- By Ian Bradley
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I just finished reading yet another journal issue replete with articles about ethics in psychology. The more I read the more disheartened I became, for I fear that rather than enriching our profession, the current zealous promotion of ethics only ties our hands and restricts our professional creativity.
Having been responsible for a large university-based department of Psychology for over 25 years, I believe that I have seen the challenges that face our profession in the public health system. I have lived through years of continual budget cuts where so-called auxilary services, basically any non-medical or nursing professional groups, were enticed into playing a suicidal game of who best can find creative ways of reducing their department’s global budget by 3, 4 or 5%. Since at least 90% of the budget was staff salaries- all contractually determined and outside the control of the department manager – most reductions were achieved through reducing supplies. Besides asking the staff to bring their own pens and paper, there was not much more I could do than work with a paucity of modern testing supplies and computers. Nonetheless, most of the staff positions survived.
However, one clear bright spot in our hospital was the historical support for what I could call “functional discipline organizational structure” where a Chief Psychologist actually controlled the day-to-day clinical activities of its members. We used this administrative control to translate our own discipline’s research findings into treatments for patients in areas as diverse as sexual dysfunctions, anxiety disorders, health habit enhancement etc. This organizational system stood in contrast to the growing trend of what is called “program management” where members of our profession report to social workers or nurses who head-up multidisciplinary teams. In my opinion, what our profession gains by being compliant members of such multidisciplinary teams only undermines our importance and status in the health system.
Twenty-five years ago, it was tough to develop and manage our first CBT clinic- a clinic for agoraphobia- in the face of psychiatrist criticism that the treatments were superficial and only symptom-focused. Referrals from psychiatrists were rarely and when they referred, we often received patients that had long been considered hopeless. However, we continued to preserve and develop a gamut of mental health programs and interventions to conditions ranging from depression, OCD, sexual dysfunctions etc.
The programs, that all had embedded measures of outcome, served as teaching arenas for our doctoral interns in Psychology while providing significant community service.
However, internally, the pressure grew to integrate our psychology programs within the psychiatry-controlled multidisciplinary team structures. While I was Chief Psychologist I resisted this integrationist movement believing that psychologists were best able to manage other psychologists and also best able to translate our own psychological research into deliverable interventions. Perhaps because I had grown up professionally in an era where psychologists played second fiddle by performing assessments rather than delivering direct treatment, I wanted to remove myself and our department from the “psych testing” model of my graduate student days. Recruiting university partners and sympathetic administrators in the battle for our independence was initiated, but the battle, according to my listening sources after my departure, continues to be waged.
The link between organizational structure and ethics will continue in the next post.