Mistakes Were Made - Carol Tavris [50]
The mental-health professions are different. People who work in these fields have an amalgam of credentials, training, and approaches that often bear little connection to one another. Imagine that the profession of law consisted of people who attended law school, studied every topic within the law, and passed the grueling bar exam; and of people who only paid $78 and took a weekend course in courtroom etiquette. You will have a glimpse of the problem.
In the profession of psychotherapy, clinical psychologists are the closest equivalents of trained lawyers. Most have a Ph.D., and if they earned their degree from a major university rather than from an independent therapy mill, they have a knowledge of basic psychological findings. Some do research themselves, for example on the ingredients of successful therapy or on the origins of emotional disorders. But whether or not they personally do research, they tend to be well versed in psychological science and in knowing which kind of therapy is demonstrably most effective for what problem. For example, cognitive and behavioral methods are the psychological treatments of choice for panic attacks, depression, eating disorders, insomnia, chronic anger, and other emotional disorders. These methods are often as effective or more effective than medication.5
In contrast, most psychiatrists, who have medical degrees, learn about medicine and medication, but they rarely learn much about the scientific method or even about basic research in psychology. Throughout the twentieth century, they were generally practitioners of Freudian psychoanalysis or one of its offshoots; you needed an MD to be admitted to a psychoanalytic training institute. As the popularity of psychoanalysis declined and the biomedical model of disorder gained the upper hand, most psychiatrists began treating patients with medication rather than any form of talk therapy. Yet while psychiatrists learn about the brain, many still learn almost nothing about psychology or about the questioning, skeptical essence of science. Anthropologist Tanya Luhrmann spent four years studying residents in psychiatry, attending their classes and conventions, observing them in clinics and emergency rooms. She found that residents are not expected to read much; rather, they are expected to absorb the lessons handed them without debate or question. The lectures they attend offer practical skills, not intellectual substance; a lecturer will talk about what to do in therapy rather than why the therapy helps or what kind of therapy might be best for a given problem. 6
Finally, there are the many people who practice one of the many different forms of psychotherapy. Some have a master’s degree in psychology, counseling, or clinical social work; they are licensed in their specialty, such as marriage and family therapy. Some, however, have no training in psychology at all, or even a college degree. The word “psychotherapist” is unregulated; in many states, anyone can say that he or she is a therapist without having any training in anything.
In the past two decades, as the number of mental-health practitioners of all kinds has soared, most psychotherapy-training programs have cut themselves off from their scientifically trained cousins in university departments of psychology.7 “What do we need to know statistics and research for?” many graduates of these programs ask. “All we need to know is how to do therapy, and for that, I mostly need clinical experience.” In some respects, they are right. Therapists are constantly making decisions about the course of treatment: What might be beneficial now? What direction should we go? Is this the right time to risk challenging my client’s story, or will I challenge him right out of the room? Making