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[A view from graduate school]
Kenneth Rogers, M.S., Ed.M.
As I have progressed through the various hoop jumping and paperwork shuffling of doctoral studies, I have become increasingly aware of a disturbing trend in the education of future psychologists. Among some of my colleagues and certainly some of my professors, there is a conscious (and partially unconscious) attempt to reduce what we do as mental health professionals into what I have dubbed “monkey psychology.” This form of psychology relies more on gimmicks than technique, behavior modification rather than clarification, and fundamentally seeks to move professional responsibility and competence away from younger professionals to author/technicians who have written about the ten easy ways to treat borderline patients.
More simply put, students are trained to treat clients like monkeys, who can be manipulated through a variety of reinforcers and punishers to come to a logical solution regardless of psychological diagnosis, stressor, or situation. This may smack of a theoretical attack but I am alluding to a philosophical difference of approach that is beyond theory; a practitioner of any orientation can adopt this stance if they are willing to concede that they can not work from an individual perspective and must resort to formulas and “only the most empirically validated approaches” in treatment.
How can we explain the genesis of this trend in psychotherapy? I suppose it starts when you are in class and you ask a seemingly innocuous question like “how do I work with a depressed client?” With a little thought, one would realize that such a question is impossible to answer correctly but some instructors persist in the attempt. Give ‘em a banana. Then teach them how to get their own bananas. A few BDI’s later, and you are well on your way to recovery. The unconscious? Don’t need it if it even exists. Existential concerns? We are all going to die so what is the point worrying about that? Why even allow patients opportunity to talk about their lives when they can learn to relax in just three easy sessions?
I suppose our cultural views of science and innovation are also to blame here. In America, people figure that if it can be done, it can be done twice as well in half the time given enough scientific innovation. The science of working towards greater efficiency...a process which works so well in manufacturing, the fast food service industry, and the computer industry but so poorly when you dealing with human problems. Believe it or not, people don’t want to be thought of as some number to be processed, especially when they are trying to communicate personal, often emotional details of their lives. Furthermore, there is the prevailing modernist fantasy that all of life’s problems can be solved through a logical, established sequence of actions and events so that “better living” is established. If my floor is dirty, I use a “pine fresh” cleaner; if my mother abandoned me at the age of two, I use Prozac. While many in our field have been critical of managed care, we should always be aware that this system is based on the above philosophy and as such is a byproduct rather than the origin of problems in the field.
Still, the belief is taught and re-taught that you as a mental health professional don’t know as much as the anxiety and depression handbook about how to treat clients. No, the client doesn’t realize that they are receiving therapy from a book but then you’ve got the credentials on the wall so who is going to argue? The payoff is especially insidious: If the client gets better, another victory for empiricism. If the client gets worse, well they just didn’t respond properly to treatment, just like the other 15% of their target population that doesn’t. With situations like this, the needs of the therapist overtake those of the clients, begging the question: Who is this therapy really designed for?
In retrospect, maybe I am more upset at the fact that practitioners call themselves by the same title that I will have upon graduation, rather than whether or not such clinicians exist. They could have their own degree (mental health technician?) where it would be clear that they do not offer therapy themselves but have sufficient mastery as to train people in behavior modification and administer the occasional Beck in a time limited series of treatments. There is no shame in this, after all some people do improve under such circumstances. But why make these students go through the farce and expense of a doctoral level of education when they are not going to use the skills and training that they could be learning if they were going to do therapy? I believe this would clear up some of the confusion that currently exists surrounding issues of theory and practice.
Even if such changes were enacted, there would invariably be some who would seek a therapy degree with the ambition to be reductionistic. Some people just can’t stand the idea that psychotherapy which takes human encounter and subjective experience seriously is difficult with an uncertain end. To this notion I am somewhat sympathetic and I am sure that any psychologist worth the title makes every attempt to make his/her treatment as brief and painless as possible. Unfortunately there are some problems that people face which are complex and involve an unfolding process which may take several years to resolve. Until the human condition itself can be “cured,” the best intervention will still be to treat the patient as a human who has (and had) experiences that make him/her uniquely different from others. This is what makes us human and treatment should follow this basic model to the exclusion of any other.
I have begun to suspect that individuals who practice monkey psychology have had some conflict in the past where they were not able to sufficiently develop the capacity for delayed gratification and as such now cannot see beyond immediate change. I am sympathetic to this as well; none of us want to give up the sweet nourishment of the breast for the uncertain world. But it is important from our earliest object relations that we are able to do this because although the outside world can be unpleasant, this is the only way one can develop a tolerance for life’s struggles. And the consequence is obvious...one grows up to learning to give therapy from a bag of tricks rather than learning to treat the client on their own.
I will not mince words here: The conduct of such individuals, be they professors or students who see clients, is unethical. It is unethical not because of what is said in session but rather what is not said: That treatment for psychological issues is possible but that some are not sufficiently trained to conduct it. That joy, suffering, meaning, and other uniquely human experiences cannot be quantified, scaled and answered in a handbook or with a 22 question true-false measure. That such experience can only be communicated and understood in a human encounter with a trained professional who is able to do therapy. That the process may be arduous, the course uncertain but courage, hope, and just a little bit of faith (more “unquantifiables”) may yet lead us to better solutions. But Monkey Psychologists beware: We are not monkeys and we do not live on bananas alone.
Ken Rogers is a graduate student in clinical psychology. He is currently the Managing Editor of the Southeast Florida Association for Psychoanalytic Psychology local chapter's newsletter, Psyche & Sol. He regularly contributes to the "Psychoanalysis and the University" section of that publication, which is devoted to discussing issues of psychodynamic training in the graduate school forum. He will start his internship with the Department of Behavioral Health in San Bernardino California this summer. This article is reprinted with permission from Psyche and Sol, Volume 13, Number 1 (Winter/Spring 2002).