Why Is the APA Proposing Sweeping Changes to Training Requirements?

Letting bias shape policy amounts to an abuse of power by the American Psychological Association.

Ben Greenberg, PsyD
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Psychology – Definition of psychology

1: the science of mind and behavior

The word psychology was formed by combining the Greek psychē (meaning “breath, principle of life, life, soul,”) with –logia (which comes from the Greek logos, meaning “speech, word, reason”).

Following a regressive trend towards medicalized behaviorism in recent years (and in contrast to significant clinical evidence), the American Psychological Association (APA) is using its outsize influence as the sole accrediting body in psychology to propose substantial changes to educational requirements across the US. If successful, this would mean that clinical training at the masters, doctoral, and postdoctoral levels will be further pushed towards emphasizing the model of behavioral health.

The proposed changes can be seen here, and comments are being accepted until October 9, 2020.

Behavioral health is a brief, manualized form of talk therapy that focuses entirely on symptoms rather than the individual who has them. As the name suggests, it is largely founded in the principles of behaviorism and cognitive-behavioral (CBT) modes of psychological treatment.

While this approach can indeed be effective in specific instances and has a solid place among other intervention models, the danger inherent in the changes proposed by the APA is that behavioral health is increasingly being portrayed as the “gold standard” of psychological intervention despite so much evidence and over a century of clinical wisdom that points to the contrary.

Designed to fit psychologists into primary care teams in rapid-pace medical settings, the behavioral health model is structured more to fit the needs of the for-profit healthcare system and insurance companies rather than the needs and context of the individuals seeking treatment. With its total emphasis on what can be observed and manipulated in human behavior, crucial aspects of experience, including emotion and subjectivity, are viewed as a “black box” that behaviorism is uninterested in, and that CBT holds as subordinate to thoughts and behaviors.

Part of the reason why the APA promotes this model over others is that it reduces the definition of mental suffering to be small enough to fit into the medical research model responsible for a great deal of unwanted side-effects in psychiatric medicine: the double-blind placebo trial. While this scientific method has been profoundly effective in addressing diseases of biological origin, when applied to mental illness and other challenges of subjective nature, it has many pitfalls and potential biases.

Confirmation bias can manifest in health care practitioners only being interested in and responsive towards that which confirms what they already know. Unfortunately, the other side to this coin is the all-too-common experience of doctors’ disbelief, disinterest, or indifference to what falls outside of the frame of reference or their worldview—a source of profound frustration and injustice for many whose illnesses are inherently complex and have a subjective component that might not be observable through their behaviors or blood test results.

This is how Western medicine in large part fails to effectively respond to disorders with complex subjective components, including mental illness, lyme disease, Morgellons, extreme forms of tinnitus, and many others. With the exclusive promotion of the behavioral health model, it is in this harmfully limited worldview that the APA is intending to follow.

The solution is simple: the APA should do what psychologists are trained to do, and listen. Listen to your own constituency and patients, and promote greater inclusion and research of diverse psychotherapy modalities that take subjective factors and individual context into account. This is not only a no-brainer, the effectiveness of approaches that take subjective factors of mental suffering into account has been highlighted in clinical studies time and time again, including in the APA’s own journals.

Part of this relates to the intractable fact that the mind/body continuum is indeed a “black box” in that it is not fully understood, is deeply complex, and requires time, patience, and effort to even begin to understand. But where this should inspire humility and curiosity towards helping patients articulate their experience to provide compassionate and targeted interventions, it is all too frequently disregarded in practice. It is not enough to neatly reduce mental suffering to mere behaviors for doctors to manipulate or medicate patients out of—to only frame the mental challenges individuals experience as behaviors almost goes so far as to blame the victim.

Behaviorism for all doesn’t work for the same reason that overprescribing psychiatric medication for all doesn’t work—mental illness and human suffering do not simply fit in manualized, cookie-cutter models of diagnosis and intervention. By establishing standards of practice that mirror the foundations of psychology as a pluralistic discipline, reflective of and curious towards the subjective nature of human experience, we can avoid the grave mistake of clinical psychology serving a reductionist worldview that is indifferent towards crucial aspects of human difference.

Considering the blind confidence professed in the behavioral health model, you may be surprised that the data supporting its efficacy has been shown to be grossly exaggerated, and that the initially positive results in studies have been impossible to replicate.

Far from generating the predicted crisis that should have given rise to more reflection and interest in other approaches to treatment including humanistic and psychodynamic therapies, though, the APA has dug in its heels and is attempting to elevate behavioral health from one approach/intervention among many to the absolute standard of care of psychological practice, period. This gesture is an egregious act of confirmation bias, and betrays psychology, which should be the field dedicated to understanding and supporting the complexity of subjective human experience, especially mental suffering.

That the APA intends to ignore its own professed values, insult its constituencies, and engage in policies of dubious ethical consequence is sadly nothing new. Most troublingly, it was revealed in 2015 that the APA effectively participated in and bolstered the Bush administration’s ethical horror of systematic psychological torture against detainees who were denied legal representation and fair trial in secret prisons around the globe. For an institution still struggling to overcome the aftermath of having committed such a profound ethical crime, very much against its own standards and regulations, we should sincerely hope for, if not demand, more humility, atonement, and consensus building.

The APA must stop attempting to confirm and enact its biases through its position of outsize power, and better act upon its own principles and research towards fulfilling its responsibility in serving the needs of its constituencies. As the APA falters, psychology in the US fails to take a leadership role in working together with psychiatry, social work, and the counseling professions towards democratically engaging real solutions to address yet another raging pandemic that has continued unabated in these uncertain, precarious times—mental illness.

Instead, the APA is increasingly choosing to defer to a deeply flawed Western medical model that it should be critiquing, rewriting, and perhaps even helping to dismantle and rebuild. Exclusively promoting behavioral health represents a capitulation to a broken for-profit health care industry and flawed research models that are the very basis of a system that chronically fails to support those who need it most.

The current proposed changes professed by the APA are another dangerous step towards a psychology without a soul—this represents a troubling failure not only to the public it serves, but to the profession of psychology itself.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

14 COMMENTS

  1. I think it is revealing what Psychiatrists mean exactly when they say our treatment is “effective, and better than placebo.”

    The corporate clinical trials do find that antidepressants are statistically significantly better than placebo. (For now let’s not address biases and flaws of these studies. Let’s just look at the exact results). These studies find that the drugs in the short term reduce the HAMD 54 point scale by about 2 points. A 2 point change in this scale can mean the person goes from saying they are not ill to saying they are ill. The psychiatrist thinking the persons facial expressions have gone from apprehensive to irritable is also a 2 point change. If someone stops losing weight it is also a 2 point change.
    That is why they think people need to take these drugs for life. Because a 6 week corporate clinical trial says that their addicting deadly drug causes a persons HAMD scale to change by the equivalent of them no longer disagreeing with psychiatry .

  2. Great article! And the timing… I”m starting a position as a therapist in one of those primary care teams with a rapid paced setting. In the interview they mentioned rapid-paced many times! Shorter visits, with a focus on brief, CBT, behavioral, medically-connected interventions. I’m nervous as I’m leaving a place that allowed for full hour and was starting to dabble in psychodynamic and deeper trauma therapy interventions.
    I’m hopeful that the brief, medical model setting still has at least some benefit the less-resourced patients they serve, and that it doesn’t lock me in to approaching problems that way forever!
    I appreciate your framing the responsibility of the APA to include diverse viewpoints. A cynical side of me see s the overreach of greed seeping in to all professions, prioritizing corporate interest over human need. I also wonder if you consider the growing trend of chat-bot AI therapy etc. as something that can add fuel to this fire. (behavioral interventions as gold standard + AI bots that do it amazingly = bills/policies that don’t provide for the good diverse therapy you mention for most people).
    Thanks again, I’ll be coming back to this article to ponder more!

  3. Not only a psychology without a soul, but without a clear identity. I would have thought that if the profession wanted to retain any credibility they should move further away from psychiatry, but the opposite is happening. We need to accept that for an ever decreasing number of psychologists it is still a calling and they are primarily moved by a need to be of service to others, while an ever increasing number (aka mini-me psychiatrists) see it as an easy and simple way to make money (“teaching” people to breath, tense and relax muscles and other “skills”, “psychoeducate” on the reptile brain and the amygdala, encourage them to keep diaries and challenge all those wrong thoughts, go for a walk, buy a pet, etc.). More and more people are waking up to this farce and that psychologists are less and less able to meet their need for human connection, genuineness and true understanding in times of crisis.

  4. Can’t say I agree with your presumtion about the existence of “mental illness” Ben but …..I hope you will allow me to hold such views without considering them to be an illness that requires me to be ‘spiked’ with benzos, have items ‘planted’ on me to obtain a police referral, and then start force drugging me for complaining about being snatched from my bed and delivered to a locked ward for ‘assessment’ before I even get the chance to speak to a psychiatrist. Still, I live in Australia, not the US.

    “Most troublingly, it was revealed in 2015 that the APA effectively participated in and bolstered the Bush administration’s ethical horror of systematic psychological torture against detainees who were denied legal representation and fair trial in secret prisons around the globe. For an institution still struggling to overcome the aftermath of having committed such a profound ethical crime, very much against its own standards and regulations, we should sincerely hope for, if not demand, more humility, atonement, and consensus building.”

    For some obvious reasons my interest in the enhanced coercive methods used at Guanatamo Bay has me wondering why someone isn’t setting up an ‘ethical’ organisation that people who ‘don’t have the stomach’ for the ‘treatments’ can leave and go to? I was subjected to 7 hours interrogation whilst ‘spiked’ with a date rape drug and not informed, and then denied access to legal representation when I complained about this act of ‘hard torture’ (in fact you might be surprised how far some of your colleagues will go to maintain their ‘good’ reputation).

    I draw your attention to a scene from an old movie about the Nuremburg trials.

    https://www.youtube.com/watch?v=Feg6rS70o1Q

    [thanks Lametamor] We are not asking what everyone did Dr Ben, we are asking what YOU did?

    Anyway, despite the huge differences of our opinions based on my ‘treatment’ by one of your colleagues, thanks for the information about the descent into Mordor by the APA.

    [Take into account the failed attempt by my government to pass forced sterilization of children without parental consent clause in the Mental Health Act 2016. Thankyou to the International community for their ‘intervention’ as there is no way a ‘citizen’ in my State would dare speak out against anything that psychiatrists request of our ‘elected representatives’. Shame they got the Euthanasia Act through. Next item on the agenda? make it a crime to criticise the government and draw attention to the similarity of the laws to those passed by National Socialists in Germany]

    • Next item on the agenda? make it a crime to criticise the government and draw attention to the similarity of the laws to those passed by National Socialists in Germany.

      Might I add.

      At present any criticism of the government that is not wanted is dealt with by referring the ‘issue’ to mental health services. My complaint about being ‘spiked’ with benzos before being interrogated/kidnapped (though they did go to the trouble of exploiting the “inherent in or incidental to lawful sanction clause of the convention against the use of Torture) to the Attorney General gets referred to the Minister for Mental Health who calls the act of complaining about such treatment an ‘illness’ that requires ‘treatment’. I do like the use of euphemisms though, the unintended negative outcomes achieved by removing the evidence of a motive by police, who can’t seem to locate their copy of the Criminal Code (which is a shame when people are being murdered while they look).

      Making it lawful for police to arrest anyone not praising our leaders and then dropping them off for ‘treatments’ in our Emergency Depts will no doubt result in some popular politicians. And a decrease in the numbers of mentally ill people (surely they wouldn’t be so mad as to dare speak truth to power such as this?). And with the new ‘home delivery’ systems in place, they won’t even need to clog the Emergency Depts, the ‘treatments’ could be delivered at home (‘spike’ them and ‘plant’ a knife on them when they collapse. legal narrative “edited’ before lawyers get to see it). The ‘marriage’ of mental health services and police complete now they have a Mental Health Professional in every station, with zero accountability and carte blanche to deal with this threat to law and order.

      Our Chief Psychiatrist who provides protection to “consumers, carers and the community” not even capable of recognising a burden of proof (suspect on reasonable grounds becomes suspect. Suss laws for arbitrary detentions and forced drugging by removing the “Criteria” from the Act without parliamentary approval. Care to see the letter?) despite him providing “expert legal advice to the Minister”. Seems difficult to me to protect citizens when you don’t even know what the protections afforded by the law are.

      Lawyers provided three letters showing the application for documents under the MHA, huge bold black font at the top of the page. Now despite these letters being provided to the Chief Psychiatrist he writes “I am of the opinion that the documents were requested under the FOI Act, and as such …….” gee I hope he checks the ‘charts’ of his patients a bit more thoroughly. And consider what he was claiming by this, that it’s okay to provided “edited” [aka fraudulent documents with the ‘spiking’ removed and other documents inserted to create the appearance I had been a “patient” for ten plus years] documents under the FOI Act? Still, they were under the impression that the police had retrieved the real set of documents and that my family had been threatened to shut their mouths about what they had done to conceal their torture and kidnapping. Interesting that mock executions and threats of rape only fall into the category of ‘soft torture’ isn’t it Ben? Coercive methods, which are deemed a “poor choice of words” according to our Police Commissioner. That is, if you record the exchange and it goes public. Otherwise it’s your “hallucination” that they refer to mental health services for silencing.

      How positively poisonous that they retrieve the proof of the ‘spiking’ and then begin slandering me as being a paranoid delusional for speaking the truth about what was done to me (victim of stupefying with intent to commit an indictable offence, namely kidnapping becomes paranoid delusional requiring copious amounts of tranquillizers and ECTs until he can no longer remember his name). It really became an issue when I provided police with the documented proof, when it’s no longer my “hallucination” but their act of torture.

      They have ‘friends’ though. Me, I don’t even get to see my family so they can conceal their crimes. 9 years now for complaining about public sector misconduct. Who knew that was such a crime.

  5. “The current proposed changes professed by the APA are another dangerous step towards a psychology without a soul—this represents a troubling failure not only to the public it serves, but to the profession of psychology itself.” I agree.

    I could quote a bunch of excellent statements in this blog, about the systemic crimes of the American psychologists. And I am glad MiA is now starting to point out the systemic crimes of the psychologists, and other “mental health” workers, not just the crimes of the psychiatrists.

    Since it is the entirety of the DSM deluded “mental health” industry, who are the scientifically “invalid” criminals, that are systemically committing crimes against innocent Americans for their own profit, and are trying to destroy America from within, that are the criminals.

  6. Sorting out confusions is the domain of philosophy not science – philosophy is about elucidations, science about explanations. Science deals with causes, philosophy with reasons. This was the essence of Wittgenstein’s philosophy, but the world has been taken over by a scientism – the great hope that a scientific answer can be found to our confusions. Some psychotherapies come closer to philosophy than science – such as Open Dialogue and Solution Focused Practices – they allow confusions to dissolve (“like sugar in water” – Wittgenstein). “We are aiming at complete clarity – so all philosophical problems should completely disappear” (Wittgenstein). Scientism is rooted in Francis Bacon, when he separated “scientia” (knowledge) from “sapientia” (wisdom) and instead united it with “prudentia” (‘Knowledge is power’). Scientism looks for leverage – in mental health this generates much suffering as we all know. Both APAs approach individual confusions with institutional confusions; but they are not alone. Most social services are making a similar error.

    • “Most social services are making a similar error.”
      Absolutely. And more and more are co-opted by the “MH” narrative. And we all know that just because there is a “majority” narrative, it is only so on the surface and is usually there because of power inequality, and not being properly informed. Psychiatry is well aware of the false narrative and is the only reason they need to defend themselves or use power.
      And “majority” narratives change over time.

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