EssaysIn DepthThe Psyche

Clinical Psychology, Psychological Science, and Neo-liberal Times

Clinical psychology first emerged as a formal subdiscipline within psychology in the aftermath of World War II. During the war, psychologists were initially hired by the military to play a role assessing recruits for psychological stability, combat readiness, and potential for officer training. They were also charged with the task of evaluating whether soldiers exhibiting symptoms of psychological trauma were experiencing bonafide psychological problems or malingering. Over time as the massive prevalence of psychological trauma became apparent, the demand for professionals capable of providing psychological treatment far exceeded the supply of available psychiatrists, and psychologists increasingly came to play a role as treatment providers as well.

The scientist-practitioner model

At the end of the war the federal government set aside substantial amounts of money to train and hire psychologists to play a central role in the assessment and treatment of emotionally traumatized veterans. In 1949 a conference was convened by psychologists in Boulder Colorado to develop a training model for the clinical psychologist of the future. The consensus was that future clinical psychologists were to be trained as scientist-practitioners. This designation for the training model reflected a commitment to embracing the identity that the profession of North American psychology had adopted early in its development as an experimental science, akin in important respects to the natural sciences. Clinical psychology training was to entail teaching graduate students both the scientific skills that experimental psychologists acquire, and the practical or applied skills that are relevant to assessing and treating patients in real world settings. In addition, the scientist-practitioner model specified that clinical psychologists would be trained to evaluate the research evidence relevant to assessing and treating patients, and that their experience as practitioners would play a critical role in generating clinical theories and principles of intervention that they could then evaluate through systematic empirical research.

Clinical psychology Ph.D. training programs fit a type of hybrid academic/professional school profile. Some of the coursework is academically oriented and some is skills oriented. In addition to coursework and Ph.D. dissertation research, students spend a considerable amount of their time acquiring supervised experience assessing and treating patients. This applied aspect of their training, which takes place in both classroom and clinical settings throughout graduate school, culminates in a one-year full-time placement in a clinical setting (often a hospital). Ph.D. candidates are paid a small salary over the course of this one-year pre-doctoral internship at an accredited site. In return for clinical experience and supervision, they provide a relatively inexpensive form of labor.

The predoctoral internship must be completed in a satisfactory fashion before candidates are formally awarded their Ph.D. degrees. Application for these internships has always been a competitive process. Graduate students apply to internship programs throughout the country and are interviewed if they make the first cut. Internship sites rank the students they have interviewed, and the students rank the sites. In the end internship offers are made, on the basis of the same type of computer based “match system” used for residency placements in medicine.

Over the last decade, the reduction in funding for mental health treatment has been an important factor contributing to a growing imbalance between the number of clinical psychology graduate students applying for internships, and the number of positions available. In recent years, average national match rates (i.e. proportion of applicants who are able to find pre-doctoral internship positions in a given year), range in the area of 65-70%. The persistence of this pre-doctoral internship shortage is one of the many crises confronting the field. In order to maximize the likelihood of finding internship positions, clinical graduate students are spending increasingly more time obtaining relevant clinical training in a range of settings prior to applying for internship. This is making it progressively more difficult for students to graduate in a timely fashion. In the end, there is always a risk that after investing substantial amounts of time and money being educated, students may not be able to graduate with their Ph.D.s in clinical psychology.

The scientist-practitioner model of clinical psychology has been the dominant model of clinical training for many years. In practice, however, it has always been a difficult ideal to fully realize. Although the stated objective of scientist-practitioner programs is to provide trainees with the expertise that will allow them to be equally at home in academia and the applied world, the majority of clinical psychologists have always chosen to seek employment in clinical settings rather than academia. Clinical psychologists in applied settings rarely continue to do research, nor do they as a rule continue to read the research that is published. Survey after survey has found that practitioners in the real world tend to find that research findings have limited relevance to their clinical practices.

One obstacle to integrating the roles of the researcher and clinician is practical in nature. It is difficult to find the time to become both a skilled clinician and a successful researcher. Another is that the two roles draw upon different sets of skills. The activities of the researcher draw heavily on the use of rational, problem solving skills, although creativity and intuition do have their roles. Clinical work can involve a type of problem solving, but ultimately it is a human encounter that entails the application of a type of practical wisdom, and requires the capacity for interpersonal attunement, responsiveness and improvisation.

Psy.D. training: the practitioner-scholar model

In recognition of the fact that many clinical psychologists will not become researchers, an alternative to the scientist-practitioner model was developed in the early 1970s. This training framework, referred to as the practitioner-scholar model, places less emphasis on acquiring research skills than the scientist-practitioner model, and more emphasis on clinical training. Graduates of practitioner-scholar programs are awarded a doctorate of psychology (abbreviated as Psy.D.) rather that the doctorate of philosophy degree traditionally awarded to graduates of clinical psychology programs. Unlike clinical psychology Ph.D. programs which follow a hybrid academic/professional training profile, Psy.D. Programs are professional schools. Most (although not all) are free standing programs, outside the university system. Most support themselves exclusively through student tuition. For this reason, students are not funded and class sizes are large. These large class sizes are another factor contributing to the growing imbalance between available pre-doctoral internship positions, and internship applicants. Although the Psy.D. model of clinical psychology training has been reasonably successful and continues to be a popular training option for many aspiring clinical psychologists, the Ph.D. in clinical psychology is considered somewhat more prestigious in the field.

The clinical-scientist model

The most recent model of clinical psychology training to be developed is referred to as the clinical-science model. The emphasis in the clinical-science model is on training clinical psychologists to be scientists first and foremost. While the clinical science model assumes that graduate students will receive some clinical training, it clear that this should take a back seat to the activities of mastering the skills of conducting systematic empirical research, applying for grant funding, and publishing research findings in professional journals. An important goal for proponents of the clinical-science model is to increase the proportion of graduates who apply for university positions. Since the clinical science model is relatively new, it is too early to know how things will play out in this respect. What is clear at this point, however, is that the clinical science model is becoming increasingly prevalent in North America.

There are number of cultural, historical and political forces that have contributed to the development of the clinical-science model. The first is the growing emphasis on accountability in the healthcare system. This emphasis is consistent with the global shift toward neoliberal policies that elevate principles of market exchange to an ultimate value. In terms of the specifics of how these forces played out within clinical psychology, we need to go back to the 1970s when HMOs first began emerging, as part of a cost-containment strategy implemented by health insurance companies in order to maintain financial profits. By the early 1990s the American Psychiatric Association had already published guidelines for evidence-based treatment of psychiatric/psychological problems that emphasized medications to the virtual exclusion of psychotherapy. It became clear to the Division of Clinical Psychology within the American Psychological Association (APA), that if they did not take the initiative for developing evidence-based guidelines for psychotherapy there was a serious risk of either 1) losing insurance reimbursement for psychotherapy of any kind, or 2) having insurance agencies develop their own standards for determining criteria for reimbursement of psychotherapy.

The move towards developing these accountability guidelines, along with a list of psychotherapies considered to be empirically supported was highly controversial within APA for a number of reasons. First, a more substantial body of empirical research has been collected by behavioral and cognitive-behavioral therapists than by proponents of other therapeutic approaches (e.g., psychoanalysis or humanistic therapies), who traditionally have been less interested in conducting empirical research. Critics of the empirically supported treatment movement argue that absence of evidence is not the same as evidence of absence. Second, they point out that it is considerably easier to conduct systematic empirical research on cognitive and behavioral approaches than on psychoanalytic or humanistic/existential approaches since they tend to be short term, entail the application of clear-cut techniques, and aim to make changes that can be easily defined and measured. And third, different researchers draw different conclusions from the same research. While some investigators read the research as consistently favoring the cognitive-behavioral approaches, many other researchers (myself included) read the research as showing that 1) psychotherapy is helpful for a range of different problems, and 2) no one form of psychotherapy is consistently more effective than others. For example, there is actually a substantial body of evidence demonstrating that well designed studies comparing short-term psychoanalytic approaches to short-term cognitive behavioral treatments fail to find differences in treatment effectiveness. But this body of evidence is typically ignored or discounted by proponents of cognitive-behavioral therapy.

Although controversies about the virtues of the evidence based treatment movement have not abated, by the late 1990s the list of empirically supported therapies developed by APA had taken on a life of its own. The majority of therapies on the list are short-term cognitive-behavioral therapies that have been tested in highly controlled settings with patients who, for the most part, are not representative of patients seeking help in the real world (patients with complex diagnostic profiles are typically screened out of research studies). In a addition, the psychotherapy conducted in research studies is delivered by therapists who are trained to adhere to structured, well defined treatment manuals, so that researchers can be assured that the treatment that is being delivered is indeed the treatment being tested. These manuals are referred to in derogatory terms as cookbooks by many practicing clinicians, who maintain that in real world settings, skilled clinicians respond in a context sensitive fashion to the emergent clinical situation rather than delivering manualized treatments in a rigid manner.

One of the embarrassing problems that has emerged for strong proponents of the empirically supported treatment approach is that many clinicians in the real world stubbornly refuse to read the most recent research, and to the extent that they are familiar with it, refuse to be swayed by it, especially if it contradicts their own clinical experience. This inconvenience is referred to as the dissemination problem. And this frustrating dissemination problem leads researchers who have invested important parts of their careers attempting to advance the science of psychotherapy, to throw up their hands in dismay, and suspect that something has gone wrong with the traditional clinical psychology training model, since apparently many psychologists who are products of this model never developed the attitudes of real scientists (or if they did, they must have lost them shortly after graduating).

Advocates of the clinical-science model hope that as it gains more and more traction within the profession of psychology, the so called dissemination problem will diminish, since an increasingly large proportion of the clinical psychologists in the field, will have received the kind of training that inculcates the scientific attitude in them. My guess, however, is that this is unlikely to happen since 1) some clinical psychologists will always continue to train in Psy.D. programs or in those remaining Ph.D. programs that have not adopted the clinical-science model, and 2) graduates of clinical-science programs who decide that they are interested in doing clinical work are going to have to go out and acquire clinical training after they graduate. When this happens, unless their graduate training programs have done a damn good job of inoculating them, their scientific attitudes are going to become contaminated by the unsterile conditions of real world settings with real patients who need their help.

I and like-minded colleagues are concerned that the clinical-science model will have a detrimental impact on the future of clinical psychology. The high degree of polarization between clinical psychologists in academia and those in applied settings has always been problematic. Our concern is that the clinical science model will further exacerbate this polarization. If this happens, practicing clinical psychologists are likely to become increasingly less interested in and less well informed by academic clinical psychology. Another concern is that because of its isolation from clinical practice, the clinical-science model will foster the development of research initiatives that are increasingly irrelevant to the concerns of real world clinical practice. We are also concerned that the limited amount of clinical training that that students in clinical-science programs do receive is exclusively cognitive-behavioral in nature, and that they tend to indoctrinated into a pseudo-scientific bias against all therapeutic approaches that are not cognitive-behaviorally oriented.

The science of psychology

Although it is true that due to developments in the field I have described here and elsewhere, I have become increasingly concerned about the future of clinical psychology, I have always been concerned about the narrowness of the education that graduate students in clinical psychology tend to receive (my graduate education was no exception). This narrowness is in part a function of the fact that since clinical psychology has a substantial applied component, it is inevitable that an important emphasis be placed on the acquisition of technical skills. But it is important not to overlook the role that the broader discipline of mainstream psychology plays in contributing to this narrowness. As mentioned previously, American psychologists made a decision early in the development of the discipline to establish its identity as a natural science, akin in important respects to other sciences such as physics, chemistry and biology. This identification with the natural sciences was by no means a forgone conclusion.

Wilhelm Wundt, generally considered the founder of the discipline of psychology, established the first psychology laboratory in Leipzig Germany in 1879. He believed in the value of laboratory research for studying human consciousness, but he never thought of experimental research as the only viable methodology for psychology, and always believed that psychology would need to maintain an important link with disciplines such as philosophy, anthropology, linguistics and history.

William James (older brother of novelist, Henry James), the father of American psychology, held a broad view of the new discipline as well. James, who studied with both Wundt and his mentors in Germany, established the first American laboratory in experimental psychology at Harvard, but his interests and writing transcended disciplinary boundaries and included philosophy, art and religion. By the time he has published his magnum opus, Principles of Psychology in 1890, he had become increasingly dissatisfied with the growing narrowness of American psychology’s preoccupation with what he viewed as simplistic form of methodological rigor at the expense of seeking genuine understanding.

American psychology’s emphasis on its credentials as a science was from the outset essential to its claim to epistemic authority and to the profession’s presentation of psychologists as experts with a marketable product. The criteria that are emphasized for psychology’s claim to being a science have less to do with factors that are relevant to the successes of the natural sciences than they do with logical positivist reconstructions of the way science works. These include variables such as the use of aggregate data, quantification, experimentation, hypothesis testing, and the search for universal laws or principles.

One of the first markets for American psychology was the field of education. It is in this context that intelligence and aptitude testing came to play important roles. The relevant research paradigm had less to do with German experimental psychology than it did with the individual differences paradigm originating in the work of the British empiricist, Sir Francis Galton (a cousin of Darwin’s). Galton pioneered the use of statistics for analyzing large data sets in order to study the distribution of characteristics such as intelligence in the general population. Edward Thorndike and G. Stanley Hall, both students of William James, played important roles in establishing the role of American psychology’s expertise in the educational marketplace.

Another important marketplace for American psychologists’ expertise was the growing self-help industry. By the 1920’s, increasing immigration, industrialization, urbanization, and disruption of traditional communities, left Americans hungry for guidance in dealing with the ambiguities, competing demands and values, and stresses of everyday life. Psychologists increasingly came to be seen as experts who could provide answers. The first popular psychology magazines were published in the 1920s, and psychology became broadly disseminated by increasingly influential popular media outlets.

During this same period, psychologists’ expertise found another important market in the increasingly influential advertising industry. Edward Bernays, an Austrian-American nephew of Sigmund Freud’s, played an important role in pioneering the use of psychological principles in advertising, public relations, and the development of American propaganda during World War I. In the early 1920s John Watson, the father of behaviorism became vice president of one of largest advertising firms in the country, after losing his academic position for having an affair with a graduate student. Over time, psychologists’ expertise also came to be used increasingly in the workplace in order to motivate employees and increase productivity. Elton Mayo’s famous research conducted for Western Electric between 1924 and 1927 (commonly known as the Hawthorne studies, because they were conducted at Western Electric’s Hawthorne Plant), played a particularly significant role in developing the psychology of personnel management.

World War II was a watershed event in the development of American psychology. Psychologists mobilized for the war effort, and were recruited by the government for a range of services including intelligence, aptitude and personality assessment, organizational management, and the production of morale boosting propaganda on the home front and psychological warfare to be used against enemy troops. As I indicated previously, the establishment of clinical psychology as a professional discipline was a direct result of World War II. And following World War II the relationship between the psychology and the military continued to flourish. The emergence of the Cold War generated a growing need for psychologists to provide a variety of services, They were recruited to screen candidates for officer training and for fitness to serve in the CIA, to advise on counterinsurgency policies in third world countries, and to assist in the development of psychologically informed interrogation procedures, and skills for resisting interrogation. Psychologists have also played a significant role in devising psychological resilience training procedures for members of the military. Vast amounts of federal support have been provided to fund psychology research that might potentially have military applications in the future. Between 1945 to the early 1970s, the military was by far the largest funder of psychological research in the U.S. And the Department of Defense still continues to be a significant sponsor of psychology research at the present time. To take one controversial example, in 2010 Martin Seligman, a former president of APA, received a 31 million dollar no-bid contract from the military to conduct research on resilience training for soldiers.

Whatever professional benefits may accrue from psychology’s self-identification as a science are accompanied by a significant price tag. For one thing, it is not, for the most part, an intellectually oriented discipline. There is no doubt that the ability to come up with a clever research design requires an unique form of creative ingenuity, and that other aspects of psychology require creativity, intellectual rigor and problem solving abilities. But by and large, psychology is not a theoretically oriented discipline. This feature of psychology is no accident. Psychologists have a predilection for Occam’s razor, since complex theories are not readily testable. If anything, psychology graduate students are taught to curb tendencies toward excessive speculation and to “stick to the data,” as it were. Young psychologists in tenure track positions are discouraged from writing theoretically oriented papers or books. Promotion and tenure are contingent on publishing empirical articles in peered reviewed journals and attracting grant funding.

Certainly there are those within various areas of psychology (e.g., history and systems, personality, social) who spend their time writing theoretically oriented papers and books instead of conducting research. But they are unlikely to be offered academic positions by well-regarded mainstream psychology departments. In clinical psychology there are a subgroup of graduates who are interested in pursuing academic careers, but not in conducting systematic empirical research. There has been a growing tendency (especially in the northeast and parts of the west coast) for some of them to undergo postdoctoral psychoanalytic and to become active contributors to the psychoanalytic literature. For them the psychoanalytic world functions as a parallel academic community outside of the university system. In fact, since the mid-1980’s when the American Psychoanalytic Association began admitting psychologists to psychoanalytic institutes (previously psychoanalytic training had been restricted to candidates with medical training), American psychoanalysis has become increasingly dominated by psychologists, who have played an important role in fostering an interdisciplinary climate drawing on a range of fields including psychology, philosophy, historical studies, sociology and critical theory.

A second cost to psychology’s commitment to its identity as natural science-like discipline, is a lack of self-reflexivity that can lead to obscuring the value systems that are intertwined with and enshrined by psychological knowledge claims that are supposedly based on objective findings. This may constitute more of a problem in some areas of psychology than others. For example, claims regarding the mechanisms through which perceptual processes operate may be potentially less problematic in this respect than claims about stages of moral development (an area where for many years, higher levels of moral development were equated with stereotypical masculine styles of moral reasoning), or theories of social or developmental psychology that reflect a Western cultural bias. The recent disclosures regarding the complicit role that the APA has played in condoning psychologists’ active participation in the development and use of coercive interrogation techniques by the CIA is perhaps a somewhat extreme example of the harmful consequences that can result from the profession’s lack of self-reflexivity and insistence on presenting itself as a value neural objective science.

Psychology, the construction of self and neo-liberalism

But many of detrimental consequences of psychology’s identification with certain features of the natural sciences are subtler in nature. Building on Foucault’s writing on governmentality, British sociologist, Nikolas Rose has published a series of books outlining the way in which psychology and affiliated disciplines (referred to generically by Rose as the psy disciplines) have come to play a central organizing role in our culture by contributing toward the construction of a particular form of subjectivity — the psychological self. The contemporary psychological self organizes subjectivity in a way that internalizes the principles of a neo-liberal culture, so that we all engage in a form of self-governance that perpetuates an advanced capitalist consumer culture, and maintains a power structure that privileges the wealthy elite at the expense of a growing proportion of the population that is disadvantaged. Consistent with Foucault’s general analysis of the way power operates in society, this model does not posit the existence of an active conspiracy of the elite. Instead it involves a self-perpetuating intersection of cultural, sociological and psychological forces that lead to the shaping of a particular from of subjectivity through the implementation of what Foucault terms, technologies of the self — principles of self-regulation and self-construction derived from our psychological culture that lead to the production of ourselves as commodities in a consumer culture.

The contemporary self is autonomous, agentic, and capable of making and breaking emotional bonds easily (What Zygmunt Bauman refers to as liquid love). We are predisposed toward looking inward for the source of our problems and have learned to regulate emotional expression in order to get along with others in the workplace. Problems in living are understood as stemming from personal failures or chemical imbalances, rather than as reflecting social and cultural problems. People have become increasingly accustomed to viewing themselves as commodities in the social marketplace. Happiness and contentment become goals in and of themselves, rather than byproducts of a life that is well lived. Therapists, life coaches and self-help books offer a range of different prescriptions for achieving happiness, and if psychotherapy is viewed as too ambiguous or labor intensive, mood enhancing prescription medications are readily available. These psychotropic medications are marketed to the public on television, just like cereals, shampoo, deodorant and mouthwash. Both Prozac and personal hygiene products hold out the promise of transforming the self into a more marketable commodity.

The choice of criteria for assessing whether or not a particular form of psychotherapy is effective is inevitably shaped by prevailing social values. It is no surprise then that given the neo-liberal climate that pervades our culture, the value of psychotherapy is assessed in terms of its efficiency, cost effectiveness, speed and efficiency. And it is no surprise that the criteria that are chosen are those that are easily measured. Questions regarding the nature of the good life are inevitably bypassed in any discussion of what type of psychotherapy should be made available to people or in any advice offered to the general public by mental health experts who are cited in the media. Should therapy help people adapt to the demands of a dysfunctional culture? Are therapists educated in a fashion that helps them to reflect critically on the social values that they themselves have absorbed?

If anything, the trend is towards training therapists to become psycho-technicians, who deliver standardized evidence based treatments rather than responsible moral agents whose personal values, beliefs and biases have profound effects on the people they are trying to help. Another disturbing trend is that over the last three decades pharmaceutical companies with deep pockets, aided and abetted by the profession of psychiatry, have waged a successful campaign to medicalize the inevitable anxieties and sorrows that we all experience as a part of living — to turn them into illnesses to be treated with the most recent miracle drugs on the market.

The need for a critical approach to clinical psychology

Tensions between the science and craft of clinical psychology have always existed, but these tensions are now being exacerbated by the growing pressure that academic clinical psychologists are experiencing to bolster their credibility as experts by convincing policy makers and the general public that they are real scientists. These pressures are being fueled by the growing role that neoliberal rationality has come to play in the healthcare system and in higher education. Clinical psychologists are becoming increasingly split into two camps: those who believe that they can hold on to their portion of the healthcare market share by shoring up their scientific credentials, and those who feel increasingly alienated from the discipline of psychology. In the context of the ongoing controversy about the extent to which APA has played a complicit role in psychologists’ involvement in the coercive interrogation of suspected terrorists, many of my clinical psychology colleagues who are psychoanalysts have resigned from APA. Their resignation is in part an act of protest, but it also reflects a growing sense many share that they have less and less in common with the discipline of psychology.

In recent years my colleagues and I in the clinical psychology program at the New School have been speaking with one another and with our students about some of the concerns regarding the future of clinical psychology that I have touched on here. There is a growing consensus among many of us that we would like to infuse more of a critical, interdisciplinary and socially engaged sensibility into our training model. Some of us have been influenced by the tradition of critical theory emerging out of the Frankfurt School, some have been influenced by the psychoanalytic critique of the cognitive behavioral mainstream, some have been influenced by feminist theory, some have been influenced by a growing interest in healthcare policy and primary prevention, and some have been influenced by a focus on themes related to racial and ethnic diversity and social justice. Another influence has been the tradition of community psychology.

Clinical-community psychology: back to the future?

Clinical-community psychology emerged in the 1960s as a critique of the traditional clinical psychology model that tends to locate the problem requiring within the individual. The concern was that traditional clinical psychology’s focus on the individual, tends to ignore the social, cultural and economic factors that contribute to the development of psychological problems that people experience. This perpetuates a status quo that favors the privileged. In important respects, this tradition of community psychology went hand in hand with the Civil Rights Movement, the New Left, the counterculture and the antipsychiatry movement.

The community psychology movement in the 1960s was deeply critical of the individualist bias of traditional clinical psychology, and in important respects, socially progressive, critical and subversive in nature. It emphasized political activism, community organizing, the development of primary prevention programs, and the deinstitutionalization of psychiatric treatment. With respect to deinstitutionalization, there was a growing recognition that the type of custodial treatment provided for patients with serious psychiatric problems, had iatrogenic effects. The development of new medications made it possible to control more serious symptoms, thus reducing the need for large psychiatric institutions where people could be hospitalized against their wills for extended periods of time. The plan was to integrate these patients back into the community and to provide high quality community mental health centers and other forms of psychological and social support that would facilitate recovery.

Unfortunately, by the early 1970s federal and state money for funding high quality resources in the community to treat the released psychiatric inmates was drying up. Many of the psychiatric patients who had been discharged ended up homeless, in prison, or in a revolving door process of short term psychiatric commitment, stabilization on medication, discharge, and subsequent symptomatic relapse followed by re-hospitalization. While the community psychology movement never completely died out in the United States, its influence tended to wane in tandem with the general decrease social activism the 1970’s. While a few clinical-community programs that began in the 1960s or early 1970’s are still in existence, many contemporary community psychology programs are associated with social psychology programs, and the major emphasis is on community oriented research rather than community organization and social activism.

On personal note, when I attended graduate school at the University of British Columbia (UBC) in Vancouver, Canada in the early 1970s, the clinical program I attended was actually a clinical-community program that had been established the year before I began my training by a Canadian psychologist named Park Davidson. Park, considered by many at the time to be the enfant terrible of Canadian psychology, had risen to prominence at an early age, by publishing a series of cogent articles articulating his vision of a Canadian brand of clinical-community psychology. While I was excited to be admitted to UBC, which was considered at the time to be a university “on the rise” (with a beautifully forested campus overlooking an ocean with a sandy beach) I had never heard of Park Davidson, or for that matter, community psychology. Park’s vision of Canadian clinical-community psychology, as I came to view it over time, was shaped by a combination of 1) a pragmatic assessment of the way in which market forces would affect the profession of clinical psychology in the future, and 2) an unsophisticated understanding of the nature and complexity of clinical expertise.

Coming from a behavioral background (this was before the days when cognitive therapy has risen to prominence), Park’s perspective was that behavior therapy skills could be mastered by technicians without the type of extensive training that clinical psychologists undergo, and that in the future, employers were more likely to hire therapists who had gone through relatively short training programs, and who could be hired for less money. Given this, he believed that very few Ph.D. level clinical psychologists were likely to working as front line practitioners, and instead their primary roles would consist of a combination of training and supervising less well educated clinicians, mental health agency and healthcare administration, and consulting to mental health programs and policy makers through a combination of program evaluation (i.e. conducting research to evaluate whether agencies are achieving their objectives) and development.

I and the other five members of my clinical cohort that year — Rene and Maurice (college friends from South Africa), Howard (from Toronto), and Harold and Susan (from the Canadian midwest) were idealistic, young aspiring clinicians who had limited, if any experience working with real patients. None of us knew anything about community psychology, nor did we understand the way in which Park’s pragmatic version of it had stripped it of its radical and subversive qualities. Once we started seeing real patients, however, it did not take us long to realize that we were not getting the kind of training that would help us in the trenches. The program faculty had little clinical experience themselves and none of them were actively working with patients. We learned to apply simple behavioral interventions from textbooks, and received little in the way of real clinical supervision from our professors. We had difficulty understanding how we were to become teachers and supervisors of front line clinicians, if we had never been properly trained to do clinical work ourselves.

Most of us picked up smatterings of clinical training in clandestine ways, and much of our learning took place through trial and error with the patients we were treating. I personally thought that Park’s forecast of the way in which market forces would substantially diminish the role of Ph.D. level psychologists as front line clinicians was overly pessimistic. In retrospect I think he was right in important respects, even though the timeline he projected was premature by about forty years.

In any event four of the six members of my cohort ultimately graduated with our Ph.D. s in clinical-community psychology (Harold and Howard left the program after receiving their master’s degrees). Those of us who went on to become clinicians learned our clinical skills in a variety of ways in spite of our graduate training. While we didn’t receive much in the way of clinical training in graduate school, we were exposed to the writing of some of the first generation of American community psychologists. If anything, however, I think we developed somewhat of an allergy to the term community psychology, because for us, community psychology came to mean “not real clinical psychology.” It is only in the last few years, as I have become increasingly concerned about what is happening to the mental health field, and where the future of clinical psychology is heading, that I have begun to reread the community psychology textbooks from graduate school days that I can still find on my bookshelves, and to reengage with some of the more critical and subversive ideas that lay at the roots of the tradition.

What is critical psychology?

Interestingly, there is a tradition of psychology emerging in various forms in different parts of the world that is coming to be designated generically as critical psychology. There is no one straightforward definition of critical psychology, and psychologists who identify with this perspective have been influenced by a variety of different traditions. These include the tradition of critical theory emerging from the Frankfurt Institute for Social Research, the work of Klaus Holzkamp (1927-1995) and colleagues at the Free University of Berlin, feminist thinking, Foucault’s analyses of the relationship between power, knowledge, and society, and a revival of the American community psychology tradition of the 1960s. Other important influences consist of the traditions of liberation psychology and liberation theology that emerged in Latin America in response to the dictatorships in the 1960s and 1970s.

Some of the key themes associated with the emerging tradition of critical psychology include: an interest in examining and critiquing developments in psychology from the perspective of other disciplines (e.g., philosophy, politics, sociology, history, anthropology and economics), an emphasis on analyzing the social and cultural ideologies that shape the construction of psychological theory and prevailing research paradigms, an interest in understanding the way in which prevailing ideologies serve to protect the interests of the privileged, an emphasis on social justice, and a commitment to combining research and theory development with social action.

Consistent with the tradition of community psychology, critical psychologists emphasize the importance of understanding the individual in social and cultural context, and of recognizing that focusing exclusively on psychological problems at the level of the individual can function to maintain problems at the social and community level. This does not mean that interventions at the individual level cannot be helpful, but it does mean that there is the ever-present danger of “psychologizing” problems rather than challenging problematic social institutions and norms. In short, there is an overall emphasis on analyzing challenging assumptions and practices within mainstream psychology that help sustain unjust political, economic and other societal structures.

There are a growing number of psychology graduate programs around the world that identify themselves as either critical psychology programs, community psychology programs, or both. But as a rule they are not linked with clinical psychology programs. For example, there is a critical psychology program at the Manchester Metropolitan University. Ian Parker, who teaches there is one of the more prolific writers in the area and is strongly influenced by both Marxist and psychoanalytic thinking. There is another critical psychology program at the University of Edinburgh, and one at the University of East London. There is a community psychology program with a strong critical psychology emphasis at Wilfred Laurier University in Canada, a Center for Critical Psychology at The University of Sydney in Australia, and a community psychology program with a strong critical psychology emphasis at the University of Melbourne. There are community psychology programs at Georgia State University, the University of Illinois, and DePaul University in Chicago Closer to home there is a Critical Social and Personality Program at the City University of New York Graduate Center (CUNY). More than one of our current graduate students in the clinical program at the New School have told us that they considered attending the CUNY program before deciding to come to the New School, but ultimately began the New School M.A. program in general psychology (the only gateway to our clinical program), assuming that the New School Psychology Department would reflect the critically progressive and interdisciplinary legacy of the New School.

The New School clinical psychology program: one possible future

In many respects, the clinical psychology program at the New School is in good shape these days. We were recently reaccredited for another seven years by APA (an outcome never to be taken for granted). Our Ph.D. students continue to matriculate through the program in a relatively timely fashion. At a time when the average national match rate for pre-doctoral clinical internships is in the area of 65-70%, we continue of have an internship match rate of 95-100%. Our graduates are well respected by psychologists in the New York area who fill key administrative positions in hospital and other agency settings. Many psychologists in these positions are alumni of our clinical program, who have a perverse sense of loyalty to their alma mater, despite the hardships they endured during their graduate training. This often comes in handy for our students when they are on the job market. And although there are growing cutbacks in the funding of mental healthcare services, our job placement statistics continue to be good.

At the same time there is a growing sense of malaise in the field. Discussions regarding the ongoing pre-doctoral internship crisis feature prominently at psychology conferences and in professional journals and newsletters. Over the last decade, APA has come to focus increasingly on identifying, developing and marketing new job niches for psychologists. The growing profusion of self-help books and workshops for training clinical psychologists to grow and market their psychotherapy private practices has become an industry in its own right.

Our students find themselves stretched increasingly thin, traveling back and forth between clinical placement sites throughout the city, in order to gain more and more clinical training in diverse settings, in an effort to increase their likelihood of being successful in the internship match. And even if the students ahead of them in the program have been successful in their job searches, it is no secret that funding for mental health care services is decreasing. A few years ago, The New York State Office of Professions passed legislation licensing four new M.A. level mental health professions: mental health counseling, marriage and family therapy, creative arts therapy, and MA level psychoanalysis. Since that time a growing number of M.A. level licensed psychotherapists have entered the job market. Although this does not seem to have had a major impact on our students’ job search prospects yet, there is good reason to think that it inevitably will.

I imagine my old mentor from graduate school days, Park Davidson, would have a rueful smile on his face if he were alive today. Despite my concerns regarding the limitations of his vision, I think that his understanding of the pragmatics of the situation were remarkably prescient in important respects. He was right that market forces would ultimately push things in the direction of hiring less highly trained (and less expensive) clinicians than Ph.D. level psychologists to serve on the front line. And he was also right (in what I infer to be implicit in his underlying logic) that it would be essential for future clinical psychologists to develop the skills to influence policy decisions if they were going to have some influence on the future of the healthcare system and on the roles that psychologists might potentially play in it. On the other hand, I believe that his prioritization of future market demands as the key orienting principle of his vision was problematic. With hindsight, I can see that it was consistent with neoliberal cultural values that were already beginning to take hold at the time.

I do believe, however, that the time is ripe for re-imagining a type of clinical psychology training that recovers some of the subversive, socially progressive spirit that lay at the heart of the original clinical-community psychology movement in the 1960’s, combined with the type of critical interdisciplinary perspective that I have discussed above. I would like to see things structured so that our students have more opportunities to engage in ongoing conversation with a variety of disciplines including anthropology, economics, history, philosophy, politics and sociology. This type of conversation has the potential to equip them with the type of intellectual tools they will need to examine what is happening in mainstream clinical psychology from a critical perspective, so that they can play a role in changing the direction of the clinical psychology of the future.

In terms of helping students acquire the skills relevant to influencing healthcare agencies and policy decisions, I believe an emphasis on the type of program evaluation and development skills that I learned as part of my clinical-community training during graduate school, are important, but too limited in scope. It will also be important for future clinical students to learn the type of skills that will help them to analyze organizational dynamics, and to function as agents of organizational change. In addition the type of participatory action research (combining applied research with active participation in both the community and the process of changing things), which was originally pioneered by the psychologist, Kurt Lewin (who was influenced by members of the Frankfurt School) is particularly relevant. I also believe that it essential for clinical psychology students to develop the type of writing, communication and media sophistication skills relevant to advocating for policy changes and to communicating with a broad audience outside the field of psychology. The skills relevant to writing up research findings for publication in a professional psychology journal, do not translate well into communicating with either policy makers or the general public.

Interdisciplinary thinking, civic engagement, critical inquiry, going beyond the mainstream, social justice, policy advocacy, public scholarship… It’s beginning to sound like the NSSR, isn’t it? In fact, I can’t imagine a more ideal institutional home than the New School, for the type of clinical psychology program that I am sketching out here in a preliminary fashion. As those who have been here for a while know…. if there are any constants at New School, they are crisis and ferment. But today’s crisis feels somehow different to me than the crises of the past. And the convergence of crisis, ferment and desire for change at so many levels — internationally, nationally, locally, and in my own field of clinical psychology, leave me feeling oddly hopeful — at least in my more optimistic moments.

Also for you:

Jeremy Safran

  • Edward Connolly, Ph.D.

    Impressive article, to say the least. Deserves a reread.

  • This piece is well-researched and chronicles the overwhelming and complex history that informs the seemingly desolate state of our field.

    This discussion could not come at a better time, both politically and personally (not that the two are mutually exclusive, of course!). As a clinical psychologist in training, I more often than not wonder a) am I reifying the psy-complex? and b) is there a way to harness a critical frame and work from within the psychotherapeutic model to create something that challenges power, oppressive structures and stigma?

    However, these questions can only have solutions rooted in activism, if we can be inspired by our teachers, our clinical supervisors, our research mentors, our more-advanced peers, our participants, our patients and our students. If we can let ourselves get incensed by the injustice around us.

    Can we challenge ourselves to engage with each other, disregard the idea that years of experience and “expertise” precludes us from learning from each other? We need to at least entertain skepticism around the idea that the psychological experience is clean and neat and can be “controlled for confounding variables.” I hope we can use this think-piece as a jumping off point to embrace our rich and interdisciplinary history (that we often try to shuck off) and carry it into the future for a revamped field of psychology. I know I personally feel a little more inspired for the challenge.

  • Billy Somerville

    I appreciate Jeremy’s thorough survey of the forces that have shaped our field, and strongly resonate with the idea that The New School could produce clinical psychologists who think critically about our profession and are motivated to offer leadership and service toward its evolution.

    There are currently, and certainly have always been, clinical psychology students at NSSR who think critically and wish for more critical discourse in our program. The progressive legacy of NSSR tends to draw a particular kind of student to our department—students who are genuinely surprised to find the status quo largely unchallenged in our lectures, seminars, lab meetings, and clinical supervision. We address this by organizing our own salon style discourse. We hearten one another and keep our critical lenses sharp by reading articles and books together, and by sharing our experiences as developing clinicians. Jeremy’s proposal would bring this work out of the shadows and make it central to the mission of the program. This would be a welcome change.

  • Madeleine Miller-Bottome

    I agree wholeheartedly with the principles of a ‘new’ critical psycholgy Jeremy imagines in this piece. It should be possible for clinical psychologists to be interdisciplinary scholars, advocates for social justice with influence over policy and the access and power to change the social and economic forces that are threatening the field and mental health treatment in general. What strikes me however, is whether these endeavors or the training required to engage in them have much to do with what it takes to be a skillful effective psychotherapist. The reality of the program as it exists now is that the majority of students’ weekly hours are spent working as a training psychotherapist and supervision. The few spare afternoons, nights and weekends are ostensibly left for dissertation research and intellectual cultivation and social activism. The call for a reimagining of the clinical psychology field is timely and badly needed. But I have to ask (as a student who herself is very eager to begin psychotherapy training) – why are clinical PhD’s made to train as psychotherapists at all? A PhD in almost every other discipline (in both the sciences and humanities) is a culmination of years of scholarly study, new research and teaching. In my experience at the New School (which I acknowledge runs differently than a large research institution like University of Michigan, for example), the clinical psychology PhD is earned mainly through those thousands of hours of clinical training and practice and a little less on intellectual discovery and independent research. This may have more to do with the scientist-practitioner model which Jeremy aptly points out may be more of a myth than a reality. I do wonder, though, if the way we apply this model in doctoral programs amounts to a proliferation of (albeit expertly trained) psychotherapists (if they can get hired over a LCSW or another M.A. level candidate) who will make important differences at the individual level in the lives of patients – – but perhaps not the scale or fashion that Jeremy is advocating that clinical psychologists should.

    Maybe one answer is to discard the one size fits all approach of the clinical psychology doctoral program, and make it so that students can specialize in degree “tracks”. Psychotherapy training could be a track that demands different hours and expenditure of time. Those who wish to apply a doctorate towards more scholarly academic research or policy involvement can be better nurtured by a track which emphasizes the coursework and training necessary for those pursuits. For the students who wish to work both as a clinician and as a professor/researcher (a diminishing career possibility these days) could be tracked accordingly. Another possibility could be the way psychology PhD’s are conferred in Europe, where psychotherapy training is sought in addition to the graduate degree from clinical institutes and the like. If the field is to be revised in the way Jeremy recommends, then we might start with the basic assumptions of what a PhD in this field should really amount to.

    • Jeremy Safran

      I think you’ve identified an important issue Madeleine. It’s difficult enough as it is to find time to learn the essential clinical skills and be a productive researcher at the at time. How might it be possible to find the time for critical, interdisciplinary scholarship and acquiring the various other skills I’ve mentioned on top of all that. You have suggested some possibilities (e.g., different tracks, acquiring clinical training prior to beginning the Ph.D. program, etc). I think there are other possibilities as well…but that’s part of a broader conversation.

    • Ali Shames-Dawson

      I appreciate your realism, Madeleine. Time is short and energies, so I have learned, do not spontaneously multiply on demand. To reach the depth and expertise in a given area requires steadfast focus, and spreading oneself too thin, or maintaining unrealistic expectations of output does not tend to have positive results on the person. That is another aspect of graduate student life that runs at least a bit counter to the content of this career: self-care and sanity can be challenged when commitments mount. To maintain optimal output in both scholarly work and clinical practice, we must be careful not to expect too much of ourselves, or to figure out how to responsibly engage without overburdening ourselves.

  • Ali Shames-Dawson

    I remember nodding vigorously when Lawrence J. Friedman, biographer of Erich Fromm and professor at Harvard’s Brain/Mind/Behavior Initiative, explained to an audience member why Fromm is taught in psychology programs all over the world but not in the United States. “Psychology has lost its moorings…and wants too much to become a hard science” he said, and I, at the time a philosophy graduate student deliberating whether and how to pursue psychology, found this to be particularly resonant. There is something comforting when an expert in the field pinpoints what might be considered lacking, and for this reason I am grateful for both the style and content of Dr. Safran’s post, as it encapsulates much of what pushed me away from clinical programs to begin with, and embodies what ultimately drew me to NSSR.

    I am a first year masters student in psychology, transitioning, so to speak, after completing a masters degree in philosophy of religion at an institution where psychoanalytic thinking, phenomenology, and critical theory were enfolded gracefully into the study of religion. In classrooms with religionists and theologians for a better part of the past 10 years (I was also an undergraduate religion major), care of the soul was a
    foundational shared value, if not career objective among a majority of my colleagues, even as we savagely desconstructed everything under the sun.

    While I felt at home in an environment that unapologetically
    placed care of the soul front and center, I myself could not claim commitment to a religious tradition and thus could not entertain the ministry as a vocation. And while philosophy once upon a time was a psychogogy (guidance of the soul), these days academic discipline of philosophy does not typically understand itself as such, or, where it does, such commitments are often obscured or shelved by the demands of the academic life. My beloved philosophers, social critics, theologians and mystics offered much by way of soul food and creative critical thinking, but no matter how moving their articulation of human experience, no matter how acute their diagnosis of society’s ills, none could afford me a compendium of applicable professional skills with which to enact the values they evinced.

    That left psychology, which promised the rigorous training I desired, but seemed, eerily, to leave the soul behind, not to mention all the good invisible stuff phenomenology attempts to get at. A science-minded friend pointed out that it only “seems” to leave these things behind, because by understanding the mind and behavior we can ‘take care of the soul’ but I worry about what is lost when the well-meaning ideals of science are deployed in a culture of capitalism hell-bent on productivity and progress. The degree to which our subjectivities assume characteristics of technological trends seems to indicate that no matter how we idealize the benefits of science, we have little understanding as yet how they will interact with our humanity. We are beginning to witness some of the fruits of our commitments, and it isn’t the prettiest picture. As Dr. Safran points out, the value of psychotherapy is assessed on the basis of efficiency, cost-effectiveness, and speed, while the moral and ethical dimensions, not to mention the art of therapy, are sidelined if not altogether obfuscated.

    My study of philosophy mostly starred Continentals intent on
    deconstructing the very thought Dr. Safran points out comprises the current scientific paradigm. In light of this indoctrination and my well-rehearsed doubts, for some years I struggled to find a clinical psychology program that I felt would be hospitable to my philosophical commitments and provide an arena for growth. Instead, much of what I found sounded the alarm bells of my inner critical theorist, as I was groomed to be deeply suspicious of the ways in which psychology-as-natural-science may totalize and reduce human experience. I’ll readily admit that in my naiveté I may have inflated the dangers, but I worried about committing my life to a discipline that assumed great responsibility for the human being but did not seem, at least in my mind, to address in a convincing way the profound complexity of human experience. As Dr. Safran indicates, cognitive-behavioral programs rule the day, and I could not imagine myself thriving in such an environment. I’d have felt like an alien and—forgive the hyperbole but I believe it—would have suffered a sort of spiritual and intellectual death just to get a piece of paper that would offer me a bit of prestige in a field about which I had my doubts. I explored every avenue Dr. Safran delineates in his post: I started and left an MSW, scoured the internet for PhD programs that might make sense given my background, and even committed to a PsyD before giving up my deposit to come to the New School. Each time I entertained a possibility, it seemed that something crucial was lost. The psychology department at NSSR was one of only a very few options where it seemed I could build a healthy relationship with science while inviting critical discourse, and even a bit of poetry, as interlocutors rather than as shunned outsiders. Dr. Safran’s optimism about the possibilities alive in the current crisis too give me hope.

    As I indicated above, there is something actually comforting about having one’s doubts confirmed. It can afford a modicum of affirmation that one’s intuition is functioning, yes, but more importantly it signals the early stages of critical community. More than one voice becomes a discourse, and we know well the power of discourse. The overriding discourse at present, though, as Dr. Safran notes, has become flattened and even largely squeezed out of the academy by a set of historical circumstances.

    I think it is also worthy of note that the same conditions Dr. Safran cites as costs to the discipline of psychology—particularly the ways in which the expectations of scientific productivity, market demands, and the mechanism of tenure collude to constrain theoretical creativity and relevance beyond the ivory tower—are akin to those cited by many (Jacoby, Bauman, Giroux, et al.) as responsible for the demise of the public intellectual. Not only do these constraints diminish what we are able to offer our field, but any social, political, and spiritual transformation rigorous critical psychology might hold in potentia remains unrealized. Rather than remaining strictly adherent each to his own disciplinary tongue, claiming incommensurable aims, objectives, and worldviews, researchers and practitioners of all fields should rally for increased efforts at translating and synthesizing across disciplines, and between subdisciplines that have become estranged cousins.

    The writing of early psychologists does not read like journal articles today. Recall that Freud radically departed from his foundational endeavor Project for a Scientific Psychology (1895) in favor of more qualitative exploration of the human psyche. Leaving aside classical analysts, there is a waning set of psychologists who align themselves with Freud’s theories, but I’m willing to guess we’d find general consensus that the spirit that informed Freud’s vast opus was one of curiosity, robust imagination, and bold theoretical risk-taking. And look at all that has come of it. Freud’s thought, clinically useless though some of it may be, has germinated so many fields its discursive power is undeniable.

    Perhaps now would be the time to reinvigorate those generative principles in the interest of inviting just a tad more creative flourish in the field. And wouldn’t it be something if that could happen without compromising all that is valuable within the scientific paradigm through which the field developed and to which it owes much? Wouldn’t it be something if this chasm of which Dr. Safran speaks between clinicians and scientists were addressed not by trying to get clinicians to ‘do more science’ or scientists to ‘get more clinical’ (who has the time to do and be all things?) but to build alliances through conferences and journals focused on opening up precisely these impasses?

    Scarcely less the novice I was when I encountered Friedman
    in grad school part one, reading Dr. Safran’s post I find myself once again nodding vigorously. Like Friedman’s comment—“psychology has lost its moorings”—Dr. Safran’s article captures a certain dissatisfaction and consternation; whereas Friedman declined to elaborate, however, Safran walks us through the mire, pointing us toward possibility by lucidly delineating both the history and current status of a discipline unmoored, or, rather, by exposing its current moorings and elucidating specific problem areas. This in effect turns the soil and creates fertile ground for new thinking. Perhaps after reading this post I should be worried about ever getting a job, but at the moment I am rather quite excited about the possibilities that arise from such a critical excavation. I think of Kuhn’s (1962) Structure of Scientific Revolutions wherein he writes, “When paradigms change, the world itself changes with them.” I like to think that if this sort of critical engagement were to continue it would contribute to just such a shift.

  • Eran Barzilai

    I would like to make a rather bold claim: psychology is not a
    clinical science. But only have a clinical subdiscipline, as substantial is it
    may be. In my thinking psychological science is almost equivalent to cognitive
    science. That is, the core of psychology is studying and theorizing about such
    concepts as memory, attention, intelligence, language, perception, executive
    functions, thinking processes, and the like. Psychology is first and foremost a
    science because it tries to adhere to the principles of what constitutes a
    science: measurability, observability, objective, replicable and testable. Nevertheless,
    psychology is a rather unique science in that its subjects of scrutiny are
    precisely not observable, not objective, and are difficult to measure (which in
    my estimation is what makes it such a fascinating science).

    As more and more psychological studies and research were performed,
    some theorists began to wonder whether some of their findings may be applied to
    clinical work. Starting with John Wastson in the 1920’s, followed by B.F.
    Skinner, and continuing with the revolutionizing work of Aaron. T. Beck and many others, psychologists have
    translated what has been, at least partly, understood in the laboratory into
    clinical application. That is, the Cognitive-Behavioral realm of clinical
    psychology is one that grows out of the science of psychology, and is still
    very much committed to the scientific methods and principles. I believe that
    looking at it this way not only makes much sense, but also shows its vast
    importance. As we do live in a neoliberal world where a client, called it a
    customer even, has every right to question professional expertise. And this
    calls for a quite different kind of science, which is not unique to psychology
    – clinical science. By clinical science I mean using what is mostly social
    studies methodologies in order to better clinical practice and understanding,
    not only of psychology, but of many other clinical area.
    This involves such issues as treatment and control groups, blind to treatment
    protocol, number of participants, ways of assessing, number of measurments, and
    many more.

    But this last point is exactly why training in both clinical and
    science is so important, not only to psychologist, but to every provider of
    clinical work. Take physiotherapist for example.
    Who would feel comfortable if a therapist were to say: “I will prescribe you
    with some exercises to do at home, twice a day for two weeks. No one knows if
    these particular exercises are helpful, to whom if so, and why. No one knows if
    doing it only once a day is sufficient, or if in fact some of these exercises
    are not necessary, and the therapeutic mechanism can be only attributed to one
    of them. But nevertheless, do them. If it does not work- I will come up with
    something else”. Many I suppose would deem such clinical work as malpractice.
    At the very core of the scientist-practitioner model is the idea that a
    practitioner is a contributing part to the clinical science. However, since
    clinical science is so complex and ample issues arise with every attempt to
    systematically study a clinical questions, clinicians, from across the clinical
    spectrum I argue, should be equipped
    with the methodological tools and understanding of clinical science. And yes,
    it does involve numbers sometimes, and many begrudge this. But using
    qualitative methods, too, reflects the psychological scientific understanding
    that we as human beings are biased, and to objectively quantify our treatment
    plans may prove helpful.

    And I am almost certain that the very same problem between clinical
    practice and academia as a representation of science exists in many other
    disciplines. I have already given the example of physiotherapy, and I would
    argue that nutrition, speech, and occupational therapy, and, of course,
    medicine itself, (and many other clinical practices are no different. In all of
    the above clinician are expected to be more than technician, and to expand the
    understanding of their work. For would it not be fair to argue that a
    professional who is not interested in understanding and improving her practice
    is not a good enough professional? Here
    come clinicians who say: “but we have the clinical knowledge and experience!”.
    “Wonderful!”, say I, “Now try and show that this clinical knowledge is indeed
    consistent with more objective, measurable knowledge, that can actually be
    refuted.” To elaborate this point, conducting clinical science is not to say
    that its only subject matter can be what is observable or measured. Rather, it
    is to try and conceptualize phenomena in an objective, measurable way. Thought,
    emotions, and feelings are neither objective nor really measurable. We as
    clinical psychologists have to come up with sophisticated ideas of how these
    concepts can be manipulated so to enable the study thereof. Will we ever be
    able to fully understand how a clinical practice works, especially that of
    psychology? I highly doubt it. But does that mean we should abandon our ethical
    obligation endeavor to do so? No. Our goal is to come ever closer, without
    narrowing or compromising the complexity of the human mind and body. However,
    in order to do so psychologists must obtain a set of methodological skills. . It
    so happens that psychology is harder to study in a scientific way—and again,
    this may well be the reason that many of us have chosen psychology as our
    domain.

    I would be very surprised if more than a small percentage of
    clinical nutrition are engaging in research. I would be even more surprised if
    more than a third are actively consuming professional articles or even attend
    professional conferences. In fact, I believe that academia is a strong interest
    of very few. Thus, I think that a practitioner-scholar, model, be it a psych.D.
    or clinical MA, is suitable for the vast majority of those interested in
    obtaining a clinical career. This will equip the graduate with both the
    clinical experience and the ability to evaluate, critique, and make use of
    research. Only those very few who are interested in pursuing a full researching
    career alongside clinical practice should apply to clinical Ph.D programs.
    Ideally, Ph.D.’s would be able to cooperate with other clinician to produce
    clinical-informed knowledge that addresses real life issues and complexities.

    Last, Dr. Safran highlighted the idea that clinical psychologist
    should be critical of the socio-cultural, historical, and political influences
    on their practice and beliefs. I strongly agree. However, I do believe that a
    very similar set of skills is used to evaluate a particular study and to
    evaluate science at large. Both entail challenging the axioms, paradigms, and
    conclusions at hand. Hence, as I agree that clinical psychology programs should
    rise critical question about the scientific method in general, and of that of
    clinical psychology in particular, I am not sure that the clinical psychology curriculum
    should be completely revolutionized in order to achieve this goal.

    • Lisa Rubin

      An excellent read, both for our current trainees and for
      our colleagues in NSSR (and beyond), describing the state and status of Clinical Psychology. Without having fully explored the history of the department (but knowing that Clinical Psychology arrived later on the scene), I suspect that Psychology was always a bit different and never quite fit comfortably into the interdisciplinary project of the NSSR, and that the forces
      spelled out here have only exacerbated that. However, I know that in coming to The New School, I still harbored hope that despite Psychology’s (near exclusive, and increasing) bend toward the natural sciences, the NSSR would be
      a place that psychology sat ‘in conversation’ with the social sciences and even humanities much moreso than elsewhere in the U.S. Moreover, I know many students that I work with have come here with the same hopes in mind, and
      indeed have been clamoring for more opportunities to be part of the critical dialogues, and interdisciplinary project that they envisioned from NSSR. We can (and have started!) to do more to make that a reality, beginning with changes
      to the curriculum that allow for more interdisciplinary coursework. Other opportunities, such as the new certificate in Gender and Sexuality Studies, have piqued the interests of many of our students. I believe the self-reflexivity
      that is discussed here is essential to the intellectual (and ethical) and survival of our field, and can be facilitated through interdisciplinary dialogue that promotes clarity about the values and assumptions that undergird our work. In this way, The New School is unique positioned as a space to develop and
      support a more critical clinical psychology.

      There are challenges and contradictions to this project.
      This does not solve the time crunch that students face, as they try to gain sufficient clinical hours, testing experience, etc. to remain competitive for internship. Those who develop their interests in critical clinical psychology will experience a need to be “bicultural” as they juggle their lives in clinical/medical settings and academia, and this can be stressful, particularly if the proper supports are not in place. Developing a critical lens on our work — uncovering the ways in which gender
      and heteronormativity, white/able-bodied/class privilege play out in the neoliberal mental healthcare context (funded by big Pharma, biotech, and squeezed by insurance industries) redefine notions of normalcy and suffering –
      can leave one feeling paralyzed and untethered. This is where the being part ofa community of scholars is invaluable, and my hope is that the program can be a hub for those wishing to push these boundaries, among peers and mentors open to
      doing the same.

      *****

      As this blog connects so many different intersecting nodes
      of concern, it was hard to know where to dive into the conversation. But, one point that struck me most was:

      Over time, psychologists’ expertise also came to be used increasingly in the workplace in
      order to motivate employees and increase productivity.

      This was part of the telling of the story of psychology in
      the U.S., but I couldn’t help but consider how it follows the discussion of clinical psychology in neoliberal times. Students/workers/citizens no longer need to be motivated en masse by their employer. Rather, following on work by
      Foucault and Rose mentioned here, the ‘dilemma of the productivity’ is shifted onto the individual, who feels flawed/unworthy when failing to meet the new
      standards of efficiency and productivity (and beauty and ‘happiness’ and wealth…). Certainly, I have been referred many a client seeking treatment to help “manage” the anxiety, anger, and disillusionment (of this moment), with the hope of becoming through treatment more productive, and thus more accomplished. So, as we grapple with these matters, I wonder (how) can we, as critically minded clinical psychologists, help people survive and thrive in such a world, and also work to
      change it so that resisting this status quo is not medicalized with a DSM (or ICD) diagnosis. Adjustment disorders all around… or, perhaps these are not conditions that people ought to adjust to.

  • Samuel Bodian

    While there were many parts of this article that spoke to me, I’m particularly interested in Jeremy’s discussion of two alternative psychologies – one which has created the modern idea of the autonomous, market oriented, happiness-seeking self and attempts to help individuals to better conform to this idea of “the good life,” and another that critically examines, subverts and openly opposes the first. I agree that The New School is already a good place for those who wish to belong to the second camp – largely because we have a reputation as a progressive, critical institution and as a result attract students and faculty who are interested in that sort of thing. I can’t help but think that this idea of Clinical Psychology at The New School as a critical, open-minded opposition is a major contributor to the “perverse sense of loyalty” people feel to the program, despite its flaws and challenges. I think that we have the raw material – the right students, professors, connections, institutional structure etc. necessary to create a program that is more committed to true critical thought, community reform, interdisciplinary dialogue and all of the other things that The New School has branded itself as.
    That said, I think that just about everyone in the MA and PhD programs would share Madeleine’s concerns regarding student overload. The idea of separate tracks is interesting – I also feel faculty and students could think of ways to make adjustments to the course curriculum of the MA and PhD programs in a way that will bring us more in line with our core values without adding to the work load. I suggest that this conversation be continued in person and on a broader scale – that the faculty and student bodies have a series of open discussions regarding the future of Clinical Psychology at The New School. Some kind of additional dialogue with other departments within the NSSR would also be a good start. Thanks for the article Jeremy – I’m looking forward to seeing where this conversation goes.

    • Jeremy Safran

      Sam…like Madeleine and Lisa, you have raised the question of how to add a critical dimension to the clinical program without exacerbating the “overload” the already exists. “making adjustments to the course curriculum at MA and PhD levels” seems to me to be a reasonable place to start. And I like your idea of a series of open discussions with student and faculty within the department, and additional discussions with other departments and divisions.

  • Gregory Kanhai

    I’m happy that this article was written at this early stage of
    my experience in clinical psychology. As it ends with a call to arms (with the pen and mind) for multidisciplinary understanding of clinical psychology at a community level, it resonates with me, even as it began with clinical psychology’s emergence in war. That process, that a discipline does not have to remain in its beginnings, but can evolve with self-reflection, is important. In the struggle of accepting the dichotomy of what clinical psychology was and is, but what it wants to be, accepting the dialectical that both will exist, is the
    self-awareness that the field needs.

    As a new graduate student in the field I feel the call to arms
    to a more dynamic understanding of the interface between the individual and social, and where in those two entities the definition of normalcy exists must be debated. As a bicultural individual (who has many salient intersectional identities in this society) I can appreciate the day when the statistical normal is not generalizable to all individuals (and where the statistical model is not the lens through which the individual is rigidly understood), but when the statistical population is more local, and where the individual is represented and understood. I think this will lead to the shift of pathology out of the under-represented individual and into the social realm where it can be debated and deconstructed, and the shift of normalcy into the multiply representative rather than the singularly normative or average. Where we don’t mistake the prominent subjective to be objective.

    This process is now beginning to be appreciated in the field of biology,
    of which I was a student. Medications are currently chosen based on statistical significance of their effectiveness, but the patient is almost never a statistical model, and the effects of medication is dependent on allelic distributions across a person’s genome, and experiential and epigenetic constraints of those genes. This is reflected in the president’s recent call for ‘personalized medicine’. The hard sciences are realizing that in understanding our world, the intricate, continuous, dynamic and dialectical need to be accepted. Similarly, the subjective mind-body experience (of both the client and psychologist) creates unique experiences and emotional associations, and understanding ways of reaching each client to induce a therapeutic experience surely requires ideological flexibility by the therapist.

    Although synthesis of general theories that explain multiple
    phenomena are attractive, they tend to ignore the idiosyncratic nature of experience at the cross-section of identities and environments (in thought, emotionality and biology). Those cross-sections, I believe, is where understanding can flourish in clinical psychology. Where the local has its place in the statistical, and the psychologist can become an expert of depth, not scope. Depth, whereby, a clinical psychologist will erase the distance (and amount of work) between training to be a scientist and an effective practitioner, while remaining uniquely indispensable.

    I’d like to think that when a clinical psychologist sits with a client, that that psychologist isn’t seeing the client as a commodity, abstraction or an other. That the psychologist has the theoretical background, the real life experience to understand the social issues that challenge the client, and the empathy to build common ground with that specific client. It may mean that expertise is more specific, but the therapeutic relationship will certainly substitute for those human relationships lost in the social processes of urbanization and technological advancement which indirectly creates(d) the need for clinical psychology.

    As a student of the New School, Dr Safran’s article puts a smile
    on my face. I look forward to the opening of inclusionary discussions, classes and avenues to shape my experience of clinical psychology into one where the ground is built on and evaluated from many intersectional and cultural perspectives.

    • Ali Shames-Dawson

      “I think this will lead to the shift of pathology out of the under-represented individual and into the social realm where it can be debated and deconstructed, and the shift of normalcy into the multiply representative rather than the singularly normative or average. Where we don’t mistake the prominent subjective to be objective.”

      I look forward to this, Greg. Thanks for your post. In the many conversations you and I have had about culture and intersectional identities, I think here I am able to see more holistically how you view the relationship between theory, clinical research, and as you put it, the cross-section of local identities and environments.

      Two things your post makes me think: that the responsibility of interdisciplinary discourse would be precisely not to come up with grand synthetic schemas but to maintain important structural boundaries in order to generate integrative diagnoses and prognoses; and secondly, that as a more concerted effort at novel forms of discourse brings the question of how culture shapes the illnesses we in our field treat, we will be able to ‘give back’ by way of clinically and research grounded theories for social change. As you put it so nicely–shifting pathology out of the individual and into the social realm. I remember once a conversation about how and when psychoanalysis dropped any overt political leanings it might once have had, and while the specifics of the conversation escape me, my overriding response remains clear in my memory–the political is personal and the personal political. What are we doing this for if not to spur change in both public and private life?

  • Doris Chang

    As a product of just such a clinical science program that Jeremy
    describes, i.e., UCLA in the 1990s, I was trained to believe in the superiority of positivist approaches to knowledge production and to advance the project of an empirically-grounded clinical psychology through rigorously designed research. Explicit in our training was a
    view that “those who cannot conduct research, practice”. Clinical practice in itself was seen as a second-tier profession that could be left to
    lesser-trained individuals, who would, we hoped, administer the effective
    treatments that we developed in our labs.

    Despite the rarity of racial/ethnic minority role models in academia, I had the unique privilege to work with Dr. Stanley Sue and a spectacular group of Asian American psychological scientists working at the NIMH-funded National Research Center on Asian American Mental Health. There, I trained to believe that in creatively and more rigorously using the “masters tools”, we could in fact challenge the status quo from within. (See Dr. Sue’s excellent piece, “Science, Ethnicity, and Bias”). My mentors at the NRCAAMH remain some of the most well-respected clinical and counseling psychologists, sociologists, biostatisticians, and epidemiologists in the field of minority mental health. I do believe that the tools of psychological science have been crucial for documenting the significant racial and ethnic disparities in health and mental health outcomes, access, and quality of care. The numerous rigorous quantitative studies that have been conducted (and for a time funded by the NIH, NIMH and other federal agencies), have legitimized, quantified, and validated many of the subjective experiences of oppression and inequity felt by scores of individuals across time and place. And these studies in turn, have been essential for providing the justification for new policies, services, and models of education and training to address these inequities.

    The power of scientific knowledge in our society is real, and efforts to evolve the field of clinical psychology into one that is more inclusive, culturally and critically self-aware depend on the continued development of an empirical knowledge base that can provide direction as to how
    and why this should be done. Otherwise, discussions of cultural competence may be reduced to moral claims that are easily dismissed by those with more power. (Recent experimental studies that help explain why police officers are prone to shoot unarmed Black men carry are now leading to the development of new training models to reduce implicit bias. But apparently the hundreds of shooting deaths that came before
    did not provide the right kind of evidence to be convincing that there was a systemic problem.)

    This is why I am not prepared to throw the baby out with the bathwater, and maintain that we do need to teach our students how to critically appraise and rigorously design studies to thoughtfully test cultural
    assumptions, to see if our clinical hunches are right (and to challenge whose clinical hunches are given more weight and why that may be). Given the widespread psychiatric abuses among racial/ethnic minorities, women, children, sexual minorities, the disabled, the poor and cognitively impaired, there needs to be some kind of policing of clinicians and the kind of care delivered behind closed doors. Evidence-based, culturally-grounded practice offers one pathway to elevating standards of care to something that can be measured, monitored, and enforced.

    At the same time, I too have felt that a clinical science that fails to incorporate subjectivity and lived experience is a soulless (in Ali’s terms) and paternalistic enterprise that limits our capacity as healers (for those of us who aim to be). To fill this gap, I have found much to learn from the fields of cultural psychology, transcultural psychiatry, and medical anthropology in terms of understanding better how to capture individual experience and meaning-making processes that help explain variation in patient responses to illness and therapeutic intervention. Integrating all of these perspectives has enhanced my own thinking but has proven difficult to concretize into tangible publishable units, given the narrowness of journal outlets, granting agencies, and tenure standards.

    The vision of a new kind of critical-clinical-community psychology program that Jeremy sketches out is exciting and would have been
    precisely the kind of place that I would have found appealing as a graduate student. I do however think it important to take seriously market forces that all of us who are not tenured are subject to. The model described above requires not only the luxury of time—it also requires the financial freedom to engage in questions other than, “Will this help me get a job?” In short, more funding for students would dramatically improve
    their capacity to think about big questions, to write, to challenge the status quo, and change the field.

    • Jeremy Safran

      I appreciate your comments Doris…Just to be clear, I am not suggesting that graduate students should not be taught “how to critically appraise and rigorously design studies to thoughtfully test cultural assumptions” (or any other assumptions, for that matter).” I’m arguing (among other things) that students should also be taught to think critically about the values, assumptions and social forces that shape the type of research that is conducted, the research paradigms that are employed, the criteria used to evaluate the validity of knowledge claims, and the factors mediating the ultimate impact of research findings. In my experience these factors (i.e. those factors mediating the impact of research) often have less to do with the rigor of the experimental design that they do with other variables (e.g. the extent to which the findings resonate with the current or emerging cultural climate, or the vividness and memorability of the research paradigm and findings (I’m thinking here, for example, of Stanley Milgram ‘s use of the “shock paradigm” to demonstrate subjects’ readiness to obey authority figures even when they believed they were hurting other human beings).

  • Guest

    article speaks so much to my struggle as a clinical
    psychology student, negotiating multiple roles (researcher, instructor, clinician)
    with serious time pressure, power dynamics, and financial restrictions. While part
    of me is dealing with whether or not I’m a good “enough” scientist (or if I
    think that’s a relevant question in the first place), the other part of me is
    only just beginning to wrap my head around the neoliberalisms that have already
    begun (and promise to continue) shaping my experience as a clinician. As a new
    trainee, I just am beginning to really understand what it feels like to respond
    in a “context sensitive fashion”. I come from an undergraduate in humanities
    that begs for an interdisciplinary approach to clinical work. Yet, simultaneously
    I am inundated with positivist frameworks of clinical psychology, both tied to
    problematic processes of medicalization, and enforced by a neoliberal
    healthcare industry that directly affects the quality of care that the clients I
    work with are able to access. This article also touches on the important polarizations
    of the field, something that is particularly complicated to negotiate as a
    student. You’re at once learning about how to critique the current field and
    having to discern where you belong in it. This affects the power that clinical
    students feel that they have to contribute to the field, and to critique the
    process of training, in more meaningful and honest ways. It is because of this
    struggle that I am incredibly appreciative of this piece, and for the eagerness
    of faculty to critically engage with students around our experience. It is so important, as a student, to hear
    psychologists validate struggles that I (and certainly others) are facing as we
    want to make positive changes in this field. My peers and I are in constant
    conversation around critical approaches to clinical psychology that integrate a
    more interdisciplinary framework and pulls from a variety of relevant
    theoretical disciplines. As you discuss so clearly in this article, it’s
    something that is not only relevant to the current demographic of clinical
    psych students, but also to the need for advancements in the field. This
    article leaves me inspired, hoping that this conversation will continue and
    this call for re-imagining will come to be a reality.

  • Emily Breitkopf

    This article speaks so much to my struggle as a clinical psychology student, negotiating multiple roles (researcher, instructor, clinician) with serious time pressure, power dynamics, and financial restrictions. Just as part of me is dealing with whether or not I’m a good “enough” scientist (or if I even think that’s a relevant question in the first place), the other part of me is only just beginning to wrap my head around the neoliberalisms that have already begun (and promise to continue) shaping my experience as a clinician. As a new trainee, I just am beginning to really understand what it feels like to respond in a “context sensitive fashion”. I come from an undergraduate in humanities that begs for an interdisciplinary approach to clinical work that draws on social context. Yet, simultaneously I am confronted with positivist frameworks of clinical psychology that are deemed central to the current field, both tied to problematic processes of medicalization, and enforced by a neoliberal healthcare industry that directly affect the quality of care that the clients I work with are able to access. This article also touches on the important polarizations of the field, something that is particularly complicated to negotiate as a student. You’re at once learning about how to critique the current field and having to discern where you belong in it. This affects the power that clinical
    students feel that they have to contribute to the field, and to critique the process of training. It is because of these struggles that I am incredibly appreciative of this piece, and for the eagerness of faculty like Safran to critically engage with students around our experience. It is so important, as a student, to hear psychologists validate struggles that I (and certainly others) are facing as we
    want to make positive changes in this field. My peers and I are in constant conversation around critical approaches to clinical psychology that integrate a more interdisciplinary framework and help us to re-imagine what clinical work could look like. As you discuss so clearly in this article, it’s something that not only speaks to the current demographic of clinical psych students, but also to the need for advancements in the field, and the communities it serves. This article leaves me inspired, hoping that this conversation will continue, and that this call for re-imagining will become a reality.

  • Jacob Nyman

    This is a thoughtful, and honest contribution about the field of clinical psychology and the state of its academic research. Central to Dr. Safran’s article is the question: Why are clinical psychologists such poor (apathetic, incredulous almost recalcitrant) consumers of empirical research? Two different kinds of answers are posited. The first is about the unique realities of the profession of psychology. The field has become highly competitive in an already overcrowded market, while simultaneously growing less restrictive in regard to whom it allows to hang out a therapeutic-shingle. Alternatively, Dr. Safran has suggested that the culture of academia, especially the social sciences, has been pervaded by market forces that canalize research into self-interested, culturally aloof projects. The social, institutional exertions of power that coerce conformity, efficiency and supplication to the bottom line, end up inhibiting counter-culture and alternative avenues of enquiry. In this way, research doesn’t meet the real world demands of patients and
    practitioners.

    Given this situation, clinical psychology seems poised either to continue insisting on its current project, even if relinquishing its expectations for full participation by the research-practitioner. Or, on the
    other hand, the field might embrace a critical-psychological response to the failure of practitioners to consume research, and so necessarily begin a critique of the research agenda itself. This path begs caution, as the type of “post-modern” critique envisioned above has not, historically been kind to empirical science. If the past has anything to teach us, more will ultimately get razed than built. Clinical psychology needs a different kind of research, not an attack of the validity of empirical methodologies.

    It is noteworthy that medicine and education are two other fields equally as vulnerable to the kinds of criticisms put to clinical psychology. All three subjects operate on a client-practitioner model, and seem to divide between those who veer toward the academic end of the spectrum and those who concentrate their career on practicing; a very few find meaningful careers as research-practitioners. Like clinical psychology, the pure practitioners in medicine and education have also been accused of adopting an inflexibility in the face of research that questions the prevailing norms about “best practice”. The fact that a movement called “empirical based medicine” grew up at all should be surprising, and at the very least sound like a foolish redundancy.

    Even with an exposure and correction of the pernicious ideological presumptions and social biases evinced by a radical critical-psychology, it’s easy to imagine that the field will remain divided and practitioners who “feel” their methods still work best, will continue employing them. A research agenda more parsimonious to the cultural sensibility does not necessarily augur a more diligent consumption of empirical findings by the field’s practitioners.

    What then? Dr. Safran points as an example to the New School, the university as nursing mother. What might come of turning the gaze of critical-psychology into the lecture hall itself? Here the cultural shift begins with the academics, with the researchers themselves. If a research-practitioner can inculcate her students with a critical-psychological sensibility, alongside a rigorous scientific training, then the inevitable real-world demands for efficiency and the bottom line might look to the fresh-faced practitioner less intractable. A critical education might provide the therapist with enough skepticism to consume research more flexibly. As leaders of the field, the judicious Ph.D., can be imagined to influence Psy.Ds., social workers and life coaches. More importantly still, an education that challenges the status quo emboldens one’s
    capacity to challenge convenient beliefs, and push beyond the confines of a narrow comfort zone. It’s hard not to hear in Dr. Safran’s article a call to the research-practitioner to go back to the classroom and re-make the field in the image of critical-empirical-psychology. This is an exciting time to be apsychology student.

  • Lisa Rubin

    An excellent read, both for our current trainees and for our
    colleagues in NSSR (and beyond), describing the state and status of Clinical Psychology. Without having fully explored the history of the department (but knowing that Clinical Psychology arrived later on the scene), I suspect that Psychology was always a bit different and never quite fit comfortably into the interdisciplinary project of the NSSR, and that the forces spelled out here have only exacerbated that. However, I know that in coming to The New School, I still harbored hope that despite Psychology’s (near exclusive, and increasing)
    bend toward the natural sciences, the NSSR would be a place that psychology sat ‘in conversation’ with the social sciences and even humanities much moreso than elsewhere in the U.S. Moreover, I know many students that I work with have come
    here with the same hopes in mind, and indeed have been clamoring for more opportunities to be part of the critical dialogues, and interdisciplinary project that they envisioned from NSSR. We can (and have started!) to do more to make that a reality, beginning with changes to the curriculum that allow for more interdisciplinary coursework. Other opportunities, such as the new
    certificate in Gender and Sexuality Studies, have piqued the interests of many of our students. I believe the self-reflexivity that is discussed here is essential to the intellectual (and ethical) and survival of our field can be facilitated through interdisciplinary dialogue that promotes clarity about the values and assumptions that undergird both the content and the process of our work. In this way, The New School is unique positioned as a space to develop and support
    a more critical clinical psychology.

    There are challenges and contradictions to this project. This does not solve the time crunch that students face, as they try to gain
    sufficient clinical hours, testing experience, etc. to remain competitive for internship. Those who develop their interests in critical clinical psychology will experience a need to be “bicultural” as they juggle their lives in clinical/medical settings and academia, and this can be stressful, particularly if the proper supports are not in place. Developing a critical lens on our work — uncovering the ways in which gender and heteronormativity, white/able-bodied/class privilege play out
    in the neoliberal mental healthcare context (funded by big Pharma, biotech, and squeezed by insurance industries) redefine notions of normalcy and suffering – can leave one feeling paralyzed and untethered. This is where the being part of a community of scholars is invaluable, and my hope is that the program can be a
    hub for those wishing to push these boundaries, among peers and mentors open to
    doing the same.

    *****

    As this blog connects so many different intersecting nodes of
    concern, it was hard to know where to dive into the conversation. But, one point that struck me most was:

    Over time, psychologists’ expertise
    also came to be used increasingly in the workplace in order to motivate employees and increase productivity.

    This was part of the telling of the story of psychology in the
    U.S., but I couldn’t help but consider how it follows the discussion of
    clinical psychology in neoliberal times. Both in terms of our students’ experience of getting through the degree, but also of the ways in which our field is utilized by clients/patients. Students/workers/citizens no longer need to be motivated en masse by their employers. Rather, following on work by Foucault and Rose mentioned here, the ‘dilemma of the productivity’ is shifted onto the individual, who feels flawed/unworthy when failing to meet the new standards of efficiency and productivity (and beauty and ‘happiness’ and wealth…). Certainly, I have been referred many a client seeking treatment to
    help “manage” the anxiety, anger, and disillusionment (of this moment), with the hope of becoming through treatment more productive, and thus more accomplished. So, as we grapple with these matters, I wonder (how) can we, as critically minded clinical psychologists, help people survive and thrive in such a world, and also work to change it so that resisting this status quo is not medicalized with a DSM (or ICD) diagnosis. Adjustment disorders all around… or, perhaps these are not conditions that people ought to adjust to.

    • Jeremy Safran

      I appreciate your thoughtful comments Lisa. I will very briefly take up two of the themes you raise.

      1) Indeed students will need to become bicultural. If we lose contact with with mainstream clinical psychology, we will also lose our ability to have any impact on its future.

      2) the “time crunch” that students face is likely to become even more of a problem, if the critical/interdisciplinary emphasis is introduced, on top of everything else students need to learn. Finding a solution to this problem, is from my perspective one of the most serious practical barriers. I think that there are ways of doing it, but I think it is better to have that conversation further down the road.

  • Matt

    Terrific piece Jeremy. In deep solidarity.

    • Jeremy Safran

      Thanks Matt!

  • Peter Glick

    It’s a terrific piece, Jeremy. I’m pleased to see you continue to man the lighthouse for us all.

  • Eyal Rozmarin

    I am deeply grateful to Jeremy for this thorough and thought challenging text. So much to think about. And so I would like to focus on one aspect of it only, the way clinical psychology / psychotherapy should be conscious and critical of itself in its relations with social, historical and political forces. Still a rare awareness in our field.

    One of the responders to Jeremy’s text argued that clinical psychology is a sub-discipline of psychology as a science. In my view this is like saying that literature is a sub-discipline of grammar. Surely grammar has something to do with how literary texts are written and read, but the former is but one of many conditions and realities animating the latter. A novel is so much more than an ensemble of grammatical units. Similarly, so much more goes into any particular human condition as it presents itself for help in psychotherapy, and of the human experience of the (hopefully) helping relationship that is therapy.

    I find that the social, historical and political context of any particular life and any therapeutic relationship is crucial to understand. This does not mean that there aren’t many therapists who help their patients without having read Foucault and Adorno, but it does mean, I believe, as Jeremy suggests, that we are all always at risk of perpetuating the sometimes oppressive social norms and realities that have been making our patients miserable to start with. The relations between well-being and conformity are of course complex, not everyone seeks a critical enlightenment that could be both freeing and alienating. But perhaps as we are now (again hopefully) conscious of trying to enable out patients their gender and sexual experiences in defiance of old heteronormativity, we can begin to think about, for example, neo-liberal-normativity and how it structures and confounds our patients’ experience of themselves and their potentials.

    In my mind, figuring out how such critical awareness could be engaged on both the theoretical and clinical registers is one of the most exciting challenges presented these days to psychotherapy and psychoanalysis. More interdisciplinarity in training is essential, although as Jeremy rightly observed clinical psychology PhD students are already maxed out as it is. And as a result (one can hope yet again), less confidence in, and reliance on psychology as a traditional, that is, positivist body of applicable knowledge, greater emphasis on the emotional and ethical dilemmas of human life and how individuals might be helped in understanding and finding their ways through them.

    Thank you again Jeremy for helping us think.

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