This week, I’m going to rant. Actually I’m going to rant about my own profession. As you probably know, I’m a psychologist. I first became involved with psychology as a student 25 years ago. Since then, I’ve spent 11 years at university studying it, and about 15 years practising it. I find the field fascinating, diverse, and immensely promising. I also find my work extremely rewarding. It’s with shame, therefore, that I have to point out that a lot of my profession is crap.
You see, there’s a big divide within psychology between research and practice. The science of psychology (literally the study of the mind) is a diverse one, stretching from clinical, to sport, to developmental, to forensic psychology (with a heap in between). Within these disparate disciplines, many people work hard to understand more about the human condition. Over the last 50 years, the science of psychology has become more rigorous and, in recent times, psychological research has been enhanced by increased knowledge of the brain, itself the product of increasingly sophisticated imaging technology, computing power, and advancements in the various fields of neuroscience (i.e, the study of the brain). Consequently, we’re learning a great deal about what makes us tick, from the brain centres that control behaviour, to an increased understanding of mental illness. Psychological researchers are even venturing where philosophers once held sway, understanding consciousness and self-awareness, and learning about just how self-delusional human beings are.
The other side of psychology is its practical application, whether in a counselling, clinical, sport, or other role. Undoubtedly there are many astounding psychological practitioners out there. These people are not only good psychologists (in that they are good at helping the people they work with), but also excellent scientist-practitioners. In other words, they practise in a way that is valid, contemporary, and empirically based, and they ensure that they remain both up to date with the latest scientific developments in their field, and skilled in its delivery. As scientist-practitioners, they have a mastery of the theoretical underpinnings of their practice, are able to understand the research being conducted and published, and can evaluate its efficacy, validity, and applicability. Most importantly, they can apply this knowledge effectively to assist those they work with.
It is a sad fact, therefore, that many practising psychologists are not applying the science of psychology. Instead, they are implementing a sort of well-intentioned voodoo* based on their beliefs, intuitions, and out of date training. Similarly, many psychologists align their practice with, or include elements of, ‘traditional’ practices (i.e., those who practise without an empirical base, claiming instead that their practice is valid because they ‘believe’ or because they claim anecdotal or traditional evidence). Let me state firmly: anecdotes are not evidence. Just because someone claims to have seen that what they do is effective does not provide evidence for the efficacy of that practice. Nor is the claim that what they do has ‘worked’ in the past. Evidence-based practice means that the technique, medication, or process being used has been independently and empirically validated using scientific methodology (that allows for falsification), with a large enough (representative) sample, and has subsequently been replicated and validated by other, independent researchers. This evidence should then be published in a peer-reviewed, scientific journal, so that it is available, and open to widespread scrutiny and evaluation.
Equally disturbing (to my mind), is the fact that many practising psychologists have little to no understanding of neuropsychology and neuroanatomy. Although psychologists don’t work with the brain directly, it’s essential that they have an up-to-date, reasonable understanding of its workings. Without this knowledge they are analogous to a chemist without a working grasp of pharmacology, a GP without an acceptable understanding of anatomy and physiology, or even a car mechanic who doesn’t understand how an engine works. Perhaps this is a failing of the current education and training systems for psychologists. Either way, it’s a glaring omission.
Interestingly, it’s psychologists who have learnt about the wide variety of human biases that limit our ability to be objective. Ironically, these same biases influence psychologists when they practise. For example, humans have a tendency to see patterns where patterns don’t actually exist. Similarly, they treat limited numbers of observations as fact. So, for example, if a person tries a technique and sees an effect (even once), he or she will have a tendency to believe that what he or she did was effective. If it ‘works’ in a couple of other people, or he or she sees someone else use it ‘effectively’, this belief will be reinforced further. Of course, the whole point of scientific evaluation is to determine whether what is being claimed to be effective actually is effective, not just whether it appears to be effective. Consequently, many psychologists believe that what they are doing works, despite doing something that has had no empirical evaluation.
It’s also important that psychologists understand the placebo effect (i.e., a measurable effect, by a technique or compound that is inert and has no clinical efficacy by itself). It’s now well understood that this effect is commonplace in psychology – many people ‘feel’ better just for having seen to someone and talked about their problems. Unfortunately, this often reinforces a psychologist’s belief in his or her ability, which might actually be nonexistent.
At this stage, it’s worth pointing out that it’s not just psychologists who often fail to practise science. Many ‘legitimate’ health professionals including GPs, vets, and even surgeons, can allow their personal beliefs, biased observations, or out-of-date training to affect their practice. And these are people who’ve actually been trained (at least moderately) from a valid, scientific base, and who should possess a modest understanding of scientific and statistical methodology. Those trained in the ‘traditional’ practices (including osteopathy, chiropracty, naturopathy, and homeopathy) aren’t typically trained in scientific methodology, making it even harder for them to question their own methods.
Why is this a problem? First, psychology isn’t witch doctorism; it is and should always be the scientific study of psychological processes, coupled with an application of these findings in a way that is, in itself, evidence-based. Anecdote-based practice is little more than faith healing, meaning that practitioners of this sort have no place calling themselves psychologists. Second, because the general public are not trained in scientific methodology or practice, they are not equipped to tell the difference between a scientific practitioner and a charlatan. When psychologists practise in a way that does not stand up to scientific scrutiny, they undermine both their profession, and the reputation of that profession. Even when they practise effectively, aligning themselves with anecdotal practitioners (it’s not uncommon to find psychologists practising alongside naturopaths and osteopaths) aligns the profession with faith-based practices, further undermining the profession’s position. Psychologists should simply know better: these days (in Australia), it takes at least six years of rigorous training to become a registered psychologist (in the US, it’s more like 10). If a psychologist hasn’t learnt enough about scientific methodology, human bias, and the necessity of an evidence base, to practise effectively in this time, he or she should not be a member of the profession (or should undertake further training). Most importantly, from an ethical perspective a psychologist has a duty of care to his or her clients, and that extends to providing treatment that has been demonstrated empirically to be effective. By using anecdotal evidence, allowing his or her beliefs or faith to influence practices, or by failing to stay current, a psychologist is simply not behaving in an ethical manner. There’s just no place for personal beliefs or ‘complementary’ practices in psychology – it’s something but it’s not psychology.
So what’s to be done. Well, change is already occurring, In Australia, psychological registration is becoming more rigorous, with a stronger emphasis on a strong knowledge base. Psychologists are also required to stay up to date (at least sort of) through regular continuing education. Nevertheless, the emphasis is still with the psychologist. It’s important, therefore, that psychological training programs provide a strong theoretical grounding alongside an emphasis on the scientist-practitioner model, and the need for continual review and ongoing training.
So, if you’re planning on seeing a psychologist (or any other health professional for that matter), ask about his or her training, find out whether or not he or she is up-to-date, and ask for evidence that his or her methodology is evidence-based. Don’t just take the psychologist’s word for it either, ask for scientific journal articles (preferably large scale, meta-analyses published in a peer-reviewed psychological journal) that support what your psychologist claims.
And if you’re a psychologist – ask yourself: am I really practising science? Or am I full of shit…
* By the way, the illustration of the Rorschach print is ironic – with no scientific basis or evidence, they’re nothing more than voodoo!