Why Modern Clinical Psychology May Be in Trouble
Today's clinical science might actually limit professionals.
Posted October 9, 2018
As a psychologist with years of clinical experience, I get really concerned about where clinical psychology is headed. Psychotherapy used to be a search for true understanding of the human experience. This meant understanding all factors contributing to how people act and feel. It was only through this complex understanding that psychotherapists could help people find ways of changing for the better.
But clinical psychology has, in recent decades, become of shell of its former self. Complex clinical decision-making and case formulation have been replaced by mechanical views of the therapy process. Clinical manuals rule treatment approaches many clinicians take. These manuals provide a “paint-by-numbers” approach (Silverman, 1996) where specific steps guide each treatment decision. There is no room for variation as each case is treated the same as every other case with a similar diagnosis. Licensed professionals are not expected to incorporate their own insights and understandings but are expected to just follow each step towards a pre-determined goal (which is similarly lacking in any individuality).
Even the well-used phrase “empirically-supported treatments” (which sounds good on the surface) is similarly devoid of any real meaning. This is an understanding of clinical approaches that supposedly emphasize the scientific method. But this approach often utilizes science only in the most superficial ways.
Here’s how a typical approach to “empirically-supported treatment” works. Hundreds of individuals who all meet the same diagnostic criteria are grouped together and specific treatment steps are applied. Members of each group are subjected to the same sets of steps with little room for variability or individuality. There is no focus on “why” problems occur. Nor is there a focus on “why” treatment steps work. There is just a focus on finding steps that work for the largest groups and sharing those specific steps with any many clinicians as possible.
Actually, it is much the same way that medicine is practiced. Physicians often prescribe medications without necessarily knowing exactly why they work. There may be some recollection of biochemistry in medical school but it is not necessary that the physician recall those details while following what medical texts say should be prescribed.
Using treatments without knowing exactly why they work is not in and of itself a problem. It is just that psychotherapy is supposed to be different.
Psychotherapy is supposed to emphasize a full understanding of why people act the way they do. Freud emphasized defense mechanisms, Harlow focused on emotional attachment and Skinner highlighted reinforcement. All the most prominent names in clinical psychology, at least up until this century, recognized understanding problems to be as important as understanding specific treatment approaches.
Science used to be incorporated throughout psychotherapeutic work. There were scientific studies of personality traits contributing to depression, anxiety and other disorders. True scientific research guided understanding of how behaviors develop and what kept them going. Conflicts occurring between individuals, and also conflicts occurring within individuals, were researched in very detailed ways. All of these issues continue to be studied but are given much less emphasis in modern clinical psychology, compared to the step-by-step therapy approaches.
Basic psychological research, as opposed to clinical psychological research, emphasizes the search for the “whys” of human emotions and behaviors. This is what makes up the scientific search for all important factors contributing to what people do and how they feel. It is the type of research that made up the bulk of psychological science up until a few decades ago. But it is also a type of research that has been less and less prominent during those decades.
And basic psychological research does not just mean research on humans. Comparative psychology, the study of behavior across different species, has been a major part of understanding human actions throughout the history of clinical psychology. Animal research played a major role in the development in each major school of psychotherapeutic thought. When the emphasis was on incorporating comparative psychology into understanding clinical psychology there was naturally an incorporation of complexities into treatment approaches. And those complexities have been lost in contemporary approaches to psychotherapy.
Basic psychological research is necessary for fully understanding the human experience and is essential for helping clinicians understand how to help people. It is only through this type of research that clinical professionals are likely to understand all they need to understand to help people change.
So, when you read about psychological research that seems useless, try to give it a second thought. Understanding things like why birds build their nests in certain ways, or what sort of noises make people feel sad, may seem useless at first. But each psychological research study may hold in it a key to understanding one small part of human functioning. And the more parts clinical professionals can understand, the more people they are likely to really help.
Silverman, W. H. (1996). Cookbooks, manuals, and paint-by-numbers: Psychotherapy in the 90's. Psychotherapy: Theory, Research, Practice, Training, 33(2), 207.