Bob Ax, PhD
President, Division 18: Psychologists in Public Service
(This article was first published in the Winter 2002 issue
of the APAGS Newsletter.)
Advocacy as Insurance
Would you own an uninsured house? Of course not.
Or would you?
You’re presently paying a huge price in time, money (including income
foregone), and effort for your graduate training and education. After all your
sacrifice, feeling a sense of entitlement—to a rewarding career and a good
income—would be perfectly understandable. However, in life there’s often a
big difference between what you deserve and what you get. When you have obtained
your doctorate, you will have, so to speak, bought your house. Insuring it, that
is, maintaining a vital, viable profession as the foundation for a lifetime
career is a different matter.
Here’s a little secret. Most psychologists now practicing and teaching got
into the profession during a sort of Golden Age—the 60s, 70s, and early 80s—when
demand was high, supply relatively low, and third party reimbursement (Now how
did psychologists get that?) had become common. Managed care was just a dot on
the horizon. We assumed that things would always be okay. Of course, all that’s
changed, and you’ve seen one facet of this, with practicum and internship
slots becoming much harder to find. Clinicians are battling managed care and
university jobs have become tremendously competitive, with some schools
abolishing tenure. You know all this. Now here’s the secret: My generation
still has jobs and most of them don’t care a fig about you.
I mean, we’re not totally heartless. If you ended up driving a taxi or
selling insurance instead of practicing as a psychologist, most of us would say,
"Gee, that’s tough, but better them than me." Now, I’m not
referring to the psychologists you read about in the APA Monitor or see
at conventions, the highly visible minority who continue to serve, year after
year, as advocates on behalf of the public well-being and the science and
practice of psychology. No, there are a few senior types, maybe five percent,
who are truly concerned about the future of the profession.
Here’s another secret: Many of these admirable men and women are beginning
to show a bit of gray in their hair. They need some young whippersnappers to
step forward and assist them in their efforts, taking up present challenges and
preparing for those to come. However, most of them, astute as they are, discount
the potential of graduate students as advocates. You’re among the most
intelligent, highly educated men and women in the country, and I know you are
capable of being effective forces on behalf of mental health issues and
organized psychology. I have been extremely impressed with the APAGS
representatives I have gotten to know over the years, people like Carol
Williams, Rob Fazio, Chris Loftis, and Diana Salvador. They are excellent role
models for you, but they cannot do the job themselves. In my generation, we
always thought that "someone else" would fight the battles against
managed care, on behalf of patients’ rights, and so on. Back then, we got away
with being lazy, but the health care market place is getting more competitive
each year. More of your generation will need to be involved, to be the
"somebody elses," if organized psychology is to survive and perhaps
thrive in the coming decades. Advocacy will be your insurance.
Advocacy 101
Repeat after me: "‘Guild’ is not a dirty word." Yes, it’s
okay to advocate on behalf of scope of practice and other issues that directly
benefit organized psychology. All health care professions are involved in
guild activities because they must be. The history of Western medicine
reflects the gradual triumph of science over dogma and superstition (Porter,
1997), but also a rapid accommodation to market forces in the latter half of the
20th century (Starr, 1982). The more recent ascension of psychology as an
organized profession since World War II—incorporating that Golden Age I
referred to earlier—didn’t just happen. It resulted from the focused,
tenacious efforts of people like the so-called "Dirty Dozen,"
pioneering psychologists who helped transform clinical psychology from a cottage
industry into a bona fide health care profession. A great book on the subject is
"The Practice of Psychology: The Battle for Professionalism"
(2001).
There are plenty of ways to become an advocate, and it doesn’t have to cost
a lot of money or time. You can get involved in state/provincial psychological
associations’ efforts, which might mean making phone calls or writing letters
on behalf of a particular issue. You can work for political candidates who
support mental health care. Join organizations like NAMI, the National Alliance
for the Mentally Ill. Show the public that psychologists are genuinely concerned
about the public’s well-being. Pick an issue: the criminalization of mental
illness, patients’ rights, violence, racism, prescription privileges.
Psychologists are involved in all of these. Educate yourself and then your
colleagues about these concerns. APAGS represents an excellent vehicle for
involvement in the important issues our profession confronts.
Advocate for psychology’s cohesiveness. Here’s something else that your
elders have not been very good at doing. We tend to factionalize, to fall out
and become our own worst enemies. This is particularly true in terms of a
practice-academia schism, reflected most tellingly in the decision of many
scientist-psychologists to decamp from APA and form the American Psychological
Society 20 years ago. Why is it that we seem to feel we can exist independently
of each other? Practice needs science and vice versa. If applied psychology is
to survive, it must ultimately be a profession thoroughly grounded in science.
There are plenty of social workers and licensed professional counselors with
good people skills, a license to practice talk therapy, and a willingness to
work for about two-thirds of what you will want to charge.
At the same time, scientist-psychologists cannot allow the development of a
public perception that psychology is a purely academic discipline, divorced from
and indifferent to practice. Should this happen, grants will dry up, as funding
sources cease to see psychology’s relevance to real-world problems, and
university psychology departments will shrink to the size of their sociology
counterparts. Make the commitment now that you and your colleagues will continue
talking with each other as your careers mature, looking for commonalities rather
than differences, and incorporating both science and practice into your
professional identities, regardless of whether you become primarily academicians
or clinicians.
Finally, I’d like to suggest you join Division 18. We care about students.
Why? Because we know you’re the future of the profession, and because we’re
public service psychologists, professional good guys and good gals.
We were the first to have a voting student representative on the executive
committee and we’ve given a student award annually since 1995. Perhaps most
importantly, the sites in which our members practice are those which provide a
great number of practicum, internship, and postdoctoral training positions. Many
of us have made a career of working with students. We need each other. (For
information on Division 18 membership and the Student Award, send me an
e-mail. We’ll help you get started in your advocacy efforts.
Perhaps you could be our next student representative.
Fewer Free Riders
There’s a term for people who work in unionized businesses, but aren’t
union members, enjoying the benefits the unions have fought for without sharing
in the costs. They’re known as "free riders." I’ve been a member
of three unions during my checkered career, and I think of organized psychology
as a union in some ways. We had, and continue to have, plenty of free riders
among my generation of psychologists. Yours cannot afford as many if you want to
keep that "house" for which you have worked so hard properly insured.
References:
Porter, R. (1997). The greatest
benefit to mankind: A medical history of humanity. New York, NY: W.W. Norton
& Company.
Starr, P. (1982). The social transformation of American medicine: The
rise of a sovereign profession and the making of a vast industry. New York,
NY: Basic Books.
R.H. Wright & N.A. Cummings (Editors). (2001). The practice of
psychology: The battle for professionalism. Phoenix, AZ: Zeig, Tucker &
Theisen.
