Advocacy: Psychology and Political Action

It was interesting to compare and contrast the recent article by Barnett (2004) in The Independent Practitioner with other views expressed by different authors, on the topic of political involvement by psychologists (Fox, 2003, Newman, 2004).

As I understand it, the gist of Barnett’s argument is that psychologists have a generic moral obligation to support their profession politically. Although that is perhaps a compelling argument for some, the analysis by Fox (2003) documents the niggardly giving habits of psychologists, taken as a group--in contrast with several other professions, such as optometry, podiatry, and social work. Fox might well have added nurses, lawyers, and physicians to this list, many of whom are even more generous in their political giving, both at the state and national level. Indeed, Fox’s theme of professional support among psychologists has been noted in these pages in years past (e.g., Saunders, 1994).

The thrust of a recent Russ Newman letter is focused on specific legislation such as mental health parity, prescription privileges, and related initiatives. Newman’s topically oriented piece apparently is predicated on the assumption that mentioning issues about which psychologists presumably care a great deal will generate additional financial support, from individuals who already contribute.

The APA political dilemma from my perspective centers instead on the lack of focus on the factors that determine psychologists’ participation in politics. Barnett in particular shows what I regard as a lack of appreciation of the psychology of psychologists. Although the pragmatism of a Ron Fox and the content orientation of a Russ Newman are undoubtedly necessary for psychology to become a more effective political force, moralistic aphorisms have not accomplished anything professionally, and in my view never will accomplish anything, in the political realm. Instead, we need to be firmly grounded in what affects psychologists, in order to develop a combined financial strategy and a political strategy that can make a genuine difference for professional psychology in the market place of public opinion.

Experience as a Teacher

When this writer was the Federal Advocacy Coordinator for Maryland, I was able to develop a team of ten psychologists, one each for our two U.S. Senators and one each for Maryland’s eight Representatives in Congress. Several of the volunteers knew their assigned federal legislators personally, including one who was a distant relative of her Congressman, another who attended church with his Congresswoman, and one psychologist who shared a dentist with one of our Senators! Most of these volunteers had never been active before in any political campaign, and several told me in private telephone conversations that they had almost been embarrassed to reveal the degree of their relationship to the person to whom they were ultimately assigned.

Regrettably to this date, aside from limited appeals on one or two occasions for individual Federal legislators in Maryland, there has never been any systematic follow up effort to raise funds for members of our Congressional delegation. This lack of political support seems typical of most state psychological associations around the country, and there is certainly little if any information about important votes in Congress on professional topics in the APA Monitor, or in other media affiliated with the American Psychological Association.

One finds a legalistic faction within APA that attempts to justify this lack of political information and involvement on APA’s vaunted 501(C)(3) tax status. That is, as a tax-exempt organization, this argument runs that APA is not allowed to “campaign” for candidates. In fact, mere mention of political issues and votes in Congress causes the term “electioneering” to surface in APA circles--a contemptuous term generically employed to refer to any type of information about political topics of the day.

Indeed, readers might ask themselves when the last time was that they saw a serious extended discussion in any APA-affiliated information source that addresses the practical political considerations surrounding a given issue. The same is true of state psychological association as well as Division publications. When this writer was the Editor of The Independent Practitioner, we did attempt to publicize some candidates for office on a bi-partisan basis, but this effort has never to my knowledge been replicated in any other APA-affiliated publication. This death of practical detail dovetails unfortunately with the passive and acquiescent political style of many psychologists, disenfranchising us all. Although some holdout hopes that a parallel C(6) professional organization will change the political landscape for psychology, this writer is skeptical--because of the current situation in APA as a whole.

The Usual Suspects

In many discussions that I have had about the political deficiencies of psychology and psychologists, there are routine complaints enumerated about the graduate training psychologists receive, which operates as a seedbed of political inaction. Psychologists are trained in a general model of service delivery, but the focus in our graduate training combines a form of intellectual rugged individualism, with intellectual distrust of the ideas of others, to produce a kind of skepticism that prevents group action and destroys the cohesiveness that is essential for lobbying and professional advancement. Coupled with the lack of collegiality and civility that has been observed widely in the field, especially in the last few years (Woody, 2001), it is no wonder that the lack of respect for the civic process among psychologists seems so widespread.

It is also crucial, I think, to emphasize the tremendous economic devastation that has been visited upon practitioners by the industrialization of health care during the last ten to fifteen years. I know that in my own practice, even though we have been fortunate to attract the services of several collaborating professionals, our profit margin has collapsed, while our expenses have climbed considerably during this time frame. More and more skilled help--particularly technological proficiency and legal and accounting assistance--is required for us to continue to operate. Many psychologists I know are only able to practice part-time, and their incomes--apart from niche areas of functioning--have either retrogressed or failed to keep pace with rising costs.

Lack of Political Tradition

Both in their backgrounds as well as in graduate training, psychologists collectively appear to lack any strong sense of political tradition. Of course, there are individual psychologists who support particular candidates and causes, but again the intellectual/academic tradition in psychology, so strongly rooted in and dominant of the APA culture, combines with acquiescent personality attributes to keep psychology a virtual political non-entity among the professional disciplines.

To give another example, a tremendous amount of attention has been devoted in recent years to federal HIPPA legislation and its impact on professional practice. From all these writings, nevertheless, it is still not clear how HIPPA legislation will affect the patients of psychologists and their clinical records, to say nothing of the role it plays for psychotherapists and psychological assessors in their interactions with patients. The likelihood of resulting harm to patients, and unwanted legal jeopardy for psychologists as practitioners, is in my estimation extremely high. Too often, psychologists are spectators who become the helpless victims of these legislative and executive initiatives.

The traditional split between psychologists whose primary interest in the field is scholarly, as opposed to those whose primary interest is in human service delivery, is one aspect of the overall problem within the profession. One need look no further than the intense controversy generated by the empirically validated treatments movement, or the powerful and entrenched opposition of various important factions within the American Psychological Association to prescribing privileges for other psychologists, as examples of the internecine warfare that is a constant subtext to the governance of APA.

APA Structural Problems

To this massive clash of internal forces, we must acknowledge the structure that the American Psychological Association itself adds to this perplexing social and cultural set of phenomena. The fact is, in APA as it exists now, there is only one office per year (that of President-Elect) that is selected by the APA membership as a whole. The Council of Representatives is elected from a bewilderingly large number of jurisdictions, using an arcane voting structure that in turn depends on an annual “apportionment ballot,” rather than state association or Division membership totals.

Each year, the Council of Representatives is re-composed annually, in various incarnations that ebb and flow in a variety of directions at the same time. This creates an organizational dynamic that resembles a huge form of musical chairs--with a floating, rotating membership. One result of this in my opinion is that few issues are ultimately settled, and various incarnations of the Council of Representatives and the Board of Directors constantly decide, undecide, and re-decide markedly similar issues over and over again, often over decades. Is it any wonder in such a structure that little of lasting importance can be accomplished, and that the same topics are constantly debated from various factional viewpoints? Thus, organizational drift leads to organizational stagnation, and ultimately to organizational irrelevance.

A separate aspect to this problem, unknown to many practitioners, is that the American Psychological Association is still today governed largely by people who are institutionally employed, not by individuals who actively practice independently. At any given point in time, majorities of the APA Council of Representatives are employed by public service institutions, universities, large teaching hospitals, and similar work settings. Is it any wonder then that people from these backgrounds have difficulty understanding the issues that face practitioners every day? While APA is ultimately a largely volunteer organization, and every organization--volunteer or not--undoubtedly will evolve its own unique and particular characteristics over time, the arcana of APA governance creates contortions that are often dramatically undemocratic and run counter to true professional progress for the discipline as a whole.

The application of the Hare method for nomination and election of members of the Board of Directors by the Council of Representatives is another example. This process illustrates the power of APA’s factionalism triumphing over democratic selection methods, rather than reflecting the will of the APA membership as a whole. Why are nominations and elections to the Board of Directors not conducted from the APA membership as a whole?

Another example of structural impediments is the selection of the hundreds of members of the APA board and committee structure each year. In APA, each Board and Committee serves as its own nomination committee. Many use pre-selected “slates” to represent various interests, often those that are compatible with the sundry factions that already exist. Again, the APA membership as a whole has nothing to say about these sometimes vitally important positions, which can affect everything that APA does organizationally--from education and training decisions, to the evolution of its Ethical Principles, to the application of science to professional activities and to the socially relevant concerns of its members.

I contend that this system is perpetuated by an APA governance that is contemptuous, in practice if not in theory, of democratic participation by the APA membership as a whole. “Reputation” alone, rather than meaningful accomplishments or actual talents in practical politics, becomes the basis for APA activities. In a professional society, this seems a tragic waste of both time and talent.

To my way of thinking, when psychologists are allowed only a limited investment in their professional society, they also feel relatively little loyalty to the culture that has been erected to take charge of that society. In my opinion, this lack of mutual trust and confidence is also reflected in the lack of financial support APA members show politically.

Finally, I believe that many APA members feel oppressed already, by their financial support of APA. There are dues, special assessments based in large part upon income, expenses for periodicals, purchases of continuing education and related fees, the cost of licenses, and the numerous, redundant bureaucratic layers of local, state, regional, and national APA organizations of various kinds. All these contribute to an atmosphere of money continuously flowing out to organizations run by psychologists, but whose tangible benefits to practitioners are largely invisible, ephemeral, or actually counter-productive.

Psychologists As Customers, Not Colleagues

Without appearing to single out any individual or particular organization for criticism, let me illustrate the sense of other-worldliness that I associate with existing psychologist-driven institutions. If we take the APA Insurance Trust, for example, and examine its products, we find immediately that the Trust offers a variety of instruments, but nothing truly resembling a product line that psychologists as employers could offer to their employees, as a work incentive and tangible benefit package. Indeed, employees of psychologists are not included in the Trust’s charter, reflecting what I have already said about the mentality of APA’s governance, as a group of people who think of themselves as employees, rather than employers.

Likewise, APA as a whole does not offer any prepaid legal service plan, nor does it offer the cafeteria of organizational services that are frequently associated with large-scale professional societies and some executive organizations. The absence of a meaningful health plan or medical savings instrument, for example, is another major absence among the Trust’s products.

In summary, what Barnett (2004) puts forward as a one-way accountability of membership to the organization, I view as a two-way street that includes accountability both of the APA as an organization to its members, as well as from the members to the organization. A marvelous example of this interplay for Division 42 members was the 2002 revision of the Ethical Principles of Psychologists and Code of Conduct (Knapp and Vandecreek, 2003). After four years of work, the Division 42 Task Force on the Ethical Principles, chaired originally by Lenore Walker and later by David Shapiro, did eventually have a significant, positive impact on the work of the appointed APA Ethics Committee Task Force, chaired by Celia Fisher.

Unfortunately, while the ECTF produced a document that has no less than 23 references to “informed consent” procedures, for example, (Knapp and Vandecreek, 2003, pg. 82-83), and no less than eleven different “exceptions” to informed consent, (Knapp & Vandecreek, 2003, pg. 84), the ECTF did little if anything to acknowledge explicitly the legal and civil rights of psychologists, especially with respect to due process and freedom of expression. This is despite the fact that there has been extensive anecdotal evidence (Saunders, 2001, 2002) of misunderstandings and misapplications of the 1992 Code, and there have been major flaws pointed out again and again concerning the substantially unchanged “multiple relationships” sections of the 1992 and 2002 Code (Lazarus and Zur, 2002).

One wonders if a group of explicitly elected members of the APA Council of Representatives--responsive first to their own constituencies, but also responsive to the APA membership as a whole—would have created the same version of the Ethical Principles that we see today. Would the Code reflect this fetish for “informed consent” and its strange concatenations around the topics of release of assessment information, for example, in contrast to Federal HIPPA statutes (Knapp and Vandecreek, 2003)?

Conclusion

Right now, it is undoubtedly true that psychologists as a group are stingy and short-sided in the extreme in their lack of support of APA’s lobbying efforts, as well as the lobbying efforts of state and provincial psychological associations. However, I disagree with Barnett that this is a question of moral necessity.

Instead, I think that it is a problem of mutuality, democracy, and a need for a systematic strategy that creates involvement and fosters active participation. In order for APA to survive and thrive as an organization, it is going to have to abandon the Albee plan, the Hare system, and the luxury of endless debate over abstractions which steer us away from the main events that make it possible for us to survive professionally.

APA has had wonderful Presidents and ordinary members who have individually and collectively made marvelous contributions to the field of psychology and who can be organizationally quite effective. These individuals need to be supported by a Board of Directors that is focused on specific tasks reflecting professional priorities -- both in practice and in other professional activities -- and by a Council of Representatives that stands and falls on a specific, recorded voting record, that supports tangible accomplishments.

I believe that tremendous economies can be achieved among practitioners, by consolidating many of the organizations to which large numbers of psychologists contribute. We need to discontinue the extensive overlap and the financial as well as professional redundancies that already exist. Then, hopefully, psychologists can realize the ambitions of a Ron Fox and a Steve Pfeiffer, and deliver to them $100.00 apiece from ten thousand loyal and dedicated psychologists, each and every year, so that a legitimate (C)(6) political organization and an allied, robust lobbying apparatus can bring together both state-level and national accomplishments; an organization that will secure and protect the status of psychology -- to the benefit of the physically and mentally ill, the developmentally disabled, and other vulnerable and unappreciated populations who need the services and skills of a vital, engaged profession.

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