The classroom. Every course is expected to include a set of components, and to ensure these components are included, each instructor is required to submit a syllabus for approval by committee. The students are barraged with variations on the same assignment, not unlike basic trainees who drop to give their drill sargeant twenty (push-ups). The redundant course assignments are flanked by a regimen of quizzes, the only respite from which is offered by the midterm itself. All this sound and fury is topped off with more than one capstone assignment, usually a final exam and a competency examination that school officials claim is required by federal law. The competency exams (e.g., a videotaped administration of a WAIS coupled with a report demonstrating correct scoring and interpretation) are tantamount to local or proximate microcosms of the orally defended doctoral candidacy exam delivered in the third year but feared from orientation. And then we can't forget about the term paper or its esoteric project equivalent for which students need to learn formatting requirements (APA manuscript style, posters, grant proposals).
And the students complete these course requirements while carefully gilding competitive applications for two required practical experiences. In addition, it is not uncommon for a clinical program training director to recommend that a student pursue a third local practicum to bolster one's hours across various categories (e.g., face-to-face hours with clients of various ethnicities; workshop and group therapy coordination) to remain competitive for the required internship. By program's end, it seems that everyone has run of out of gas, faculty included, as they only periodically monitor the progress of the school's equivalent of a dissertation-light (requiring a comprehensive review of relevant literature), which usually end with the faculty passing term papers ranging from eminently forgetful to worthless.
After All This, Why Do the Graduates Fail to Impress?
- Garbage In, Garbage Out
Many profit-driven professional school programs do not screen at the front end, letting in just about everyone but then load the curriculum with superfluous assignments designed to rank or weed out students. The program is acutely aware it can be faulted for flooding the market with graduates, as it is aware that it has limited resources (faculty) to allocate to advanced students, from whom their doctoral candidacy exams and dissertations require time and paperwork. This would not be as egregious (only exploitative) if, in the final analysis, the creme consistently rises to the top. Unfortunately, psychology professors have a habit of embattling students with opposing viewpoints or personality characteristics, either referring 4.0 students to some punitive and remediational committee for conduct or attitude problems in the name of professionalism or unfairly nit-picking and giving marginal grades to students they do not like despite the fact they performed better than peers. In the end, too many poor students are let in the front door and, while many of these poor students will be weeded out along the way, many will survive to outlast quality minds who should have never been pressured to resign. The system fails to improve on that of traditional clinical programs (PhD programs housed within universities) that are highly selective with poor selection habits or misguided selection criteria. (The PhD clinical programs will then put their students through an inefficient curriculum characterized by excessive knowledge production skills and impertinent, redundant, and pedestrian knowledge delivered in units designated by the field's branches).
How Do Poor Students Get Through in Large Numbers?
This is where I should mention that I think there are some very bright practitioners out there; however, I believe the quality of the practitioner is attributable to personality factors and to independent (i.e., extracurricular) efforts to understand the human condition. I believe the clinical program curriculum and the attitudes among too many of its faculty work against clinical acumen, case conceptualization, and true professional development, serving primarily to provide minimum essential guidance and validation for students with no inherent direction and to re-program students who bring independent skills and experiences. When we manage a framework of expectations designed to control chaos in our subject matter and in our colleagues, we create a culture of mindless conformity and complicity with the templates:
- Select a diagnosis from the Bible of Manualized Diagnosis, the DSM
- Select a textbook to assign to your students and then use the outlines in the teacher's guide and the test items in the publisher's test bank to construct lectures and exams
- Fill the holes in the research literature by replicating prior research with small modifications (upping the dosage, varying a variable, redefining a control group, or applying the manipulations to an ethnic sample)
- Write up one's research or case formulation by replacing bodies of text or details in someone else's paper with your own
The student who has the simplest time in these programs are those who are not likely to be sidelined by their own ruminations. When I took the course on the administration of the WISC, I was often sidetracked by the implications of the exam structure for theories of intelligence, but if you wanted to succeed in the course, you better spend all your energy memorizing where the stopwatch and pencil need to be during each step of the standardized test administration. To illustrate my point, and this is an extreme example, never make the mistake of telling anyone you design original dream research based on inspiration from Swiss psychiatrist CG Jung. In a clinical program, you can expect the following consequences:
- original implies there is something lacking in the literature, and that you will not be celebrating the history of the field by loading your paper with citations that credit others in the field. You will be branded as arrogant, self-indulgent, or untrainable.
- original also implies that someone cannot rely on their expectations and experiences to skim your paper with minimal effort.
- your reference to dreams will draw bemusement from contemporary clinicians, who are wholly unfamiliar with classical dream theories. Also, in light of the fact managed care companies will only reimburse for certain types of therapies over a limited number of sessions, dream interpretation is not time efficient. Dreaming itself is another source of chaos psychologists feel the need to control by categorically dismissing as impractical, impertinent, unsound, untested, arcane, or downright random.
- CG Jung is a classical theorist who did much of his work outside psychology as an M.D. who would not have been bound by APA style guidelines and committee approvals had he even been practicing today. His writings are published across a series of 20+ books in a style considered too intellectual or discrepant to be understood. There is simply too much to read and it is generally believed that one needs to be Jung or to have Jung's personality to learn how to conduct Jungian therapy. It does not lend itself to manualization nd training, and his emphasis on deep structure and the irrational aspects of the human condition fail to resonate with the values and skill sets of contemporary psychologists. Aligning yourself with his name speaks volumes about you and could spell career death in certain circles.
The dilution of Psychology's talent pool becomes much more of a threat as Cognitive-Behavioral Therapy (CBT) increases in popularity as a result of the fact it is simple enough to be manualized -- and more endorsements from managed health care because it is cost-effective. And it's democratic. Unlike psychodyanmic therapies, no immeasurable, ineffable, or congenital talent is required to dispense CBT. Just read the manual and submit to training. Everyone can be a psychologist by these standards. Students of basic intelligence can be trained en masse in CBT.
Socialization into Professional Culture
In many clinical programs, students have to negotiate a massive structure of expectations (i.e., academic requirements and social reinforcement) that siphon time and energy from the task of absorbing and integrating what they've learned. It comes as no surprise to me that even intelligent students have difficulty remembering what they've learned from semester to semester and are unable to put 2 and 2 together into a transcendental perspective, not that faculty would deem such individuation desirable. Rather than inhouse seminars on time budgeting and stress management, programs should exercise one of many options to free students for contemplation or reflection so they can mature personally and professionally. The price of failing to do this is indoctrination into a one-size-fits professional identity and a dependence on external agencies for validation and guidance. You end up turning out PhDs who like to use the term "mental hygiene" and fashion themselves the Van Helsing wing of a psychological CDC. If you're a clinical psychology graduate student in training, you don't want to be caught wearing sunglasses on a cloudy day lest you like aspersions cast on your "reality testing," not to mention your mental health, professional fit, and character. And you'll find yourself embarking on a defensive odyssey complete with references to the brightness of some overcast skies and your prescription lenses, when all they wanted to hear is "habit."
The consequences of managing a gild by cloning professors are not unlike those of making photocopies from photocopies. After a certain number of generations, the quality is degraded, and nothing spells trouble more than too much of a bad thing.
Manualized Diagnosis and Therapy
A common framework of expectations that provides solidarity and discourse is necessary -- up to a point. We do need to be able to communicate with one another and, in some instances, build on each other's work. The Diagnostic & Statistical Manual of Mental Disorders is a tragically necessary tool, allowing colleagues with a variety of theories and training to communicate with one another and with managed care. But honestly, we need a way of measuring the DSM's proportion of GPE's (Graduate Psychology Education) Gross National Production (i.e. education), because I suspect that the role of the DSM in psychopathology training is increasing as is the number of research studies driven by DSM constructs. This is scientific validation and training after the fact, which is to say that once psychologists adopted the DSM as a diagnostic tool, it seems they've decided it was necessary to justify its use with research aimed either to evaluate the validity of DSM disorders or to evaluate the efficacy of interventions applied to client populations defined by DSM nomenclature. A lot of us overlook the fact these disorders were born in committee, which is not to say they are entirely arbitrary and without a basis in epidemiology, but let's face it, the DSM is an enormous animal that has to be fed. I would be interested to know what the DSM costs the field in money, hours, and personnel as a basis for estimating its proportion of an equivalent of a Gross National Product for Psychology. In my opinion, where there is nothing wrong with the DSM in and of itself, my point is that it does not live in and of itself (i.e., it is not an only child and has to learn to share). Psychology should be exploring rival diagnostic tools and should certainly encourage clinical research that is not couched in the language of the DSM. Once we professionally canonize such a massive classification scheme, we make it resistant to change. This is no longer a guide to research, but the sake for which research is performed. We stop studying the human condition and end up studying its method of classification. Since its inception in 1952, the DSM has ballooned from a 63 page document to a 900+ page document over four editions. This manual that is not capable of consolidation or re-organization, and like a house of cards, it will ultimately crumble under its own weight. What does the future hold for the DSM? I suspect we will see a litany of new disorders based on popular deviations that grab headlines, like web addiction and road rage, until the DSM reads more like a psycho-legal code. The resemblance of the numerical code that corresponds to each disorder (e.g., 300.21 for Panic Disorder With Agoraphobia) to sections of the penal code will become striking.
While epidemiologically, these disorders may refers to typical clusters of symptoms across the general population, this can hardly be treated as an analog map of human dysfunction and, even if it could, it would still require an understanding of normal or optimum human functioning so that we could better understand the unique psyches of our own individual clients. The DSM, originally published by the American Psychiatric Association, is a loose collection of disorders which in all likelihood stem involve significant organic contributions. Even where psychological education and understanding could help a client manage these disorders, a clinical curriculum increasingly oriented by the DSM Compass stunts such psychologistic education.
While a classic case of a DSM disorder should be noted for the file, I do not trust therapists to detach themselves enough from the disorder to develop an independent and comprehensive case conceptualization, nor do I trust the most recent generations of therapists from forcing a complex case into a DSM hole. But my major concern with the DSM is that it will ultimately spark a growing class of specialists who lack the tools and the tendency to conceptualize the whole person beyond his or her mood or anxiety disorder. Manualized therapies for specific DSM disorders are symptomatic of a therapy culture in which therapists can expertly deploy differential diagnosis within the class of mood disorders and yet prove no better at understanding sadness than the layperson. A therapist can appear well-trained while reciting the symptoms of major depressive disorder and appear even more knowledgeable distinguishing them from those of the mood disorder with the esoteric label, dysthmia, but I am not impressed with their insight into the value and function of sadness within the life and personality of the client.
Was it any surprise in a DSM-centered training program that the faculty and students got a little trigger-happy? I have to admit I was surprised by how often students are referred by faculty -- and by other students -- to the committee that investigates reports of pathology in students. When I address the issue, just about the only people who are not surprised are the laypeople. Invariably, it is pointed out that psychology attracts students who want to make sense of (or work through) their own issues. I do not want to over-emphasize that point. While attraction (i.e., who the field appeals to) is a usual suspect, I also think psychology's shortfalls are shaped by a complex coalition of culprits that include selection (i.e., who the field admits from among the applicants), socialization, bureaucratization, and homogenization.
The popularity of the DSM is symptomatic of a much broader culture that also
promotes the popularity of the cognitive-behavioral approach to therapy. It is so simple that just about anyone can write or comprehend a CBT manual, and managed care companies will reimburse for it because it is time-efficient and because there is a semblance of common sense to it. I mean, CBT is about restructuring cognitions, instructing a client to stop thinking this or that way or to abandon this unreasonable belief or expectation. It is a useful tool to have in one's toolbox. Unfortunately, rather than target CBT to appropriate beliefs within appropriate clients (i.e., CBT is more effective for some clients and problems than for others), we find too many psychologists globally administering a metaphysical CBT and thus targeting specific beliefs or behaviors at the expense of the broader person/situation. This is managed myopia. Professionalization, managed care, and a steady erosion of psychodynamic theory will create conditions in which CBT-myopia festers among future generations of therapists. The Hazelden Foundation publishes illustrated REBT pamphlets (Anxiety & Worry; Guilt; and Perfectionism) that look like they belong in grade school libraries and I fear that this is the future of psychotherapy. But I don't want to hit this point too hard lest someone recommend REBT therapy. REBT and, more broadly, CBT seem perfectly suited to the dispositions of contemporary psychologists, who are products and survivors of a training culture in which student cognitions about people and psychology are heavily structured and restructured by their professors.
I am sympathetic to the psychodynamic critique of CBT. There is much to us that is irrational and that can't be stuffed like a fullback at the line of scrimmage. The irrational elements in us will just go underground and emerge in a different form, but we don't understand this because our fetish for all things rational will not allow us to grasp concepts like symbolism and symptom conversion. To extend my football metaphor, if the irrational elements in us can't run between the tackles, it will run around them or toss the ball back to the QB for a downfield throw to a wide open receiver. I see such end runs and aerial assaults at work in psychology professors, whose psychopathology is no less spectacular than a successful triple reverse.
Like the researchers, a growing class of psychologists treat the psyche as a primitive cauldron of irrational, impulsive, and unsocialized elements from which the person and the world around him needs to be saved. Underwriting the DSM is a definition of disorder based in distress or impairment. If a client is DSM-diagnosable, there is expertise the therapist can bring to bear, but alas too many therapists are outside their wheelhouse in matters of existential crises, conflict, optimum functioning, normal psychopathology (i.e., phobias and fetishes), phenomenology & frontier (e.g., dreaming), life phase issues, and individuation. The clinical training does little to prepare the budding therapist for this, nor does it do much to help the budding therapist prepare him- or herself. The efficacy of the therapist then depends on his or her acumen, intelligence, and independent reading, reflection, and research.
But the psychologist treats all this "stuff" that lies outside the training universe (which is contracting) as chaos to be controlled or terror to be managed (Greenberg, Pyszczynski, & Solomon, 1986). They find a way to marginalize or maim this material, treating it as secondary and secretion, a byproduct or misunderstanding of the mundane, whereas more classical schools of thought once treated these elements as foundational.
The draw of CBT for too many psychologists is that it places them in the position of mental hygienist and police officer, who is more than willing to intervene to tell you how irrational you are and how this irrationality is making life miserable for yourself, others, and scientific reality. You are a virus to these psychologists -- a public health threat -- and you need to be cured of your human nature. I distinctly remember one of the professors at the clinical program on which the book is based telling her audience that they needed to think of everyone -- their friends, their family, the man on the street -- as potential patients.
And CBT and in particular REBT seeks to root out the irrational beliefs in its clients, but I am afraid that in the process, it teaches its clients to demonize irrationality itself. While it may be effective to treat certain beliefs as problematic because they have become rigid -- because the client has elevated them to supreme principles and in so doing reduced the freedom and flexibility available to adjust, grow, and create beliefs with positive coping potential -- we need to remember that it is a hyper-rationality that is responsible for this. The process itself is a hyper-rationality and its products are irrational -- which is quite an irony. But this is lost on the less intelligent practitioners of CBT -- and that is quite a growing class when you consider the simplicity of CBT has made it appealing to so many new students and its manualization has made it accessible to them -- the less intelligent practitioners confound the irrational beliefs with the hyper-rational process of dichotomous thinking, etc., that produced them. The result is that we demonize material from irrational sources (e.g., dreams), which is actually an altogether different animal. The problem is that in falsely dichotomizing rationality and irrationality, some CBT therapists can be accused of administering CBT in a very un-CBT like manner. This is not unlike brain researchers who in the name of science use a metaphysical materialism to argue against researching a dream's meaning or functionality.
Now CBT practitioners are not the only practitioners who can be accused of an un-CBT-like rigidity. I know one therapist who gave his internship supervisors a hard time. He was not amenable to training because he refused to conceptualize a client outside the Rogerian perspective, reviling all directive therapies as manipulative. In his view, it was important as a therapist not to suggest any course of action or conceptualization to a client. As a therapist, he was there strictly to listen and offer unconditional positive regard. While this may be helpful for many clients, many clients benefit from insight-oriented or directive therapies. But I think I understand where this marriage to Rogerian therapy springs from. The therapist in question has believed since childhood that he was a woman trapped in a man's body and his life sought acceptance for his gender identity issues and subsequent sex-altering surgery.
So within a business built around managing chaos, one can understand how creative, critical, and exploratory spirits like myself can find the going tough. As a researcher, I always designed my projects so as to provide myself with the broadest possible view of the chaos. I think this exposure to the depth and scope of a phenomena or frontier is healthy, which is ironic when I consider my own phobia for heights and depths. By contrast, too many of my fellow academics and practitioners avail themselves of every means at their disposal to turn away from the scope and depth of the data.
There is so much about the psyche we do not know, and I fear that in our research and training -- in all the organizing, professionalizing, and socializing -- we will make it virtually impossible for us to learn more through exploration or serendipity. Just like the academics are too busy being scientific to be psychologistic, the clinicians are too busy being mental health delivery professionals to address any aspect of normal or positive psychology. The medical model is their business model and therefore they have to constantly work to manage their impression as a legitimate profession within the network of health professions and within the framework of expectations and accountability. Everything is so incredibly regulated -- so micromanaged -- so standardized -- right down to the fonts and margins of our papers. Which raises another point.
All these expectations that are being managed. The vast majority of Psychology's denizens are apt to believe it is the personal choices and freedoms -- like where to put the period -- that is arbitrary -- and that standardization is the cure. But I believe they have it backwards. There are implicit reasons for our stylistic choices. We may not always know why converting our text to double-spaced makes us somehow less satisfied with what we have written, and I submit that this kind of reaction is indicative of the fact that at some level we feel we are violating a fundamental marriage between the message and the medium of our work. The true student of dreams may be inclined to resist these stylistic requirements because the very reason he or she is interested in dreams has to do with the fact that he or she is interested to know that mystical and meaningful union between the manifest dream image and the latent thought or fact that image expresses. Was it arbitrary of the dreaming mind to select a tornado to symbolize the particular sort of adversity the dreamer would encounter the following day? Could the dream have selected another image? Any image? A hurricane? An electrical outlet? A pair of scissors? The student of the dream believes there is an intrinsic connection between the physical characteristics of experience of the image and the nature of the idea or experience to which it refers. Such is a marriage of message and medium in symbol. Consistent with this interest is an appetite for freedom, an imperative to exercise some discretion over how one formats one's paper, because writing style and format can be viewed as something which grows out of or unfolds from the theme or message of the paper. To such a person, it is the APA style format that is arbitrary and that is quite oppressive. Most people in our field do not understand -- cannot appreciate -- the friction felt by the student with this kind of philosophy. And I use the term "philosophy" here, but in many cases, we're talking about something congenital in the disposition of the student, something that deserves more than the pejorative label, 'reactance.' For this reason, I am inclined to believe that the professional requirements -- and the properties of the standardized process by which careers are shaped in successive approximations to a professional ideal -- discriminate against certain types of students with certain types of interests. It is the less obvious and less intentional of the ways in which the field discriminates against students of dreams, but I can say quite confidently that it is because of such mechanisms that students of dreams will have a difficult time of it and why dreaming will never be adequately understood. That's the sacrifice made by the field. It can excise or abort these students for non-compliance in a cosmetic enhancement to its professional persona, but as a result, certain phenomena are not going to be as well understood. We like these stylized DSM disorders, but when we get down to it, these are not phenomena and it saddens me that granting agencies will fund only clinical research using DSM disorders as subject variables. And yes, I meant it when I said 'cosmetic.' This is not pharmaceutical or astrophysics research we're doing. We could even afford to relax the peer review requirement. Psychology is not like some of those other fields where professors can stand in front of a class and speak of a "prevailing view." We have a lot of phenomena and a lot of research findings in this field, and we have no evidence whatsoever dictating how to connect the dots. So we discourage our professors from connecting the dots at their discretion. We think that in such a case we would be damaging our students by subjecting them to the bias of one individual. In fact, I think the field has evolve to the point where the individuals appointed to these positions and the graduate students admitted to these programs for training are those who are not disposed to thinking about how connect the dots. They are interested in mastering the components in which they are trained and never play with the big or even the middle-level pictures. As experimental psychologists, they are interested in some highly circumscribed, technical, or pragmatic issue and in the techniques that make up the knowledge production assembly line. As clinicians, they are specializing in some population or disorder, and are often busy mastering the diagnostic and therapeutic techniques on which they will be evaluated. So who among us is attending to the human psyche?
To be fair, I will say there are some scholars out there who do this field an injustice when they pay too much attention to the philosophical foundations of the field -- to the point of ignoring the implications of the philosophy for human experience. I have known psychologists who spend their entire career immortalizing Aristotle, advocating morality, or researching what the philosophers made of the essence of skepticism. Psychologists have a knack for distracting themselves from the sine qua non of their own field.
fireflySun.com Report List
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Wyatt Ehrenfels Reveals Groupthink, Abuse in Psychology Faculty Evaluation of Graduate Students: Wyatt Ehrenfels
Wyatt Ehrenfels Begins Sequel to Fireflies in the Shadow of the Sun: Wyatt Ehrenfels
Wyatt Ehrenfels Exposes Counseling Center Hiring Preference for Gays, Lesbians: Wyatt Ehrenfels
Wyatt Ehrenfels Diagnoses the Diagnosticians with the Shadow DSM: Wyatt Ehrenfels
Prominent UC-Davis Dream Researcher Dodges Wyatt Ehrenfels Draft of Reformers: Wyatt Ehrenfels
Wyatt Ehrenfels Teams with Management Consulting Maven R. Mallory Starr: Wyatt Ehrenfels
Overview of Wyatt Ehrenfels Dream Research with Cancer Patients: Wyatt Ehrenfels
Wyatt Ehrenfels Comments on the Short Falls of Teaching in Psychology: Wyatt Ehrenfels
Popular Psychotherapy All about Controlling Chaos: Wyatt Ehrenfels
Washington National Cathedral Site of Synchronicity in Novel by Social Psychologist: Wyatt Ehrenfels
Wyatt Ehrenfels Comments on the Value of a Degree in Psychology: Wyatt Ehrenfels
Wyatt Ehrenfels Offers Strategy for Self-Science of Dreams: Wyatt Ehrenfels
Wyatt Ehrenfels Attacks Psychology on Two Fronts: Wyatt Ehrenfels
Connie Vaughn Teams with Wyatt Ehrenfels to Explain Why She Is Not a Psychology: Connie Vaughn
Benjamin Willard Elected President of Wyatt Ehrenfels Fan Club: Benjamin Willard
Wyatt Ehrenfels Identifies Flaws in U.S. News Report of Psychology Employment Prospects: Wyatt Ehrenfels