From their vantage point on Capitol Hill, psychologists Ted Strickland, PhD, and Brian Baird, PhD, see firsthand how politicians consider psychology yet another mental health discipline. Most senators and members of Congress are unaware of psychology's basis in cognitive and behavioral science or its broad reach into such areas as aging, educational testing, job safety and treatment of terminal illnesses, to name a few.
Although serving their constituents is their first priority, both Strickland (DOhio) and Baird (DWash.) consider themselves ambassadors for psychology as well. So far, they've found that their political colleagues generally understand psychological practice, but show little understanding of psychologists' research, training and credentialing.
In a Q&A with the Monitor, Strickland and Baird underscored that overcoming that knowledge gap is critical for the field's future. Not only are psychologists' voices essential to the debate over reimbursement, winning the right to sue managed-care companies and securing funds for psychology training, they also must be heard on their research and work on public-interest issues, from child care to violence.
Q. How is psychology perceived on Capitol Hill?
STRICKLAND: Perceptions are mixed. There is still some mystique that surrounds the profession, and that's reflected in jokes and different kinds of comments about "shrinks" and so on, but they're always good-natured. I don't think there's any hostility or negative feelings toward psychology.
BAIRD: There's an appreciation of the importance of mental health counseling in general. But there's little knowledge about training and expertise of psychologists...to what extent the scientific method and research are part of psychological training or what the requirements are for supervision or internships.
Secondly, there is lack of knowledge about what we do in counseling and the research literature demonstrating efficacy. If you were to ask the average member of Congress what happens when you go see a psychologist, they might say, "Well, I don't know, they talk about your feelings." But does anybody say that psychologists are trained in treatment interventions that have demonstrated efficacy? Probably not.
Q. How well do you think politicians understand psychology--is there confusion with other professional disciplines?
STRICKLAND: Yes, people don't make a lot of distinctions between the various mental health professional groups--psychology and psychiatry, for example, the generic counselor and alcohol and drug treatment providers and so forth. There's a blurring of professional groups.
BAIRD: There are problems with not making the distinction between what psychologists do in counseling and counseling writ large. People hear you should see a counselor. They don't know what that means necessarily. And it's too easy just to focus on confusing us with psychiatrists. We've heard that a thousand times. The more pressing issue for our profession is defining us as ourselves in relation to issues that are addressed in Congress.
I was at a hearing a while back on teacher testing, and I began asking about criterion validity (a measure of how much variation in test scores corresponds to a criterion, such as a behavior or another test score, being tested). Not a lot of people in Congress know about criterion validity. Members of Congress don't necessarily know that our profession does have the expertise. We need to communicate that so people start turning to us.
Q. What about the scientific aspect of psychology? Is that misunderstood as well?
STRICKLAND: I think it is misunderstood. One of the things I value the most about psychology is that our profession has set the standard in research methodology. Most of what we think we know about human behavior has come from psychological research. The history of psychology has contributed a great deal toward not just our understanding of human behavior, but our use of the scientific method to understand it. We need to get that message across.
BAIRD: [Most people in Congress] don't understand that our treatments are research-based or the outcome data supporting the validity of those treatments. Or of the applicability of scientific method and psychological knowledge to issues that the Congress addresses--testing, school violence, parenting, child care, infant development and neurological development.
Even in the mental health realm, there's often an effort to destigmatize mental illness by biologizing it, which is certainly a component. But that leads to treatment compensation based on biological treatment, not psychosocial, psychotherapeutic or behavioral interventions.
Q. Given the misunderstandings, what can psychology do to better educate Congress about what it does?
STRICKLAND: We make public-policy decisions here all the time with a fairly superficial understanding of what we're dealing with. Psychology can contribute to these decisions our research tradition and history and expertise. A couple of examples--addictive behavior, alcoholism, drug abuse, smoking behaviors. To come up with effective, defensible public policies based on something other than anecdotal information and personal opinions, we need research from psychology.
Also, I think we could emphasize our research in ways not specifically related to our own economic well-being. Often, I think psychology shows itself on the Hill advocating for policies related to the economic benefit of psychologists. There is nothing wrong with that, in fact, psychology should do more of that rather than less. But there are other ways psychology can have a presence up here--relating accurate, valid research data to important public policy issues--that are good for society and not just the profession.
BAIRD: Psychology has been helped by having Ted Strickland and myself here. Legislation has been drafted that has left psychologists out, and we've managed to get psychology put in before it was introduced. Legislation has been drafted that failed to appreciate the subtleties of licensure laws, and we've addressed that.
Secondly, it really does help when psychologists meet with their congressional representative on the Hill or through visits in their districts and town meetings. Personal contacts are vastly superior to letters.
Q. In terms of legislative initiatives that could affect psychologists--where psychology needs to focus the most to make gains--which are on the front burner right now?
STRICKLAND: I'd like to see psychology remain engaged in mental health parity and the Patients' Bill of Rights. Securing psychology graduate training funding through the Graduate Medical Education program is also important, and I think we are going to have a positive resolution there in getting Medicare reimbursement for psychology trainees. I'd also like to see us move beyond mental health issues and be an equal advocate for prescription drug benefits and affordable, comprehensive health care for all citizens. Our profession has very well thought out humanistic ethical principles, which protect the people we work with and advocate for antidiscrimination policies that emphasize inclusion and tolerance.
BAIRD: The most front-burner pieces of legislation right now are parity and Patients' Bill of Rights. Psychology needs to make sure that the exclusion for mental health damages in litigation for patients is not retained. And we need to keep pressing for the mental health parity bills, educating employers and insurance providers and consumers about the benefits of mental health parity. The central challenge is helping people understand that there are drawbacks to only providing parity for more severe mental illnesses--that you will increase your costs.
The more chronic mental illnesses are more expensive to treat versus mild depression and mild anxiety. For those, we have proven that relatively short-term treatments will save employers money and improve quality of life at relatively low costs. That's not to say that we shouldn't treat the severe illnesses, but we skew our costs-benefits ratio if we don't fight for the broader spectrum. Through the scheduled rewrite of the 1996 Mental Health Parity Act, psychology has an opportunity to educate the public and people in office about what we do. If we miss this opportunity, we confirm our critics and undermine our legitimacy.
Q. What are the biggest obstacles to passage of some of this legislation?
STRICKLAND: It is almost impossible for me to overstate my anger at the Health Care Financing Administration in terms of Graduate Medical Education, because professions all the way from psychiatry to pastoral counseling are included under that program, yet psychology is excluded. It's a battle that we have been fighting for years. There have been so many promises made that haven't been kept, deadlines set that have been ignored, roadblocks put in the way unnecessarily. I think, though, that the issue will be resolved and psychology will be rightfully included.
BAIRD: Obstacles to Patients' Bill of Rights are the Republican majority and the insurance lobby. The parity bill is also being fought heavily by businesses and insurance. Their lobbyists are going around to businesses and telling them that parity is going to increase their insurance premiums by 20 or 30 percent. Well, our data suggest that the maximum increase is going to be only 2 or 4 percent.
And if they're presenting inaccurate information and our people who advocate on the patients' behalf and on the behalf of our profession are not presenting counter-data, how do you think the votes are going to go?
Q. To overcome such obstacles, how can psychologists get involved and help in working on those issues?
STRICKLAND: Psychologists can assist by belonging to and supporting APA. Psychology needs APA. So they can work through APA and their state organizations. The Ohio Psychological Association, for example, is incredibly active in legislation at the state level and they are up here frequently as well, but it's at the state level where a lot of the laws affecting health care and mental health care are enacted.
BAIRD: Psychologists can call their members of Congress. You don't have to go through APA to lobby. You ought to talk to APA about priorities. You ought to get data from APA. Then you ought to set up an appointment with your member of Congress. You ought to get 20 psychologists together through the local psychological association.
Ask your member of Congress for a meeting when they're in your district, or show up at a town hall meeting, or stop by Washington, D.C., sometime. Call APA's Practice Directorate or Public Policy Office and say, "Twenty of us want to meet with our member of Congress back in our district."
Q. As we move into 2001 and beyond, where can psychology make the most contributions in terms of social issues being considered on the Hill?
STRICKLAND: Discrimination. Discrimination continues to be a very serious problem in this country, whether it's discriminating against women, gays, people who are economically disadvantaged, people who are physically challenged or ethnic groups.
It's destructive and harmful, and, as a professional group, we need to take a strong stand against it. We can do that, basing it not only on our humanistic motivations, but on our research findings that it is harmful and destructive and limiting in terms of people being able to reach their potential.
BAIRD: Early child development. We should have a stronger voice in the issue of testing in academia. We have very good research on violence in schools. We need to advocate more for the role of psychology in health treatment--for treatment of physical ailments, cancer, head injuries, the whole host of illnesses that have psychosocial components, either as consequences or contributors. There's a crying social need for us to share our research. The notion of giving psychology away, which was part of my community psychology training, is something we need to do more of.
Q. As a psychologist, what do you think about the way the political process works on the Hill?
STRICKLAND: Much of what we do up here is based on ideology, and I think those ideologies in their extreme forms see good people and bad people, yet they don't see people. The slightest issue can escalate into what is perceived by some people as a battle between good and evil. You hear these firm statements or judgments about conditions or people and situations--that just refuse to take in a host of variables that may make this situation different.
I also think the public is often bored with us. They're out there trying to live their lives, and they don't see us as terribly relevant. But we are very relevant because everything we do up here eventually affects the way they live their lives. I saw that connection, and that's why I wanted to be in Congress.
BAIRD: I'm more impressed every day with the remarkable political system we have relative to almost every other system in the world. Are there ways the system can work better? Absolutely. We need campaign-finance reform. But it was Alexis de Tocqueville who suggested that the great danger of a democracy is that people become so enamored of enjoying their liberties that they no longer attend to its maintenance.
Psychologists are guilty of that, too. We take for granted the hard-fought privileges that we enjoy and opportunities for training or treatment. Or research dollars. Sure, we could make the political system work better. But I think the most important responsibility is for the citizens themselves, and that includes psychologists, to be active participants.
For information on getting involved in advocacy on psychologists' behalf through APA's Public Policy Action Network or e-mail.