Post 3 of 4 : Ans. to FAQs: "Info. & Precautions for Therapy
Cognitee
Post 3 : Ans. to FAQs: "Information and Precautions for Psychotherapy
Consumers":
Part 6:
Complaints of *GROSS NEGLIGENCE* Should be Filed Against the APA
The nature of the overall complaint is directly below. More about the
specific deficiencies leading to the complaint are below that:
THE POSITION AND GENERAL COMPLAINT:
It is my view that as surely as we hold the medical establishment
(e.g. the CDC) responsible for epidemics of physical health, and as
surely
as we hold the Fed. Trans. Safety Board responsible for airline safety,
the
Amer. Psychological Assoc. has some notable responsibility for services
needed if they are not being provided.
With the present critical rise in teen suicides, I question whether
all that is reasonable and responsible is being done for the provision
of a
system of mental health care. If a problem goes unabated, the answer is
(as
it would be for other agencies or institutions): "NO". I have argued
that
the psychological establishment is *grossly* negligent in providing
encouragements for basic foundation research that would point up special
needs where professional work is most needed (and thus lead to the
development of better care through reasonable specialization) *AND*
would
lead to the development of a SYSTEM of mental health care providers AS
IS
REASONABLE, with a variety of roles. I also see the organization failing
to
support the development of a common and reasonable science-practitioner
role that IS arguably THE ONLY THING that will advance the science
generally. I have clearly outlined the nature of problems and
deficiencies
and they are not being addressed. There is a general self-satisfaction
OR a
willingness to improve only on their terms; clinical psychologists and
their major parent organization show no willingness to make many
improvements OR even any willingness to do investigations that may lead
to
more reasonable specializations OF ROLES in the field and improvements
in
services.
The pompous presumptuousness and pretentiousness of clinical
psychologists, I say, is beginning to kill our children. We've seen the
record of the APA and its members on mental health care for a long time
now. How long are we going to give them ?? At least we can see the rise
in
psychological problems unabated as a sign that CLINICAL psychologists
are
not doing a good job, can't we? OR SHOULD THEY BE ALLOWED TO SIMPLY TAKE
RESPONSIBILITY (AND CREDIT) AS CONVENIENT?? NOBODY'S GOING TO LET THEM
DO
THAT. Snake oil "works" sometimes, too.
Although the APA is not a government institution my point largely
stands !! Especially since there is no government agency in the role of
"policing-of-needs" job for clinical psychologists. Some say "the APA is
just a professional organization." Not so; it is an accrediting body for
programs in higher education !!!! Think about this situation:
How would you like it if the standards of good research and
training
for a profession were accredited (and monitored) by a private guild
union
out to promote its membership AS IS? How would you like this to be true
when the standards of self-representation and practice of this
professional
group has been (for a century now) based in good part ON MYTH? How would
you like it if the training programs I'm referring to take place in
UNIVERSITIES, in programs ostensibly offering the best (and "highest
level") of training? Well, this is precisely the case with universities
and
the American Psychological Association. This private lobby organization
ACCREDITS programs of public higher education at the highest levels. It
is
also very clearly possible to show that basic foundation research has
not
been done to establish the counseling/therapy field -- to show where it
stands, how services offered compare to the help that might be provided
by
other reasonable helpers AND related research that would show where
special
techniques and treatments really need to be developed. It is very
possible
to argue that there is gross negligence in the reasonable provision of
treatment because of self-protective presumptions on the part of the
group
and their lobby organization, the APA. The APA, I believe, is now
culpable
for gross negligence in failing to make reasonable provisions for care
and
could be sued by families whose members have suffered from needless low
levels of care and from unreasonably unspecialized care.
What the guild lobby and union (the APA) has done is to secure a
*legal* status for its members (i.e. they have lobbied for a position of
power in society and have to some large degree achieved that). Only
people
with certain higher ed. qualifications (and a license) can represent
themselves a "psychologists," offering services clinically. Now this
would
be fine, but this licensure, ETC. is no guarantee of quality in
standards
or practices OR quality in education !! And the APA is doing an
absolutely
awful job of securing good research and (relatedly) good education and
standards in-practice.
It is my view that the point has been reached where clinical
psychologists do more to hold up AND PREVENT needed services and science
progress than they do good. The APA basically facilitates this. Others
could step in and likely do most of the job clinical psychologists now
do.
And I do hold the APA and clinical psychologists responsible for
deaths already. There has been more of a concern about power and
politics
(e.g. licensing and laws giving clinical psychologists exclusive "turf")
than there has been concern OR INVESTMENT for developing an appropriate
tested science. Now I know they have their myths, convenient concerns,
and
rationalizations, BUT THAT DOESN'T MEAN A THING. These "professionals"
have
all the trappings and glory a group could possibly have and be so
useless.
I have indicated basic foundation research needed and why. The points
are
OBVIOUSLY unassailable, except on grounds of presumption, myth, and
pretense. All clinical people (INCLUDING THE NEW APA PRESIDENT, SELIGMAN
HIMSELF) try to do is drag down (they hope once and for all) the few
studies that have been done on some important questions. AND THEY ARGUE
SO
ALL MIGHT BE SATISFIED WITH POOR SCIENCE ! They like to discount gaps in
research by citing the presence of *other largely unrelated* pieces of
research. Well, in real science, one thing does not make up for ANOTHER
!!
They support basically whatever studies SEEMS TO BACK THEM (pick and
choose). They are NEEDLESSLY SATISFIED WITH poorer studies than could be
done and with studies that are less than that which would be needed to
back
things-as-they-are.
The research on the question of professional efficacy vs. other
helpers (not yet well answered at all and which has been neglected for
17
years, since the last good study) is pivotal to providing a sound basis
for
the creation of a system of personnel as mental health resources *AND*
to
finding the truly difficult problems where professional work should be
concentrated. AND: Nothing has been done AS APPROPRIATE, given the
nature
of the subject matter, to set up a system that would yield continuously
improving inter-rater reliabilities on many fronts. The local science-
practitioner role I have outlined would do this, and having
counselors/therapists become such practitioners should be part and
parcel
of graduate training. If each training institution had some
*continuously*
ON-GOING specialized research, this would also help greatly (though this
alone may not suffice).
"Therapists" are often nothing but a bunch of self-serving, hacks.
They practice "science" (act. technology, or an "apparent form" of
such),
as convenient (usually as an isolated incident to get their degree), and
otherwise make claims of "art" as convenient. Well, it is all both at
the
same time. The emphasizing one or the other as convenient for propaganda
has to stop. Adaptational problems are becoming more rampant in our
society. Children are dying by their own hands. Maybe clinical
psychologists don't think that is worth talking about, but others may.
P.S. It will not be long before even those without clear knowledge of
where
the "science" is, of the short-comings of the field, and of the active
avoidance of science foundation research, come to view clinical
psychology
as deficient. When Skinner's ideas for learning (after Sputnik) were not
thought up to it, look what happened to him. Given the APA and clinical
psychologists show insufficient initiative in the field, possibly the
psychiatrists will end up with the real job. It really doesn't take
people
who "know much", because no one does. It may (given how crude things
are)
just take caring psychiatrists to turn things around. Maybe no one will
turn things around.
---------------------------------------------
Nature of Deficiencies Seen in research and practice, leading to the
complaint:
Review of argument, in brief:
The modus operandi is wrong for good continuing (integrated)
research
on several fronts and real science. The RECORD shows us more here: Just
one
example: The DSM committee had very, very, very few studies on
inter-rater
reliabilities of diagnostic criteria to look at before they came up with
DSM-IV options. Look at the 40 most common diagnoses (DSM-IV Sourcebook,
Vol. 2): the committee had far less than half that many studies on the
reliability of criteria (and this is even though there are multiple
criteria (often around 8) for each disorder). This is very telling. ARE
WE
GOING TO LET THIS HAPPEN AGAIN BETWEEN THE DSM-IV AND DSM-V???? I have
argued for a true science practitioner role, where clinical
psychologists
(typically) work together regularly to develop (on a continuing basis)
better and better inter-rater reliabilities about diagnoses (or
behavioral
problems), treatments, and assessing outcomes.
The fact that only 2 sorts of control groups (placebo and waitlist)
are used is very telling. This leaves all questions about the efficacy
of
"professionals" vs. other reasonable sources of help unanswered and IN
ONE
MAJOR WAY does not allow us to locate the most serious problems
objectively
and concentrate professional resources there. Where new treatments need
to
be developed they are not. Also it does not allow us to to get
indications
about the utility of briefly trained peer counselors or
"paraprofessionals," so as to provide more helpers. That way we could
have
more help and more accessible help where possible and prudent. The
negligence is overwhelming. ARE THEY GOING TO CONTINUE TO FAIL TO
RATIONALLY INVESTIGATE PROVIDING A SYSTEM OF MENTAL HEALTH PERSONNEL??
ARE
AREAS, WHERE A CONCENTRATION OF EFFORTS ARE NEEDED TO DEVISE NEW OR
BETTER
TREATMENTS, GOING TO REMAIN UNFOUND??? Pretentious clinical
psychologists
are our killing children right now. They have been exposed. The sort of
answer needed has been outlined. Someone will bring this field down soon
if
changes are not made.
Complaints of gross negligence should be filed against the APA
frequently. Only by hitting "deep-pockets" can we force and assure
quality
treatments.
Some Concluding Remarks:
HMOs are squeezing out mental health care AND it is the field's own
fault ! Why? Two big reasons: (1) Basic foundation research to show that
professionals are better than other reasonable sorts of helpers (e.g.
well
selected and trained peer counselors or "paras") have not been done. The
last well controlled study done on this was done in 1979 and it showed
the
other reasonable helpers just as good for a broad range of problems.
Supposedly progress has been made, but the field is too cowardly to test
themselves or establish the basic foundation for their field. I have
argued
how these studies, using more briefly trained (and well-selected) "other
helpers," are just as ethical as many of the "efficacy" or effectiveness
studies done nowadays. AND, I have ALSO argued how these studies ARE
NECESSARY to help illuminate those problems for which special methods
need
*yet* to be developed. The counseling/clinical psychology field has let
us
down. We are all suffering because of this. And because of the low
credibility of the field and the lack of clear results and established
procedures in many areas, HMOs are providing GROSSLY inadequate mental
health care. AGAIN, it is the field's fault, basically for the reason
just
outlined above AND because of (2) (below):
(2) The field has yet to establish any common sort of REAL
science-practitioner role that would result in MUCH MUCH more work being
done to show inter-rater reliabilities to diagnoses (or problem
identifications) and with subsequent treatments and results. Many in the
field of counseling/clinical psychology LARGELY FALSELY claiming a
"science-practitioner" role. This is typically at least largely a fraud.
Typically clinicians do not work within individual agencies developing
and
showing any inter-rater reliabilities. Because of this, we KNOW they are
not science-practitioners. I have gone on to argue that they do not even
operate IN ACCORD with science, for there are too few studies and FAR
too
few continuing studies for there to be clear procedures to model for
most
problems. Thus, for most problems, "therapists" do not even operate IN
ACCORD with science (like your local M.D. most often does). Being an
intelligent "science reader" and extrapolating idiosyncratically from
studies does not make one a science practitioner, in even the loosest
sense. To be a science *reader* is not even a particularly professional
activity; many intelligent lay persons can do this (and EXTRAPOLATE AS
WELL). BECAUSE THERE ARE OFTEN NO STANDARD, ESTABLISHED PROCEDURES FOR
PROBLEMS, HMOS ARE GOING BY THE MORE EXTRAVAGANT CLAIMS OF SUCCESS,
DENYING
MANY OF US THE NEEDED CARE. At the same time, some problems are not
being
treated because they are not seen as treatment worthy or treatable. THE
**FIELD ITSELF** IS TO BE BLAMED.
-------------------
For additional well-justified and well-supported criticisms of the
counseling/"therapy" field, see House of Cards by Robyn Dawes (1994).
This
book is now available in paperback from The Free Press (N.Y., N.Y.
1996).
The author is a former clinical researcher and the book is thoroughly
grounded in the research literature. One thing Dawes describes is the
clear, large body of evidence that "clinical judgment" is virtually
never
helpful in predicting the future behavior of clients. Only formal
(standardized) sorts of assessments have been shown to be of any
predictive
value. Over 140 studies on this matter *virtually all show* that
"clinical
judgment" either doesn't help *OR hurts* the ability to predict several
client behaviors (one behavior that is especially noteworthy here is
violence).
-------------------------
-------------------------
** FOOTNOTE to Part 3: The way progress in developing "better"
diagnostic
criteria proceeds today illustrates what is wrong with the way things
operate and are done today. It displays the lack of appreciation for the
grassroots INDUCTIVE work that, it seems to me, has to be done. True,
the
"diagnostic options" decided on by the DSM COMMITTEES every decade or so
*are tested* AFTER THE FACT for inter-rater reliability (AS I MYSELF AM
AWARE, and as I indicated in the essay). BUT, the problem is: Do you
wait
for rare committee meetings to try to piece together a set of best
"options" on a relatively rare basis OR do you strive for better
reliabilities for criteria *AND better criteria* more often, on a more
local level ?? Yes, PEOPLE must first have "guesses" about what might be
better criteria and *then* investigate them. BUT this need not ALL be
done
by rare committees ALONE doing this work. Doing virtually all such
diagnostic development work JUST by committee (meeting every decade or
so)
is loaded on a hypothetico-deductive side as opposed to a grassroots,
more
inductive, discovery (and yes, trial and error) approach.
One could argue that INDEED you DO (and MUST) **DISCOVER*** the
better
criteria, rather than formulate them en masse in our heads during "big
committee" meetings. What our present attitude suggests, and what is
done
now, is the figuring of nature out in our heads and then (only
afterward)
testing your limited range of relatively constrained ideas. Wouldn't it
be
better for some local consistent (**everyday**) work to go on to find
criteria that are understandable and show (demonstrate) inter rater
reliabilities and also relate to disorders? SHOULDN'T THIS AT LEAST BE
DONE
*IN ADDITION* TO THE inter-rater reliability work associated every
decade
or so with "committee work" ? PRESENTLY THIS IS NOT DONE, AND I WOULD
ARGUE
IS ONE BIG THING THAT HOLDS UP DEVELOPMENT OF THE FIELD. We are
basically
both being pompous and pretentious, while at the same time abdicating
basic
science responsibilities.
---------------------------------------------
Please go on to the Addendum (the Addendum is Post 4)