Exploring the Tension Between Educational Psychology and Child Psychiatry

Researchers explore efforts to integrate educational psychology and child psychiatry.

Sadie Cathcart
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In a paper published in the International Journal of Inclusive Education, Danish researchers Bjørn Hamre, Lotte Hedegaard-Sørensen, and Søren Langagerb examine the nature of collaborative relationships between educational psychologists (working in schools) and child psychiatrists (working outside of schools independently or through external agencies).

Through comprehensive, semi-structured interviews with Danish educational psychologists, researchers concluded that there is an overall openness and interest among school-based psychologists to join forces with professionals across disciplines to maximize the quality of life and educational performance among students. However, the team was also able to establish a picture of some of the obstacles that challenge the interpersonal relationships and joint student support efforts between educational psychologists and the out-of-school psychologists/psychiatrists with whom they collaborate.

Some of the themes that emerged in interviews included 1) an interest in better integration to avoid a reactive culture, in which student risk factors are discussed and addressed in advance, 2) a desire to eliminate the perceptions of hierarchical roles among collaborators, and 3) the potential for educational psychologists to assume the role of facilitator for supports to students in school settings. Some features of inclusive schooling, a movement in Denmark prompted by statutory policy changes in 2014, are at odds with the medicalization of social and emotional elements of childhood. However, interviews pointed to an interest among Danish educational psychologists in addressing student needs based on function instead of a diagnostic label.

The publication begins with the following quote from one of many qualitative interviews Hamre and colleagues conducted with participants:

“It seems to me that it’s all about the definition of power, and it’s about professional imperialism.” (A psychologist, commenting upon collaboration between psychologists and psychiatrists)

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Historically, schools in Western contexts have relied heavily on disciplinary and educational practices that exclude students with pronounced social, emotional, and behavioral challenges from engagement with all peers. Students with “special needs” are sometimes separated from their peers with classroom behaviors more conducive to the learning environment. The current push for inclusive learning environments, although sometimes politically and monetarily motivated, enables students with diverse psychosocial and contextual backgrounds sharing the same classrooms.

In Denmark, as in Australia, the UK, and the US, this movement is coinciding with an increasing trend in childhood psychiatric diagnoses. There has been a reduction in children with “special educational needs” classifications by two thirds since the country’s 2014 reform, and the national goal is to halve the number of students being referred to be educated in segregated environments. However, according to authors, Denmark’s efforts towards inclusion “… appear to be on a collision course with the rising interest in psychiatric diagnoses and the rapid increase in the number of children encompassed by the child and youth psychiatric assessment.” Ultimately, there are more students in typical classrooms with psychiatric labels than ever before.

“Educational psychology has shifted from a culture of testing and trouble-shooting towards more attention to a child’s environment and socioemotional factors, mostly due to the national political agenda of inclusion,” the researchers write.

“International research and debates within ‘critical educational psychology’ seem to have had very little impact. This may partly be an underlying explanation for some of the findings in the empirical study highlighting why the professional development of educational psychology is challenged by the growing dominance of child psychiatry.”

Shifts in educational policy and psychiatry necessitate interdisciplinary collaboration between educational psychologists and child psychologists. Educational psychologists, or school psychologists, are typically responsible for improving school-based supports available to students with unique social, emotional, and behavioral profiles, whereas child psychologists and psychiatrists tend to embrace a more biomedical understanding of behavior.

Most child psychologists and psychiatrists practice outside of an educational setting. When placement and intervention determinations are made by external agencies, they are often made by individuals a few steps removed from those ultimately implementing in-school supports.

“Sociological critiques of special needs education have emphasized the problematic aspects of segregated provision: injustice, marginalization, stigmatization, and exclusion. The current debate on special needs education and inclusive education is aligned with this critique and focuses on teaching to diversity,” the researchers add.

“The emphasis is on teachers’ ability to make sense of individuals’ differences in their teaching, without relying on specific disability categories for teaching strategies. The question about differences between students in school is how these differences are understood and what difference they make for teaching.”

Qualitative, empirical examination of educational psychologists’ perceptions of interdisciplinary collaboration occurred between 2013 and 2015, during a larger project through the Copenhagen Municipality’s Children and Young People’s Service Department designed to improve the quality of collaborative efforts between psychologists working to support students across environments. Interviews pertained to dynamics associated with interdisciplinary service delivery and were limited to the perspectives of professionals employed within one particular discipline. All discussions were approximately 45-minutes in length.

Consistent with Foucauldian philosophy, Hamre and team approached their investigation with the guiding notion that “neither psychology nor psychiatry reflects a neutral scientific position.” They endeavored to explore educational psychologists’ perspectives about the sociopolitical climate guiding psychological science at this moment in time in a particular cultural context.

“Psychiatric diagnostics have long been an integral part of the educational system. The inclusive agenda implies a desire on the part of teachers, educators, and politicians to rethink how diagnoses are produced and transferred in schooling. The present study questioned how the transfer of diagnostic knowledge from educational psychologists to teachers problematizes the school system’s role in the (re-)production of psychopathology. Achieving inclusive education requires an awareness of the structures of exclusion. This article has touched upon the need to focus on how diagnostic language and practice are constructed in interprofessional settings and risk interrupting the inclusive agenda.”

There are characteristics of Hamre and colleagues’ study that may not directly translate to structures in place in the US, yet their findings have internationally relevant implications. Efforts to promote interdisciplinary collaboration, broaden channels of communication, and develop common language accessible across school-associated support personnel could together serve to improve in-school experiences for students of all sorts in classrooms composed of children with diverse backgrounds, learning styles, needs, and goals.

 

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Hamre, B., Hedegaard-Sørensen, L., & Langager, S. (2017). Between psychopathology and inclusion: The challenging collaboration between educational psychologists and child psychiatrists. International Journal of Inclusive Education, 22(6), 655-670. (Link)

4 COMMENTS

  1. This interpenetration of the school and the psychiatric hospital is catastrophic. It should be noted that school is one of the leading factors in children’s psychiatrisation regarding suicide, violence and self-harm (Hansen 2011, Lueck 2015, Plemmons 2018).

    I wrote an article about it on my blog, in French.

    https://psychiatriedroit.wordpress.com/2018/07/28/lecole-est-responsable-de-12-des-suicides-chez-les-jeunes/

    I have a friend who has endured the joys of psychiatry in the school environment. Every night she returned to the psychiatric hospital, where she was locked in her solitary confinement cell. At school, it was a completely drugged wreck, sleeping on his desk. She scared other children. My friend describes this period as “surrealist” because everyone was acting as if nothing had happened, when something awful was happening.

    The treatment of anorexics is extremely cruel in France: psychiatrists use massively isolation cell, and drugs of course. After the chemical treatment and the isolation cell, my friend began to develop severe hallucinations, which she had never had before. She was rediagnosed “schizophrenic”, obviously. The hallucinations are never gone.

    Fortunately, she stopped the neuroleptics about a year ago, the hallucinations became less painful, and she began to take control of her life.

    It is essential to prevent the collaboration between school and psychiatry. [Comment moderated].

    Hansen B , Lang M (2011). Back to school blues: Seasonality of youth suicide and the academic calendar. Economics of Education Review 30 (2011) 850– 861. 10.1016/j.econedurev.2011.04.012

    Lueck C et al. (2015) Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance? American Journal of Emergency Medicine 33 (2015) 682–684. 10.1016/j.ajem.2015.02.055

    Plemmons G, Hall M, Doupnik S, et al. (2018) Hospitaliza­tion for Suicide Ideation or Attempt: 2008–2015. Pediatrics. 2018;141(6):e20172426

  2. The title of this article is pure click-bait, for me! That such a thing as “child psychiatry” even exists, is proof to me just how sick, twisted, and depraved our society truly is. There’s serious discussion among quack psychiatrists, – there’s really no other kind of psychiatrist, – as to the possibility of “diagnosing” and “treating”, with neurotoxic drugs, so-called “mental illnesses” *IN* *THE* *WOMB*! Think about that….
    But Sadie Cathcart, I have to call you out on something. You seem to be using “psychologist”, and “psychiatrist” as if they are the exact same thing, and/or are interchangeable. I think that’s sloppy writing, and intellectually dishonest. When the subject comes up, as often as I can, I ask people if they know the difference between “psychologist” and “psychiatrist”. Most are puzzled, and don’t even know there *IS* a difference! Much less what that crucial difference is! You need to understand, Sadie, that this level of ignorance and confusion in the public mind has been deliberately created by the “Mental-Illness-Industrial-Complex”. BOTH “branches”, or “practices”, draw credibility from being associated with the other. And psychiatrists especially can hardly be honest with the public about their neuro-toxins. The gross over-drugging of school children is facilitated by psychologists, but implemented by coercion and action of psychiatrists. Mass-casualty school shootings are only one more effect of mass psychiatric drugging of school children. Please, Sadie, carefully re-read your article above. I think you confuse psychiatry and psychology. Please DON’T.

    • Hi Bradford,

      I couldn’t find the passage where psychiatry and psychology were interchanged, was it in a particular passage that you meant?

      I thought the article was about how educational psychologists – who tended to avoid diagnoses were having language/conceptual issues and ethical concerns about how to interact with individual child psychologists and psychiatrists, partly because both the individual groups were tending to use the language and concepts of ‘medicalisation’.

      Unfortunately, these days it doesn’t have to be a psychiatrist doing the drugging, a lot of it is done by GPs.

      But I think the idea was not just about drugs it was about the diagnoses themselves, and the very different way of looking at childhood problems. The educational psychologists were tending to look at problems in terms of environment and emotion and function and how to solve issues or cater to them without labelling the person. The individual psychologists in this case were seeming to lean towards labelling the children with “mental illness” categories. Of course, the psychiatrists were too. I think that’s why

      “Educational psychologists, or school psychologists, are typically responsible for improving school-based supports available to students with unique social, emotional, and behavioral profiles, whereas child psychologists and psychiatrists tend to embrace a more biomedical understanding of behavior.”

      I think that’s why it says “out-of-school psychologists/psychiatrists” in the paragraph:

      “However, the team was also able to establish a picture of some of the obstacles that challenge the interpersonal relationships and joint student support efforts between educational psychologists and the out-of-school psychologists/psychiatrists with whom they collaborate.”

      It’s not using the terms interchangeably, just saying that there’s a mix of psychiatrists and psychologists in the out-of-school group, and they were identifying some of the obstacles were applying to collaborating with both psychologists and psychiatrists in the out-of school-group.

      • It’s less the author’s fault and more the addition of other words on top of psychologist and psychiatrist. Example neuro-psychiatry or psychodynamic therapist.

        The person you are replying to is probably referring to this issue in the narrative since alternative perspectives can be hard enough as it is but then MIA articles sometimes create looser narratives in order for better and simpler storytelling blog narratives. Something which is often helpful but can lead to problems when few other sites or blogs are competing with MIA to reframe the narrative of studies.