don't find the image of kindergym funny. I do like your previous post though and think you raise some good points. There are good responses to psisci's question and I hope you don't go run off and make babies before I have time later today to respond...

[Therapist4Chnge]

Originally Posted by amy203

The APA can invest in lobbyist and educating the public, but it's not going to work very well if they don't have anything better to say than "psychologists go to school for a very long time and learn in-depth techniques."

I didn't want to side track the discussion by including some of the general steps in between hiring the PR firm and getting our message out. For those who care, I wrote a blurb below.

[off topic]
One of the first steps in establishing a PR presence is to ensure that you have the message you want to spread (a full service place could help develop this, or refer to a firm that specializes in this area). Once the message is established, it can be pushed out to the public, and also down through the ranks, which would provide a basis to work from. This message would include focus areas/goals, talking points, etc. [/off topic]

You have a very valid point about the general lack of response to questions of differentiation. I really hope we can work on this, or we are really going to put ourselves behind the 8-ball.

-t

[amy203]

Originally Posted by MeghanHF

I'm sorry you aren't starting off with a sense of humour and don't find the image of kindergym funny. I do like your previous post though and think you raise some good points. There are good responses to psisci's question and I hope you don't go run off and make babies before I have time later today to respond...

Meghan - apologies! I thought your post came off as a little harsh (and I meant a sense of humor about the "role plays in the corner" which I found pretty funny - in fact I think all posts should now consist entirely of imaginary dialogue between Bob and stereotypically arrogant psychologists and/or incompetent therapists), but I should have paused before I posted! Looking forward to your response.

[Therapist4Chnge]

What makes humor funny are the grains of truth in the humor. In our case, the "scenes" provide the humor and grains of truth in this discussion. I'm hoping we can continue the discussion, and acknowledge that the issues raised in the 'scenes' are problematic and are worth talking about more in depth.

As an aside, it was quite entertaining to pen my scenes.

-t

[psychwhy]

As I alluded to in my original post, I find the fact that we even have this discussion quite telling in understanding why psychology finds itself in this predicament.

From first hand experience with the APA, I found it rather interesting that they seem more intent on protecting their turf from other psychologists (infighting) instead of protecting the profession as a whole from encroachment from lesser trained practitioners. There was much handwringing over portraying a "guild mentality" and fear that assertiveness be seen as arrogance. In one discussion of a state's recent adoption of a scope of practice law that included the creation of four new Master's level titles, a doctorally trained psychoanalyst openly asked if she would need to now obtain a Master's level credential so she would be able to continue referring to herself as a "psychoanalyst."

We seem to take for granted that the other doctoral professions are chugging away with unified solidarity. As one who found the psychology internship match process demeaning and demoralizing, I was rather shocked to learn that the medical residency match process (on which psychology's is based) has been loudly criticized by some physicians. In fact, some went as far to file suit alleging antitrust violations. The suit was dismissed, but after hearing psychology colleagues suffering with less than exemplary training programs because they feared potentially career-ending retribution from rocking the boat, it seemed interesting that physicians-in-training didn't seem to feel similiarly constrained.

I don't know why psychology and education seem to have suffered the same fate in today's society -- they are both expert professions that many assume have only caring enough as the main qualification. Let's not forget that it was only ten years ago in Jaffe v. Raymond that the US Supreme Court validated the therapist/client privilege and Justice Scalia, in dissent, suggested "For most of history, men and women have worked out their difficulties by talking to . . . parents, siblings, best friends, and bartenders -- none of whom was awarded a privilege from testifying in court. . . . Yet there is no mother-child privilege."

Seems like it isn't just your "average Antonin" who misunderstands a psychologist's role!

[doctorpegasus]

Sorry! Posted the same thing twice!

[doctorpegasus]

First of all I'd like to say how much I have been enjoying all of the views in this thread.

I would like to say that in the UK we don't have the problem of insurance companies or patients having to pay large amounts of money to see a therapist/ counsellor or Psychologist.

The NHS system works on matching client/patient to therapist or Psychologist. This is based on the patient/client problem. For example if it is mild depression the patient may be refered to a counsellor for a short course of CBT.

If the patient has more complicated problems then they may be refered to a Psychologist. The only trouble with this is long waiting lists and patients problems then get worse if they are just left to it.

There is a big difference between this system and the U.S system, maybe something could be learnt from this???

Finally I would like to say that Psychologists do so much more than 'just' see patients/clients

[50960]

Amy I have avoided responding to you because I know you are new and others would respond for me. I understand how busy one is when a student as I have been there. I am no less busy now as a practicing psychologist; the difference is now I am making up my own mind and not having to regurgitate useless PC stuff we get shoved down our throats in school. Remember this, being nice, PC, accomodating and passive may make your pateints feel better, but they will not get better. Psychology is in crisis for many reasons, and I choose to be part of the solution not the status quo problem.

BTW, welcome to SDN!!

[MeghanHF]

I meant for my earlier post to come off harsh because, while I do find the dialogs funny, in context they detract from the importance of the issues at hand. I just finished a day of seeing far too many patients and am aghast by the mental health needs in my community. What's worse is the area is flooded with mental health practitioners of all kinds but I am still at a loss to find practitioners at any level that I'm comfortable referring too.

In addition to the things written above, psychology is bringing knowledge of the biopsychosocial basis of human behavior, multiple theories of psychopathology, evidence based practices, and testing and assessment to diagnosis and treatment. No other mental health credential or other field combines those ellements with both the breadth and specificity of a 3-4 year PhD or PsyD program. It's not only the book learning but the application of theory and knowledge (i.e. pre and post doc internship) that is important in the process to becoming a psychologist. Moreover, we are both clinicians and researchers, meaning that we are actively engaged with generating new knowledge about psychology. It's not a process that ends with licensure - we publish, teach, and continue to learn.

So, those are some thoughts. I also just want to reitterate what psisci wrote - that being "accomodating and passive may make your pateints feel better, but they will not get better" - and stress how common and how harmful that can be.

[Logic Prevails]

MeghanHF: Sorry you didn't like my "touchy-feely pants" comment. When is - do as, I guess. Although I appreciate your wanting to confront the issues presented in the opening post, I don't think your "wikipedia" type answer really illuminates much (though it sounds like an answer your school would be proud of).

I will focus PsiPci's initial question to this: what is CLINICAL PSYCHOLOGY?

From his initial comments, I think this is what he was thinking about - and really, this forum is for clinical psychology and we should have an idea about what our role is and should be.

Firstly, I will say that MeghanHF's answer is likely what clinical psychology is TRYING to be. Due to lack of consistency, regulations, and quality of programs, in addition to the sheer breadth of areas these programs try to cover, I would guess they fail more often than not - that is, if the goal is to provide a well rounded clinician in all of these areas. I think PsiPci was hinting at this issue in his initial post:

Originally Posted by psisci

Are we trumped up therapists with a big title; are we scientists who belong back in the lab; are we primary care mental health providers who need to know about bio-psych- and social aspects of health care?

I think that we can be all of the above, depending on the strengths and weaknesses of our programs and the types of supervision etc. we seek out upon graduation.

Now, a trickier question is what SHOULD we be...

Here is my personal, "non-textbook," "non-brainwashed by my program" response to this question...

I think if we call ourselves clinical psychologists then we should be as such. Not academics working in an ivory tower during the week and in a clinic on weekends. For those who want to do research, we should have a separate degree track for experimental psychologists who want to do clinical research in mental health settings. My personal opinion is that we are spreading ourselves too thin to be REALLY competent at both. I know a few of you do this on the board, and I'm sure you will argue against me, but I won't take it to heart because you need to justify your own existence (cognitive dissonance and all that).

Now, if we aren't front-line researchers, what should we be?

We need to have a flexible understanding of different psychosocial paradigms of mental illness AND mental health - not just CBT or other "EVT's." We also NEED to get up to speed on the neuroscience of our discipline. For some reason, most programs don't seem to put much emphasis here. I think this needs to change. We need to at the very least have a basic understanding of current psychopharm, so that we know potential side-effects and issues that might affect our assessments and treatments.

As for the client, patient thing... MeghanHF, I wonder if you were doing "couples work," whether you would feel the need to call them "patients." Clearly, we need to be flexible in what we call them. In a hospital, then yes, they will all be patients, but no in all cases.

So these are my basic thoughts on what clincal psychology is and what I think it should be.

Fire away.

[MeghanHF]

If by Wikipedia type answer you mean, clear, concise and comprehensive, well then ya got me. If it would seem more personal, I can try to rewrite it to be less polished and include more spelling mistakes. I'm trying to understand on what basis you think you have me pegged...you don't really know much about me - what program I attend, what my clinical orientation is, or how I practice. My response was written from my experience and I think you'd be surprised to learn more details about me. I personally find those things I posted to be true...in addition to this, most of the time, if you are practicing authentically utilizing all of your skills - knowledge, insight, experience - people will call you crazy, challenge you, even block your entry to certain jobs. So, it's okay with me that we disagree.

I don't realy think you've answered the question, other than to say we need more neuroscience and psychopharm classes, and I disagree with you on the research point. At the doctoral level, we are not supposed to be clinical machines practicing from a manual. Rather we make original contributions to the field and advance knowledge. Research and clinical work inform eachother and it's faulty logic to seperate them. One important idea that I think you've implicitly stated is that while there are huge deficits in our education and the regulations of the field, we are not simply the product of the system that credentials us. We are indeed indivduals who should be wary of brain washing and towing the line.

On your last point, I am currently working with a couple in an independant practice and they are my "patients" with poly-substance abuse issues, Axis II diagnoses, and relationship problems.

Thanks for your thoughtful post. Have a good weekend.

[PsiKo]

Originally Posted by MeghanHF

If it would seem more personal, I can try to rewrite it to be less polished and include more spelling mistakes.

Honestly, you'd fit in much better if you did. Also, a soupçon of poor grammar and wacky word choices here and there would go a long way toward making you stick out less.

[50960]

Hey this reminds me of growing up in po-dunk Ca. I got told I used too many big words to hang out with the good-ole boys......

[PsiKo]

Originally Posted by psisci

Hey this reminds me of growing up in po-dunk Ca. I got told I used too many big words to hang out with the good-ole boys......

That's funny. I was kinda thinkin' of you (but not only you!) when I wrote my last post.

I think a haberdasher could make a very handsome living clothing the many emperors around here.

[psychanon]

Originally Posted by PsiKo

Honestly, you'd fit in much better if you did. Also, a soupçon of poor grammar and wacky word choices here and there would go a long way toward making you stick out less.

Let me just use this comment as an opportunity to point something out.
"A lot" is two words. There is no "alot."
Not to be a grammar nazi, but I must have seen this mistake about a thousand times by a bunch of different people on this forum, and it grates me.
Okay, that's it, go back to the topic now.

[Logic Prevails]

Originally Posted by MeghanHF

If by Wikipedia type answer you mean, clear, concise and comprehensive, well then ya got me.

No, I mean it sounds like dogmatic regurgitations that you might see in a "program statement" for a typical doctoral program in clinical psychology. Your answer speaks little of what you personally think it is (as you see its applications the real world) and what you think it ultimately should be. The only thing you have shown is that your program has done a good job in making you believe that their training is the right training (i.e. how things are is how they should be). Live on the edge a bit here - give some critical and creative thought. Do you think most of your colleagues posess all of the qualities you had mentioned (and in equal proportions)? Would you not change anything about the current model of training?

Originally Posted by MeghanHF

If it would seem more personal, I can try to rewrite it to be less polished and include more spelling mistakes.

No need to belittle people. If you think you are better than everyone else on this board, it would be polite to keep it to yourself.

Originally Posted by MeghanHF

I'm trying to understand on what basis you think you have me pegged...

I don't. You were the one that called people out on not providing more serious posts on this topic. Now I'm calling you out on not being able to think outside of your comfort zone, to provide less knee-jerk responses based on current dogma about clinical psychology and to give this topic some creative thought.

Originally Posted by MeghanHF

I don't realy think you've answered the question, other than to say we need more neuroscience and psychopharm classes,

Okay, well I don't know about you, but that sounds like a pretty big component, and you are not going to learn much by adding just a couple courses. What I am talking about here is a huge shift to a more medical model. You'd never be able to simply 'tack this on' to the existing framework we have for a doctoral program (it would take 10 years to complete a degree). In my opinion, the research emphasis has to be dulled down a bit.

Originally Posted by MeghanHF

and I disagree with you on the research point. At the doctoral level, we are not supposed to be clinical machines practicing from a manual.

I'm not sure I follow what your point is here. I am arguing AGAINST your basic CBT/manualized coursework and MORE emphasis on theoretical integration and depth being taught in graduate programs. But yes, this would be at the expense of a prominent research emphasis (see below).

Originally Posted by MeghanHF

...Rather we make original contributions to the field and advance knowledge.

This is where you need to be a bit flexible. I am not saying that research is not crucial to the field. What I am saying is that the people doing research should have a very strong background/understanding (perhaps more than what is given in a typical clinical program). Clinical psychologists would in my model of training have the research/statistics background they need to intelligently review/comprehend/criticize the literature and not much more. Instead of being "front-line" researchers, they could consult those who would fill this role. Filling all of these shoes is just too much if the goal is to be the most competent clinician we can be. I think aiming for exeptional competence at too many things will spread us too thin. Even though doing research (rather than just understanding it) might help you become a better clinician, I would argue the time is better spent learning about neurobiology/psychopharmacology. Current programs tend to neglect this imporant area.

I hope this gives a better idea of what I am talking about. Please note that I am not attacking you personally - I enjoy some debate and I feel the forum tends to get a little stale in terms of conservative opinions.

[Therapist4Chnge]

Originally Posted by Logic Prevails

we are spreading ourselves too thin to be REALLY competent at both.

For some reason, most programs don't seem to put much emphasis here. I think this needs to change. We need to at the very least have a basic understanding of current psychopharm, so that we know potential side-effects and issues that might affect our assessments and treatments.

I just had this arguement during a discussion I attended last week. I argued that one of clinical psych's most glaring weaknesses is our limited biological base. Unless you specialized in Health, Neuro, etc.....you probably didn't get the kind of training I think we need as clinicians. I think nueroanatomy, neurophysiology, and another pharma class or two should be added. The initial response is always, "well what do we cut?" THAT is the problem. We must adjust to the need, not shoehorn the 'need' into the pre-existing system. If it requires another 2, 3, 4 courses...so be it.

-t

[MeghanHF]

Nice Post!!

Originally Posted by Logic Prevails

No, I mean it sounds like dogmatic regurgitations that you might see in a "program statement" for a typical doctoral program in clinical psychology. Your answer speaks little of what you personally think it is (as you see its applications the real world) and what you think it ultimately should be.

Psycholgy is bringing a scientific understanding (evidence based) of our most primitive drives and emotions, our terrors and our passions, fear of death and fear of life, and breaches developmental processes (psychosocial). It is approaching each individual with compassion and teasing out the unique threads of their cognitive structure, personality traits, attachment style, their motivations and the structure of their defences (multiple theories of psychopathology). It operates in the interpersonal realm and uses interactions between two or more people to reveal projections and transferences/coutertransferences to produce corrective experiences and create change (theory, psychosocial, bio). It works with neurobiological factors by way of new experiences and information, psychopharmocology, and recognizing physical manifestions of psychic processes (bio). Testing and assessment facilitates diagnostic accuracy, combining psychometric properties with human interpretation (t & a). It applies to private, clinic, and hospital settings as well as to sociology, poltics, philosophy, architecture, art, and liturature.

I'm still not sure you've answered the question of what psychology is yourself...

Originally Posted by Logic Prevails

Do you think most of your colleagues posess all of the qualities you had mentioned (and in equal proportions)?

No but if you were in my area I might well have someone to refer to...

Originally Posted by Logic Prevails

No need to belittle people. If you think you are better than everyone else on this board, it would be polite to keep it to yourself.

I agree I have been rude. However, being polite sometimes gets trumped by irritation, wanting to stir things up and provoke. It is not always the gold standard. I do not think I'm better than everyone else on the board.

Originally Posted by Logic Prevails

What I am talking about here is a huge shift to a more medical model. You'd never be able to simply 'tack this on' to the existing framework we have for a doctoral program (it would take 10 years to complete a degree).

Will you please say more about this? I agree with the importance of neurobiology and psychopharm but how do you envision a more medical model? How would this be different from medical training? On the research issue, I think we simply disagree. Perhaps this is accounted for by PhD vs. PsyD degrees.

I'm not sure I've addressed everything but please let me know what I've missed. I would like that alot...

[doctorpegasus]

Mmmmmmmm.........

I thought psychology was about effective communication, and being able to be understood by everyone. Big words are very impressive but what is the point of being a psychologist if no-one understands you!

On the point about whether psychologists should be dishing out pills (psychopharmacology-big word)............Are psychologists just trying to be psychiatrists?

I don't particularly agree with this. I thought psychology had moved on............as far as mental-health goes talking- treatments are the answer. We don't want to go back to the old days of just bunging people on loads of meds.

Just my opinion.

[Logic Prevails]

Originally Posted by MeghanHF

Psycholgy is bringing a scientific understanding (evidence based) of our most primitive drives and emotions, our terrors and our passions, fear of death and fear of life, and breaches developmental processes (psychosocial). It is approaching each individual with compassion and teasing out the unique threads of their cognitive structure, personality traits, attachment style, their motivations and the structure of their defences (multiple theories of psychopathology). It operates in the interpersonal realm and uses interactions between two or more people to reveal projections and transferences/coutertransferences to produce corrective experiences and create change (theory, psychosocial, bio). It works with neurobiological factors by way of new experiences and information, psychopharmocology, and recognizing physical manifestions of psychic processes (bio). Testing and assessment facilitates diagnostic accuracy, combining psychometric properties with human interpretation (t & a). It applies to private, clinic, and hospital settings as well as to sociology, poltics, philosophy, architecture, art, and liturature.

I'm still not sure you've answered the question of what psychology is yourself...

I think you said everything I would have written. It sounds like you have a good balance there.

Originally Posted by MeghanHF

Will you please say more about this? I agree with the importance of neurobiology and psychopharm but how do you envision a more medical model? How would this be different from medical training?

Firstly, I would like to see some consistency in what is taught in clinical psychology programs. Although most programs offer CBT, there is little consistency in whether students will have been exposed to attachment theory, interpersonal theory and current psychodynamic approaches. We need to have some regulations for what is being taught. In terms of covering the neurobiology, we might have 4 week "units" similar to med school, covering neurology, limbic structures, post-central cortex, pre-central cortex, integration/dysintegration and psychopharmacology.

Originally Posted by MeghanHF

On the research issue, I think we simply disagree. Perhaps this is accounted for by PhD vs. PsyD degrees.

Yes, we do disagree, but my views come from my experience in a PhD program. I have spent too much time working on a thesis that will not make me a better clinician. I have worked too many hours on trying to publish for the sake of publishing. If the goal is to be the best clinician possible, I feel the time is better spent on some of the things that I have listed above. We don't need to cut research out altogether... we just need to lessen the emphasis for the sake of including what I feel are more important areas. Sadly, everything that I know about the brain has been saught out by me, taking courses that are not required, sitting in on psychiatry rounds at a nearby hospital, and talking about these issues with others in the community. It frustrates me that the "best" clinical students were the ones that put all of their effort into research, and not in their practicums or learning about the relevance of biology. Most of the students I graduated with couldn't tell you the function of the hippocampus.

Originally Posted by doctorpegasus

On the point about whether psychologists should be dishing out pills (psychopharmacology-big word)............Are psychologists just trying to be psychiatrists?

No, they should not try to be psychiatrists. But they should at the very least have a basic understanding of psychotropic medications and their side effects. Clinical psychologists need to know how these drugs affect behavior - it is relevant to treatment. They also need to know how medication might influence performance on assessment measures.

Originally Posted by doctorpegasus

I don't particularly agree with this. I thought psychology had moved on............as far as mental-health goes talking- treatments are the answer. We don't want to go back to the old days of just bunging people on loads of meds.

I am not talking about prescribing - just understanding on a basic level how these medications affect thought and behavior. In terms of learning about the brain... the days of having JUST a psychosocial client conceptualization will be nearing an end soon. What we are talking about are two sides of the same coin. When we do effective "talk therapy" we are, in some way, changing the brain. Having an understanding of how the brain works, in addition to having a firm understanding of psychosocial processes and theories, will give a more holistic view of the individual. You wouldn't necessarily include talk about the brian in a report, but having this knowledge may at times give you a guiding framework for doing your "talk therapy." In addition, it will flag for kinds of "hard-wired" (for lack of a better term) issues that you might need to refer to a neurologist. We don't need to replace psychiatrists, just be more informed about the biological components that we are treating with our "talk therapies."

[MeghanHF]

Originally Posted by doctorpegasus

I thought psychology was about effective communication, and being able to be understood by everyone. Big words are very impressive but what is the point of being a psychologist if no-one understands you!

I am not trying to impress or intimidate. I am using the language of our profession to communicate with colleagues assuming mutual understanding of the concepts. I recognize folks are at different stages in their education on this forum and encourage people to ask questions. I think it would be more condescending to dumb down my responses...

[MeghanHF]

Originally Posted by Logic Prevails

Firstly, I would like to see some consistency in what is taught in clinical psychology programs. Although most programs offer CBT, there is little consistency in whether students will have been exposed to attachment theory, interpersonal theory and current psychodynamic approaches. We need to have some regulations for what is being taught. In terms of covering the neurobiology, we might have 4 week "units" similar to med school, covering neurology, limbic structures, post-central cortex, pre-central cortex, integration/dysintegration and psychopharmacology.

Sounds good to me!!

Originally Posted by Logic Prevails

Yes, we do disagree, but my views come from my experience in a PhD program. I have spent too much time working on a thesis that will not make me a better clinician. I have worked too many hours on trying to publish for the sake of publishing. If the goal is to be the best clinician possible, I feel the time is better spent on some of the things that I have listed above.

I get your point and do agree that emphasis on research and publishing in academia often has no relationship to being a good clinician, researcher, teacher, or anything other than ego (of professors) and prestige (of the university). My experiences are different and therefore my outlook on the integration of research and clinical work is luckily removed from politics. My view has more to do with continuing to advance the field and asking questions that result directly from clinical work while incorporating new advancements into practice.

Originally Posted by Logic Prevails

Sadly, everything that I know about the brain has been saught out by me, taking courses that are not required, sitting in on psychiatry rounds at a nearby hospital, and talking about these issues with others in the community.

I think this is part of our challenge. As you and I have come to a broad agreement on what psychology is, it seems impossible for that amount of complex information to be covered by a single program. Yes, as you have suggested, more neurobiology should be covered because it really is fundamental to what we do. But there will always be a need for us to seek out information elsewhere and I think at a doctoral level we should want to seek it out. I get pissed off and dismayed by students who just want the degree and don't care about actually learning the material.

[doctorpegasus]

Originally Posted by Logic Prevails

No, they should not try to be psychiatrists. But they should at the very least have a basic understanding of psychotropic medications and their side effects. Clinical psychologists need to know how these drugs affect behavior - it is relevant to treatment. They also need to know how medication might influence performance on assessment measures.



I am not talking about prescribing - just understanding on a basic level how these medications affect thought and behavior. In terms of learning about the brain... the days of having JUST a psychosocial client conceptualization will be nearing an end soon. What we are talking about are two sides of the same coin. When we do effective "talk therapy" we are, in some way, changing the brain. Having an understanding of how the brain works, in addition to having a firm understanding of psychosocial processes and theories, will give a more holistic view of the individual. You wouldn't necessarily include talk about the brain in a report, but having this knowledge may at times give you a guiding framework for doing your "talk therapy." In addition, it will flag for kinds of "hard-wired" (for lack of a better term) issues that you might need to refer to a neurologist. We don't need to replace psychiatrists, just be more informed about the biological components that we are treating with our "talk therapies."

Yep! I agree with you on that.

Thank you.

[doctorpegasus]

Originally Posted by MeghanHF

I am not trying to impress or intimidate. I am using the language of our profession to communicate with colleagues assuming mutual understanding of the concepts. I recognize folks are at different stages in their education on this forum and encourage people to ask questions. I think it would be more condescending to dumb down my responses...

My comment that psychologists need to use understandable-language was NOT directed at you and I am sorry that you took it that way.

It was a general comment about psychology, and personally I am fed up of reading a load of 'gobbledegook' that seems to sprout out of some people's mouths just to try and impress.