Shall We Continue to Train Clinical Psychologists for Second-String Jobs?
- Author:
Wallin,
Baltimore Department of Education and Johns Hopkins University The following facts are well known:
1. The American Psychological Association twelve years ago established a section of clinical psychology whose fundamental aim was to “advance professional standards in the field of clinical psychology.” In furtherance of this aim, the section adopted as the minimal requirement for membership, the Ph.D. degree in various branches of psychology, and the publication or the preparation for publication of “a contribution of importance to the literature of mental tests or of clinical psychology.”
2. Because of the recommendations of leading clinical psychologists and because of the example set by a few institutions of higher learning, the curriculum for clinical psychologists has gradually been expanded to include not only the major branches of psychology, such as normal, abnormal, clinical, criminal, experimental, genetic, child, educational, industrial, and social, but also group mental and educational tests, educational diagnosis, the education of deviating types, mental hygiene, psychoanalysis, psychopathology, mental deficiency and disease, nervous disorders, and frequently other branches of medicine.
3. To obtain a major appointment in clinical psychology, it is now necessary to have the Ph.D. degree, to have obtained about four years of specialized training (counting the senior year in college), and, in all probability, to have had several years of practical clinical experience. This exacting requirement is not excessive in view of the technical nature of mental diagnosis, provided responsible positions are available for thoroughly trained clinical psychologists.
4. It is notorious that such positions are becoming less and less available, if we exclude a few teaching positions in the universities, a few research positions, and a few directorships of public school, state education department, or institutional clinics or bureaus. Most of the directors of mental hygiene clinics or child guidance clinics are physicians, and most of the directors of testing 1 Prepared for the Ninth International Congress of Psychology, New Haven, Connecticut, September, 1929.
bureaus or departments for handicapped children in school systems do not possess the qualifications of clinical psychologists, nor are they required to have such qualifications, in fact many possess very limited technical training for the handling of work which is, after all, essentially technical.
5. The reason for the situation depicted above is fairly obvious. Organizations have been established for the definite purpose of bringing about the establishment of child guidance or mental hygiene clinics everywhere, for the purpose of extending the scope of such clinics to include all types of mentally maladjusted children, and for the purpose of placing physicians at the head of such clinics at a remunerative professional wage.
Some of these organizations maintain alert intelligence divisions, whose function is to discover projected private or independent clinics and exert friendly pressure to have physicians appointed as directors, while they studiously withhold recognition from all bureaus, clinics, or departments not directed by psychiatrists. The only function of the clinical psychologist in a clinic, according to the theory on which this system of promotion is founded, is as a subordinate technician, to give and score tests. The clinical psychologist is referred to indiscriminately as the “psychologist” or the “psychometrist,” whether or not he or she (usually she) is a technically trained clinical psychologist with a Ph.D. degree, or merely a tyro just out of college, or a grade teacher who prefers testing to teaching. The salary varies from about $1,200 to $3,000, occasionally somewhat higher. Frequently, the salary scale is lower than that in effect in large school systems for elementary teachers, while the professional status is about the same. The “psychologist” often occupies a place distinctly inferior in stipend and rank to the so-called psychiatric social worker, who frequently is a teacher, a nurse, or a young college graduate with a semester or two of training in psychiatric social work. No matter how well equipped, the psychologist in these clinics is merely a helper, a technician, a tester. A considerable number of them have secured very limited technical training. A few courses offered by departments of psychology and a normal school diploma or a bachelor’s degree is about the extent of training of many of these so-called psychologists.
6. Two outstanding consequences have followed in the wake of this organized attitude toward the psychological clinician. In the first place, with a few notable exceptions, a distinctly inferior type of psychologist represents the profession on clinic staffs. With the term psychologist indiscriminately applied on the one hand to any infra-psychologist who may be employed to give mental tests, and2 on the other hand, to the brood of pseudo-psychologists swarming over the land and deluging the daily press with bombastic advertisements of their magical esoteric powers, is it to be wondered at that the term psychologist has become a stench and a reproach.
In the second place, the well-trained, experienced clinical psychologist, even though he may be better qualified to direct a guidance clinic than a young physician who has pursued a few months’ course in a child guidance clinic and who has no technical preparation whatever in the field of differential education, is forced into teaching or research or some other line of activity, although he has faithfully prepared for and prefers to devote himself to organizing and directing clinical work for mentally maladjusted children. 7. Society and the state are fully justified in setting up efficiency standards for all types of public service in order that the public funds may be wisely and economically expended.
8. But neither the state, nor any private organization, is justified in bringing about the establishment of personnel qualifications which discriminate in favor of the members of one profession and against the members of another profession who are as well trained or better trained for the work in hand.
9. It is notorious that clinical psychologists, with the training now offered by the leading departments of clinical psychology, are fully as competent to direct behavior, or mental hygiene, or psychological, or child guidance clinics, as most of the physicians now in charge of such clinics. It is equally notorious that the physicians who have achieved highest success in this field have done so not because of their medical training but because of their psychological training and insight. In point of fact, because of the high income which firstclass psychiatrists command in private practice, compared with the modest income of college professors, is it not probable that a higher order of clinical psychologists than of psychiatrists can be secured for the directorship of public child guidance bureaus. After all, the work which such a bureau or clinic must do, and the requirements with respect to staff and technique remain the same whether it is directed by a clinical psychologist or by a psychiatrist.
3 Of course, both the clinical psychologist and the psychiatrist require the services of well-trained mental testers or psychometrists. No criticism of them is implied. They subserve a very important function. But they are not clinical psychologists.
10. If I have presented the situation correctly, and I believe this has been done in all essentials, psychologists are faced with two alternatives.
Either the departments of psychology should inform their students that there is little future for upstanding clinical psychologists without the M.D. degree, except in teaching and research, and advise students who want to go into psycho-clinical examination work to transfer to medical schools, no matter how poorly the training offered in such schools may prepare them for the fundamental psychological work which must be expertly done in mental hygiene clinics if the service of such clinics is to be of a high order of merit. Or, if the psychologists are convinced that adequately trained clinical psychologists are fully competent to direct bureaus or clinics for mentally maladjusted children, no matter by what names such clinics may be known, and if, because of such belief, they continue to train clinical psychologists for clinical service, then the associations of psychologists and the universities should assume the obligation to see to it that the clinical psychologists get an even break, and that they shall not be deprived of their place in the sun by legislation drawn in the interest of a class, or be discriminated against by organizations or individuals in control of appointments. What should such a square-deal program involve? It might include (1) campaigns of public education to neutralize inimical propaganda and to secure the support of educational and social organizations and institutions which have no axes to grind, but which are unselfishly devoted to the improvement of the mental, educational, and social welfare of society, especially its juvenile members; (2) the appointment of state legislative committees to assist in shaping desirable legislation; and (3) the maintenance of some type of organization whose function should be to secure setups in mental clinics or bureaus supported by public funds which will not discriminate against properly trained clinical psychologists. That legislation can be secured which accords psychologists legal recognition is shown by the enactment of the New York Mental Deficiency Law of 1919, and the Ohio statutes of 1929, a decade later. The latter authorize juvenile and probate courts to place psychologists on their staffs of examiners.
Shall we as psychologists frankly face the question here presented, or shall we continue to dodge it? I content myself with merely raising an issue, which I know is giving concern to many psychologists.
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