Traumatic Event

It’s not everyday you wake up and find your profession in midst of a holy war.

Yet that seems to be what’s happening in the profession of clinical psychology. A new journal article to be published next month by Timothy B. Baker, Richard M. McFall, and Varda Shoham (2009) suggests that psychology is falling apart. Specifically, the researchers argue that graduate training programs for psychologists studying to become psychotherapists has taken a wrong turn and needs to be turned around before it’s too late.

So what steps could be taken to fix the apparent problem? Funny you should ask, because not only do the authors have a prescription, they actually started implementing their prescription more than a year ago.

Is Psychology Like Medicine?

Baker et al.’s argument largely relies on comparing psychology to medicine. After all, they both help people get better. To me, though, such a comparison belies some psychologists’ inferiority complex — always wanting to be “real” doctors, garnering the same kind of respect as “real” doctors do.

The crux of the argument hinges on whether it’s a fair comparison — is psychology like medicine? If so, then perhaps there’s some merit in looking at the medical model for its training. If not, then looking at how medicine trains doctors — while an interesting intellectual exercise — is engaging in a logical fallacy.

The human body is a complicated piece of plumbing and electrical work all put together in one messy piece of organic material. But it’s solid, real. You take a scalpel to the skin and you know exactly how much pressure to apply to make an incision. We now know to scrub our hands before surgery to prevent infection from organisms that live on our hands.

We still basically have no idea how the brain works, however. We can’t flowchart working through someone’s imagination, or an emotional reaction to a traumatic event. Sure, we can treat these things, but is it the same as what we know about and how we treat the human body?

It would seem to be a far more fair and an “apples to apples” comparison to not look at how doctors train in medicine (since very few doctors do anything like psychotherapy), but rather look at how other professions train their students to become psychotherapists. After all, you wouldn’t look toward an electrician’s training to understand how to train a good programmer (although both share many commonalities, such as good problem solving skills and the ability to design complex systems).

Despite the fact that other professions provide more psychotherapy than psychologists do, these researchers apparently believe that other professions don’t have much to offer psychology’s training programs. “Master’s level” training is just assumed to be inferior by definition.

If Psychology is Like Medicine, Is Medicine Creating Good Science Practitioners?

Let’s say that the researchers’ comparison is somehow valid. Is medical training really the “gold standard,” creating good doctors who keep up on the research and their medical training throughout their career? Do most doctors use evidence-based procedures in their profession?

The answers are not at all clear. Medical science advances at such a great rate (there are over 5,000 biomedical journals in publication and over 400,000 research citations added to MEDLINE every year), it would be irrational to suggest that most medical doctors keep up with the research. If they did, the medical profession wouldn’t only just now be getting around to practitioners actually following evidence-based medicine guidelines. If the medical model of training was one worth modeling, why has it taken 60 or more years for doctors to actually start doing what the research tells them what works?

Research suggests that many physicians don’t practice what their training supposedly preaches anyway. Buchbinder et al. (2009), for instance, found that in a study of 3,381 general practitioners who actually have a special interest in back pain, the physicians held pain management beliefs contrary to the best available evidence.

Hay et al. (2008) noted in a different survey of physicians that, “Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and evidence-based medicine summarizing electronic clinical resources rather than refer directly to the evidence-based medicine literature.” Sounds familiar, doesn’t it? The medical literature is littered with similar examples. Medicine is not exactly doing an exemplary job of training scientist-practitioners after all — they study one thing, and practice another.

Even if we take it that some physicians do keep up with the research, is that inherently a good thing? With research that’s been ghostwritten by pharmaceutical companies and clinical trials that bear no relationship to reality, it’s legitimate to ask — What research can we trust and generalize from? Most research studies have been designed and conducted in such a manner as to minimize other factors that may influence the results. But because of this, most real-life patients don’t resemble the people used in most research studies. There’s no way to know whether a particular research study is going to stand up to the test of time.

A Solution to the Imaginary Problem

A straw man argument is when one side creates a position that distorts or exaggerates the other side. I’d argue that, sadly, this is exactly what Baker and his colleagues have done.

Psychology isn’t failing to churn out good therapists so much as it’s failing to churn out psychologists that meet the authors’ own arbitrary definition of what constitutes a “good clinician” — those with a rigorous background in research. Would you expect any different argument from three Ph.D. academic researchers?

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