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Fixing a Major Gap in Clinical and Counseling Psychology

Posted on May 8, 2019 at 9:10 PM

One of my concerns about modern clinical and counseling psychology is the degree to which any aspect that recognizes human complexity has been removed. Complex clinical decision-making and case formulation have been replaced by mechanical views of the therapy process. Clinical manuals rule the treatment approaches many clinicians take. These manuals provide a “paint-by-numbers” approach (a term first used in Silverman, 1996) where specific steps guide each treatment decision.

“Empirically-supported treatments” is frequently used to describe what modern therapy is supposed to emphasize but that term often seems devoid of any real meaning. It is supposed to reflect an understanding of clinical approaches emphasizing the scientific method. But this approach often utilizes science only in the most superficial ways.

Here is the way much of what is called “empirically-supported treatment” works. Hundreds, or even thousands, 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.

Counseling and psychotherapy are 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.

True scientific research guided understanding of how behaviors develop and what maintains them. 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 is the approach used for studying psychological processes. This type of research used to be emphasized much more than it is now for guiding psychotherapy. In fact, it used to be emphasized as much as clinical research. Laboratory and observational studies were used to more fully understand factors contributing to clinical issues. Basic psychological research was understood to more fully apply the scientific method than could ever be the case in clinical settings.

And basic psychological research does not mean just 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 Freud developed his theories of defense mechanisms, he made frequent references to Darwin. Harlowe’s work with monkeys was key to understanding the complex workings of emotional attachment. And Skinner used rats and pigeons almost exclusively in his work on understanding reinforcement and other behavioral processes.

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 psychotherapy.

Comparative psychology research has a benefit over human psychology research in that the scientific method can be applied more directly and more rigidly. Animals can be studied under a larger variety of situations and can be studied for longer periods of time than humans. Recent ethical changes championed by APA have certainly put appropriate limits on animal research and have set very strict rules on how animals need to be treated. But those rules have not changed the amount of very important information that can be garnered by rigidly-controlled studies and observations of animal behavior. Studying animal behaviors under this type of control, if you will excuse the cliché, helps us not only understand animals better but helps us understand ourselves better.

In recent years there have been some attempts to move forward into getting clinical psychologists again to recognize and incorporate more of comparative psychology into their approaches. I have been pleased to be involved in some of those efforts. I was one author of a recent book, along with Dr. Terry Maple, entitled “Comparative Psychology for Clinical Psychologists and Therapists” (Marston & Maple, 2016), which focused on addressing this issue directly. I also was pleased to be the Guest Editor of a recent Special Issue of “The International Journal of Comparative Psychology” entitled “Exploring the Intersection of Comparative Psychology and Clinical Psychology”. There are several members of SBNCP who wrote excellent articles for this Special Issue and it is available as an open-access publication at https://escholarship.org/uc/uclapsych_ijcp/30/0 (volume 30).

There are a few other books that address this very important issue. One book that looks at the issue from the perspective of psychiatry is Evolutionary psychiatry: A new beginning. There also was a recent “Call for Papers” in the APA journal “Translational Issues in Psychological Science” for a special issue entitled “Animal Models as Empirical Foundations for Practice” (http://www.apa.org/pubs/journals/tps/call-for-papers-animal-models.aspx). What is particularly promising about this planned Special Issues is the journal is specifically focused on involving graduate students at the very beginnings of their careers.

Undergraduate students show a strong interest in understanding animal behavior, even if their ultimate professional goals are clinical, but often lack the opportunity to study the subject. Colleges and universities need to be more open to offering these course selections (with a particular emphasis on helping students understand comparative psychology’s contributions to clinical psychology’s history and what modern comparative psychology offers aspiring clinicians). Graduate clinical programs have even less access to comparative psychology offerings even if students show a strong interest in the material. Given that the focus of clinical programs often has to be on what licensing agencies require, leaving less room for electives not related to licensing exams, there may be less room for courses specifically dedicated to comparative psychology. But even here there is often the opportunity for single lectures or special seminars to help students understand the importance that understanding behavior across human and nonhuman species has for understanding clinical conditions. Clinical students in the process of training will take the opportunity for learning experiences even if they are not earning school credit. What is most important for them is understanding how the material comparative psychology addresses is relevant to understanding the conditions they expect to treat.

Comparative psychology focuses primarily on the importance of basic research. This has, unfortunately, led to recent difficulties for the field as funding agencies and government and university programs emphasize applied research (Maple, 2016). My hope is that the next generation of clinical psychologists will have more of an understanding of comparative psychology and its importance than do recent generations of clinical professionals.

REFERENCES

Maple, T. L. (2016). The rise and fall of animal behavior labs: The future of comparative psychology. Animal Behavior and Cognition, 3(3), 131-134.

Marston, D. C., & Maple, T. L. (2016). Comparative psychology for clinical psychologists and therapists: What animal behavior can tell us about human psychology. Jessica Kingsley Publishers.

Silverman, W. H. (1996). Cookbooks, manuals, and paint-by-numbers: Psychotherapy in the 90's. Psychotherapy: Theory, Research, Practice, Training, 33(2), 207.

Stevens, A., & Price, J. (2015). Evolutionary psychiatry: A new beginning. Routledge.

 

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218 Comments

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8:53 PM on March 29, 2021 
What is state of direct observation...introspection and extrospection as a fundamental in balanced questioning/reporting...

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