- By Ian Bradley
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In my previous post, I described the organizational structure that allowed our hospital’s department of psychology to develop and manage mental health programs that directly served the public. These were delivered directly by psychologists working in the Department of Psychology and not on multidisciplinary team. I also outlined the threats to the maintenance of this discipline-centered organizational structure – threats that I considered to be important.
I believe that the clinical work of psychologists is best managed by other psychologists rather than social workers, nurses or any other professionals as would be the case in program management. Explaining why efficacy in therapy might be important to measure or why neuropsychological assessment takes so long – all things that I have heard psychologists trying to justify to non-psychologist team leaders are both demeaning and inefficient. Psychiatrists who manage psychologists are, in my experience, less picky and more collegial. But since at least in Quebec, psychiatrists are not employees of the hospital. Why then have what are in essence private entrepreneurs manage people who do work for the organization. Integrating our teams under psychiatric leadership just didn’t make sense to me.
Less one think that my career experience is perhaps isolated or parochial, in the same day’s flourish of journal reading I also scanned articles concerning how the American Medical Association was promoting disinformation about psychologists to restrict our practice or how American health insurers were disallowing psychological coverage. The form of the challenges might vary, but real challenges to our discipline exist.
However, after reading yet another article about professional ethics I wonder what world the writers live in. Invariably, the underlying tone of the article seems to assume that our profession having such power needs constant vigilance in order not to run amok, either with our clients or society in general. Most scenarios used for teaching ethics involve heavily contrived and convoluted situations inspired by academic or legislative minds that enjoy creating either unresolvable or unlikely scenarios. Debating whether or not to accept single-malt scotch from a client at Christmas – an item I once confronted on an ethics exam -is not an issue that is germane to our profession’s growth.
My experience with young people entering the profession has steadily grown in admiration; I am continually impressed by their research competence and profound desire to help clients in therapy. However, instead of witnessing conversations reflecting these natural abilities, I find most clinical interns so infected with fear about making a “wrong ethical decision” as to be imprisoned in some complex cognitive spider web of doubt and inertia.
It is no wonder then that my administrative door was frequently darkened by both staff and students asking for direction concderning so-called ethical issue. Invariably, my response was “ what do you think?” since the act of critical thinking seemed to be missing in a stereotypic interaction that stressed more fesses-covering than analysis.
I contrast how we shackle our young people with fears about doing harm with the manner in which engineers, software developers or business entrepreneurs train their young. In my contact with these professionals, the enthusiasm of what can be achieved, created or developed are paramount. Each new software or business problem doesn’t begin with a long litany of what can’t be done, or what untoward but highly unlikely scenarios might unfold.
All of us went into this profession to help, but the profession itself now needs help. Further Jesuit-like debates about obtuse ethical issues are counter-productive. Instead, we need to teach our doctoral students to be aggressive promoters of our profession that continues to offer a richness of creative assessments and interventions unmatched by any other mental health profession.