In this issue

Outgoing President's Message

Who stole psychology and how might humanistic psychologists get it back?

By Maureen O'Hara

In the past month stories about the APA's complicity in the use of torture-sorry-enhanced  interrogation techniques-have shown that the observation  that a small group of committed people can change the world holds true not only for those interested in enhancing the human condition, but also the reverse-- particularly when that group is very focused, has the support of a US Senator, the apparatus of government, senior executives of the organization, and a largely disengaged and complicit membership to work with.  Small groups can and do change the world-it's called cultural leadership. 

Former APA Executive Director Bryant Welch, writing recently about APA and torture for the Huffington Post, remarks psychology used to be a liberal field. (Welch, 2009)   And certainly from accounts in undergraduate psychology text books about the contributions of psychology's pioneers, people entering graduate school can be forgiven for believing it still is a liberal discipline, aimed at caring for those who are suffering, working for social justice, and cleansing the doors of perception of those seeking to become more fully actualized.  

Once accepted into a doctoral program (I know there are inspiring exceptions to this, but among APA accredited programs these are rare and becoming rarer) it doesn't take students long to learn that that clinical psychology has become a lot like the medical world it once challenged and now emulates--a conservative professional guild with a particular way of understanding the world that aims more at behavioral engineering,  control of deviance,  and professional advancement , than it does on human liberation,  wellbeing, and growth. As David Elkins writes in his upcoming book, Humanistic Psychology: A Clinical Manifesto, to be published later this year by University of the Rockies Press:

To their consternation, students discover that many of their professors and supervisors are not impressed by their compassionate attitudes and interpersonal abilities.  They are told, implicitly or explicitly, that to become a "real psychologist," they must learn to think in medical model terms and learn medical model techniques and procedures.  Oh yes, warmth and compassion are all fine and good but only as ways to "soften up" clients so that they will be more cooperative and compliant with the "treatment." […]  By the end of their doctoral training, most students have been transformed into medical-like experts who "diagnose" "pathology" and "administer treatments" to "cure" "mental disorders."  They have become "junior physicians." {Elkins, in press}

Loaded down with APA required courses on statistical methods, diagnosis of "pathology" and insistence that students are fully trained in evidence based "disorder-specific treatment plans", and complete their internships in APA approved sites (if they can find one) these aspiring healers are left little time for philosophical exploration, study of the humanities, engagement with politics and spirituality, critical perspectives or alternative therapeutic paradigms. Cultural leadership will have to wait.  To survive and get through school without owing two fortunes, not just one, these once idealistic folks either drink the KoolAid and "go native"--adopting the world view and values of the culture they find themselves in-or reluctantly suck it up for the next several years, hoping to reclaim their vocation, their dreams of social transformation,  their solidarity with the disenfranchised and the oppressed until after they have graduated, earned their ticket to make a living and paid off some of their mountain of tuition debt.   

Over the last two decades psychology has undergone a conservative restoration of sorts,  sliding back to its philosophical and methodological roots as a would-be natural science. The clinical divisions and the practice directorate have become more entrenched than ever in the conceptual frames, unexamined assumptions, metaphors, metaphysics, logics, view of human nature, epistemologies, ways of explaining existential  reality, that founding humanistic psychologists Carl Rogers,  Abraham Maslow and many others,  identified as part the problem of modern life, not the  solution.  After a period in the ‘60s and ‘70s  when psychologists thought enough about Rogers' and Maslow's transformational ideas to elect them both President of APA,  the movement within APA's clinical practice divisions and the efforts of its gatekeeper classes has been inexorably back towards a modernist medical paradigm that objectifies people as “patients,” considers those suffering distress as having diagnosable mental illnesses, disordered  or "sick" and prescribes the use of  "goal directed disorder specific treatments" including drugs to be  "provided" by experts who know what's best for them. Though permitted prescription power in only two states so far, in the last several years APA has spent millions of our dollars attempting to get state boards of psychology to give psychologists the power to write prescriptions.  

Now, I am no Luddite and if this paradigmatic shift towards psychology becoming a subspecialty of medicine had been accomplished through the accumulation of evidence that demonstrates the validity of these theories and the superiority of their application over other forms of practice, then all well and good.  But as we all know, that is not the case (Wampold, 2005). The paradigm wars in the APA have been won through politics not science.    

To justify its shift to the right, APA has been able to take advantage of conservative cultural shifts in the wider society since the "Reagan revolution" of the 1980s.   In the same way the humanistic psychology rode the left- moving wave of the liberal 1960s and '70s, those in power in APA have successfully ridden the wave back to the political right taken by much of the rest of America.   Through its gatekeepers on the Commission on Accreditation, editorships of the Monitor and the American Psychologist, the APA website, PR efforts, the inside the beltway habitat, its relationship to government and the military, to the drug industry and insurance and managed care companies, APA has consolidated its position in an "expert centered" health care industry that fits neatly into a world view dominated by command and control thinking, corporate interests and marketplace values.

This industrialization of care was supposed to make psychological help more accessible and affordable, but  according to research done by the California Mental Health Care Workforce group it has not done so (McRee, T., C. Dower, et al. 2003). Quite the reverse, with most clinical psychologists now concentrated in affluent urban centers where people can afford health insurance and where 45% can afford to pay out of pocket for the therapeutic orientation of their choice.  Services of any kind are still very hard come by in rural and poor areas-in some California counties there is not one single licensed psychologist--with perhaps hundreds of thousands of people nationally suffering severely or moderately for the want of humane, low cost, community based and client-centered services.  

Humanistic psychology was born out of an intention to change the frames through which psychology saw itself and the world.  The cover of Goble’s book The Third Force: The Psychology of Abraham Maslow is the observation that Maslow, "was challenging the most basic precepts on which the study of man has been based for a century."(Goble, 1970).  Maslow himself said of humanistic psychology, "this is not an improvement of something, this is a complete change of direction."(Goble, 1970). 

In my Spring 2009 president’s letter, I commented that humanistic psychologists always have had a radical social transformation agenda and have regarded their work as cultural leadership towards an advancement in consciousness.  Though many early humanistic psychologists were invested in healing, Maslow was not interested in developing a new form of therapeutic intervention and neither was Rogers. As early as the 1940s he said, “Therapy is not a matter of doing something to the individual …instead it is a matter freeing him for normal growth and development” (Rogers, 1997, p.6). The target of the Third Force was transformation of virtually every aspect of human experience--science, mental health, education, business, religion, and politics to free people to pursue their highest development.  This new psychology was to be a Copernican revolution, with a new world view, a new understanding of the uniquely human experience, and new ways of thinking about how to organize self and society.  To the degree to which this led to therapeutic change, well and good, but for Rogers and Maslow-and many others over the intervening decades, including me--though welcome as an additional benefit, this was not the highest purpose of the humanistic program.  

Humanistic psychologists aimed to take psychology back from the physicians, natural scientists and behaviorists and to reframe it as part of a larger cultural movement toward an expanded view of human possibilities that it shared with other emancipatory movements. These included the civil rights and feminist struggles, the gay rights movement, the anti-nuclear , anti-war and peace and reconciliation movements and the embryonic "green" movement, where issues of liberty, love, diversity of perspectives, personal identity, spiritual aspiration, systems thinking, creativity, imagination, values, politics,  and a critique of the embedded practices of power, were all gist for the psychologist's mill.  Maslow and his colleagues lay down the theoretical gauntlet to the leaders in the discipline who proclaimed such philosophical and paradigmatic issues settled, and argued that clinical psychology -and the mental health disciplines in general--could now comfortably settle down to the business of being a unified values neutral discipline whose only moral obligation was to the methods of normal medical science (Miller, 1992).

Well, a generation later we can see how the story played out, with clinical psychology now narrowly conceived of as a "health care field".  Since and the publication of the DSM III the 1980s psychology has wedded itself to systems of categorization that serves government policy.  insurance and drug company interests far more than clients'.  Clinical psychology has become mired in reductionist and instrumentalist thinking, offering overly simplistic explanations for complex and emergent human phenomena.  In the arena of practice this has led directly to the dominance of short term individually focused cognitive therapies and marginalization of concerns about context, consciousness and values.  Human distress is met with a soul killing overuse of psychoactive medications for everyone from infants to centenarians.  

But humanistic leaders were once optimistic and believed that their new view point was so compelling as to be unstoppable.  It was only a matter of time, they thought, before all psychology embraced this new paradigm. Many believed that the creation of the Division 32 within APA meant somehow that humanistic psychology had become academically respectable and a paradigmatic transformation of the whole field was just around the corner.  At the 25th anniversary conference of the Association for Humanistic Psychology Rogers declared the battle won and pointed to humanistic programs in education, psychotherapy, the proliferation of growth centers, alternative schools, and grass roots humanistic activism as evidence of success.

What was tragically missing in those heady times, when innovation, experimentation, exuberance (and hubris) were the names of the game, was any real understanding of institutional power, political savvy and organizational dynamic.  Though it is clear that the hi-jack of the emancipatory spirit of those times was accomplished by a concerted and well funded campaign from religious and political right,  I have to believe that had those humanistic pioneers been trained as community organizers in the Alinsky tradition for example, instead of as academics, they would have been better prepared for the backlash that was inevitably generated  by their radical challenge to the established power structures. They might also have predicted that the power elites within APA and those who shared their interests were unlikely to step aside without a fight.  A fight that the Third Force, with most of its strength already outside the academy, with its preference for dialogue and its aversion to sharp elbows and old school political organizing (or any organizing at all) when pitted against the power of a professional organization with over one hundred and fifty thousand members as of 2009,  could not, and ultimately did not win.

The huge strategic mistake we humanistic psychologists made was allowing the emancipatory framing that deliberately put the humanistic discourse outside of, alternative to, and critical of medicalized psychology, to become seduced and co-opted by it. 

Over my almost 30 year career as a psychologist I have watched the seduction take hold.   I have heard all the arguments and rationalizations and gone along with a few of them, "Students need to get licenses to practice legally", "It is possible to give unto Caesar by buying into the medical paradigm just so far, while doing emancipatory work once the office door is closed";  "We need to be realistic because practitioners need to earn a living";  "Some clients need medicalized treatment or need a diagnosis to get insurance reimbursements";  "APA has become more open to diversity so we can seek accreditation without selling out" ; "Our graduate programs won't survive if we don't offer mainstream training" and so on and so on. 

All reasonable, but compromise by compromise,  humanistic and transpersonal psychologists too have slouched towards the medical world.  In the 1970s Dick Farson, a colleague of Rogers and Dean at California Institute of the Arts for a time, asked how different humanistic psychology would have been if instead framing itself  in the language of psychotherapy we had used the framing of theater asking not does it work as a therapy but does it mean something as an experience.   But the gravitational lure of the medical solar system, even for a minor planet, was too strong.  Instead we held our noses, swallowed our medicine, bought and taught each new edition of the DSM and billed insurance.  We now justify humanistic approaches not as paths to greater freedom, as vehicles for self-fulfillment, wholeness and deeper engagement with experience, nor as a moral framework that aims at social justice and relationships of mutual respect, but rather because they are as effective as CBT in reducing the symptoms of depression.  In my view that process of gradual compromise has robbed everyone, future humanistic psychologists and the broader society, of what humanistic psychology really had and still has to offer—not a better mousetrap, but a new way of thinking about human possibilities.   But that was then, and this is now. The signs are everywhere that the mental health "industry" is close to collapsing under its own ineffectiveness.  People across the spectrum-- from left to right and from consumers to the President--are crying out for innovation in how we address the psychological wellbeing of individuals and communities without going bankrupt.  The gravy train that fueled the rise of medicalized psychology and made our compromises with it if not wise then at least pay off , is running on empty and if we are to avoid unaddressed suffering on a massive scale we urgently need new ways of thinking about psychological health.   Business as usual is not working and within the industry new ideas are in short supply.  

People at all levels are waking up to the need to reframe the looming issues of the day such as health care.  In a recent session with health care workers dealing with a funding crisis in a metropolitan mental health system, my colleagues from the International Futures Forum asked the question, "What are you all pretending is true that you know in your heart is not?"  Their collective answers shocked everyone and revealed a disturbing level of complicity in a failing system. Answers included,  "pretending a 15 minutes med check is sufficient to establish trust and figure out what's wrong", "that people from the mildly anxious to the acutely psychotic need expert care," " that there is a correlation between years of training and practitioner effectiveness",  that the "despair we see every day is due to "illness" that we can "treat" with CBT and drugs when we know it is the result of poverty, deprivation and abuse," and,   "what I do as a counselor will lead to a better outcome for a homeless client than a job, social support and what they can do for themselves,  when evidence suggest otherwise".  Even more shocking for a group of mental health professionals was that they volunteered that they believed the mental health care system contributed more to the well being of providers-in salaries, status and professional identity--than it did those seeking help, who were often subjected to dehumanizing revolving door pseudo-treatment and subtly encouraged to become dependent on counselors, therapists, welfare workers, rather than empowered participants in their own recovery.  

It is not hard to find people in leadership roles who believe the industrial health care system is broken.  That is both the bad news, and the good news.  Prone as I am to seeing opportunities even in very dark scenarios I am willing to predict that as the old mental health system melts down, a huge opportunity for radical innovation is going to open up.  I want us to be ready for it.  

I anticipate, not unreasonably if California is any bellwether, that no matter how conservative those in power within APA have become, that except for services to the severely distressed, the era of psychologist domination of the mental health world is rapidly ending.  I also expect that if practitioners have the gumption to offer low cost innovations that seek to enhance human capacities and develop approaches that will mobilize clients' resilience and inborn drive towards self-healing and self- actualization and spread the word, the best days of the humanistic vision may be ahead of us, not behind us. 

Here's why I say this.   In 2004, Californians passed the Mental Health Services Act that mandates funds for an entirely new approach to mental health care. The language in the Bill opens the door for a humanistic response. One section reads:

This program combines prevention services with a full range of integrated services to treat the whole person... These successful programs, including prevention, emphasize client-centered, family focused and community-based services that are culturally and linguistically competent and are provided in an integrated services system. (Accessed online)

Thanks to Proposition 63, between  250 and 500 million new dollars are now available for mental healthcare. (Even during these economic hard times when California is near bankrupt the voters  turned down a bill that would have diverted some of this money).   But there is a catch. These monies cannot be used to support "business as usual".  In the language of the bill itself consumers and taxpayers demanded a less pathologizing, more prevention and community oriented and client--centered approach. Yes, the term "client-centered" is right there in the bill.   I do not think they are referring to classical Rogerian therapy, but they are pointing to a philosophical shift from seeing authority for care as vested in experts to a view in which people are seen as empowered participants in their own healing and growth.  They are making this shift because the research supports such a move and because the empowered citizens of California demand it.

What does this mean for the future of humanistic psychology? 

This is not the place for a detailed "to do" list but I do have some ideas.

The first and perhaps the most difficult step is that must give up the benefits of sleeping with the enemy.  If battered women have taught us anything in their struggles to get free of abusive spouses or addicts about how to get free of their dependency, we need to stop kidding ourselves that just being inside the tent means we are free and we have won the fight for legitimacy.  As long as we are willing to tailor humanistic and transpersonal doctoral programs to become acceptable to a legitimization industry whose entire world view, values and conceptual framings have no room in them for ours, we will never be able to establish any real alternative on its own terms.  No one can obey the instruction to "not think about diagnosis" even if they think you can.  

Branch out.  There are new humanistic professions waiting to be developed.  Just look at how coaching has exploded over the last decade.   We must prepare current and future doctoral students to succeed in a world where most counseling and psychotherapy will be done--if at all--by Masters level practitioners, at lower market rates. Regardless of APA's mandates about doctoral curriculum we need to make sure that graduates from humanistic programs are prepared for diverse careers and not only as mental health providers.  We should be helping then prepare for jobs as teachers in new Masters specialties onsite and online, administrators, program designers, grant writers, project managers, community organizers, support group facilitators, psycho-educators, and team members in new kinds of systems of care.

We need to develop diverse Masters degree programs built around innovative compilations of knowledge, skills and attitudes .  These might include psychological literacy education in K-12, effective parenting education and early interventions to build resilience, elder wellness, client self-care, community organizing, immigrant integration, facilitation of civil society initiatives for housing, child care, spiritual comfort and guidance, and a host of other human-to-human activities.  

Given that the future will emerge through political as well scholarly savvy, it will be important for humanistic psychologists get involved in policy discussions now swirling around the future of health care. We have something very powerful to offer those who make decisions that could help them focus on developing approaches that liberate the self-healing potential of clients that we all know is there and put the professionals in the role of educators and facilitators who are there to, as Albee said, "to give psychology away". 

And last but not least, we must learn to use the new social networking media to get our ideas out of the academy and into the street. Our journals are of very high quality but of a fairly narrow reach, while the ideas of humanistic psychology speak directly and powerfully to a wider public who want simpler language and more personally relevant information.  APA has a website that gives out advice on everything from stage fright to schizophrenia.  We can follow their lead.  We can identify those in the larger society who are already speaking in voices that resonate with the humanistic vision-starting with a President who talks of empathy, dialog and community as issues of foreign and domestic policy.  With press releases at the ready we can support and strengthen progressive positions with information from the original psychology of hope. As we have seen in Iran these past weeks, electronic media changes the power dynamics of everything.  It gives everyone a chance to be heard, allows ideas to find new audiences and it permits small groups to find each other.  

The humanistic message is once more on the ascendant. When an American President takes his daughters to a slave-trade marshalling prison and acknowledges both our capacity for evil and the possibility for transcendance, and hopes it will lead them to work to and oppression, he is talking our language.   When Californians vote for non-pathologizing mental health services, they are talking our language.  As I said, small groups can change the world—yes we can.

References

  • Anand, P., Hunter, G., & Smith, R. ((2005)). Capabilities and Wellbeing: evidence based on the Sen-Nussbaum approach to welfare. Social Indicators Research, 74:, 9-55.
  • Davidson, G., Sanson, A & Gridley, H ,. (2000). Australian psychology and Australia's Indigenous people: Existing and emerging narratives. Australian Psychologist, 35, 92-99.
  • Elkins, D. N. (In press). Humanistic Psychology: A Critique of Clinical Psychology and the Need for Progressive Alternatives. Boulder, Colo: University of the Rockies Press 
  • Goble, F. G. (1970). The Third Force: The psychology of Abraham Maslow. New York: Pocket Books.
  • McRee, T., Dower, C., Briggance, B., Vance, J., D, K., & O’Neil, E. (2003). Mental Health Workforce: Who's meeting California's needs? : UCSF Center for the Health Professions.
  • Miller, R. D. (1992). The restoration of dialogue: Readings in the philosophy of clinical psychology. Washington, D. C. : American psychological Association.
  • Rogers, C. R. (1977). Carl Rogers on personal power: Inner strength and its revolutionary impact. Dell: New York.  
  • Wampold, B. E. (2005 ). Do therapies designated as ESTs for specific disorders produce outcomes superior to non-EST therapies?  Not a scintilla of evidence to support ESTs as more effective than other treatments.  . In J. C. Norcross, L. E. Beutler & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions (pp. 299-308, 317-319). Washington , DC: American Psychological Association. .
  • Welch, B. (2009, June, 18, 2009). Torture, Psychology and Daniel Inouye: The true story behind psychology's role in torture. Huffington Post. Accessed June 26, 2009 http://www.huffingtonpost.com/bryant-welch/torture-psychology-and-da_b_215612.html