President's Message

Here is my thesis, my text if you will: the world needs a profession of psychology, but the version that is currently available is sadly lacking in meeting that need. The hope for a strong, relevant, and robust profession of psychology simply has not yet been met. In my opinion, that is one of the tragedies of our times.

The real tragedy of psychology’s failed promise as a profession is not that it is guided so little by science, for what is truth? Nor that the effectiveness of our treatments is open to question, for what profession does not constantly confront such questions? Nor that charlatans and sham psychologists abound unrepudiated, for when has society ever been free of such? No, our tragedy and great failure is that we know so little about how to help our fellow man and are poorly positioned to apply what we do know. We should be more concerned with how to prevent war, how to deal with poverty, how to cope with racism, and the reduction of human misery than with the truly petty questions that clog the channels of too much of our scholarly discourse. Wrestling with big issues and large-scale solutions gives professions their significance and purpose.

Invited Plenary Address, Annual Convention of the American Psychological Association, August 2003, Toronto.

Instead of focusing on the great unknowns of the human condition and how to improve it, we argue over the nature of evidence. Instead of attacking the important human issues with what we have, we first want to convert everyone to the same methods and get rid of anyone who does not think the same way. Instead of conducting ourselves as confident and competent professionals, we obsesses over whether our practitioners have the right attitudes. In need of lightning bolts to illuminate the storm clouds of human misery, we have only lightning bugs! Others may not agree with my conclusions or fault my flowery rhetoric but I am sincere in believing that we psychologists have miserably failed in our social responsibility to build the psychological profession that is so desperately needed. Even if you do not agree with that statement, perhaps we can at least agree that we could do much better. In the time I have available, my hope is to stimulate thinking that is, if not out of the box, at least out of the ruts in which we have been trapped for far too long.

As an insider observer and participant in the development of the profession for the past four decades, it has often seemed to me that we disagree less over what the important human problems are than we do over how we should resolve them. And we disagree about the “how” to such an extent that we never get around to addressing the what --- much like a dysfunctional family that never takes a vacation trip because its members cannot agree on which airline to use!

Let me be clear that I am not opposed to research or to science. But I am critical of what I believe to be a misplaced emphasis on the nature of truth and on the “correct” methods of investigation. We lack an outward focus on the great issues and the great needs which psychology could and should address. Instead, our focus is inward on the quality of our science and how we know what we know. Our focus on science is sometimes too self-conscious, too self-righteous, and too strident, for our own good. We have a penchant for worrying so much about our scientific legitimacy that we draw overly narrow definitions of science and scientific methods and reach silly conclusions about how to discover truth.

This is not a new habit for psychology. In his presidential address over 60 years ago, Gordon Allport (1940) noted that our discipline’s survival depended on its ability to address society’s needs; which was not happening because of an overemphasis on fidelity to method which, in turn, prevented investigators from adapting research methods to the demand characteristics of the problems:

Methodism as the sole requirement of science means that all the faithful crowd onto a carpet of prayer, . . . Psychology as a science … can be justified only by giving mankind practical control of its destinies, not by squatting happily on a carpet of prayer. (Allport, 1940, p22-23)

A modern version of Allport’s “methodism” may be found in the controversy regarding so-called evidence supported treatments (EST). APA’s Society of Clinical Psychology (Division 12) compiled a list of manualized psychological interventions for specific disorders based on randomized controlled studies [Norcross, p 345 for citations]. Publication of the list brought quick objections from several other APA divisions and individuals, worried about possible misinterpretations or misapplications of such a list.

Understandably dismayed by the shoddy practices and extravagant claims of some clinicians and the perceived failure of organized psychology to forcefully address such unscientific and unprofessional behavior, some scientists inappropriately advocated for the incorporation of EST therapies into accreditation standards and their acceptance as the standard, ethical practices for clinical interventions (cite CPA task force, Lillienfield and Section 3 Presidential address). Some even went so far as to call for professional organizations to impose stiff sanctions, including expulsion if necessary, on clinicians who routinely used interventions and assessment instruments that were deemed devoid of what those scientists deemed a lack of supporting data (Lohr, Fowler, and Lillienfield, 2002).

Not surprisingly, many clinicians objected to what they viewed as an overly narrow definition of research and the assumptions underlying the decision rules, as well as misguided attempt to gain favor with an increasingly discredited managed-care industry by convincing them that psychology was scientifically legitimate. The discussion quickly moved to arguments over definitions of science, what qualifies as research, and the nature of evidence; a debate that continues unabated 10 years after the first list was published and which led to vitriolic attacks of colleagues by their opponents on both sides of the issue.

Division 12, or any other group, has a perfect right to use whatever decision rules it likes with respect to categorizing evidence or acceptable research designs, but suggestions and/or intimations by some that the list be used to evaluate clinical practice, reveals fundamental differences between the views of EST proponents and many other scientists and practitioners. Because I previously discussed the problems I see with such attempts in my APA presidential address (Fox, 1996), I will only summarize the major points here.

First, the EST list that some would impose on practice is based on an overly narrow definition of science that most practitioners and many scientists would not accept. Restricting evidence to what is demonstrated in randomized, controlled studies ties practice to a definition of science that mimics the physical sciences and leads to a rejection of the very idiographic approaches that clinicians are forced to pursue by the very nature of their work.

Second, if practitioners actually restricted themselves to only those therapeutic approaches that have been scientifically validated, they would be limiting their role to that of a technician (Peterson,). Clinicians rarely face clearly defined problems for which they can prescribe predesigned solutions. Rather, the most common need is for flexible, problem solving solutions for complaints that are not precisely definable and that change with time.

Third, the fact of the matter is that if clinicians restrict themselves to applying only narrowly validated or known techniques; they will never be of much value to society. Lest you think that statement is an invitation to charlatanism, remember that clinicians do not have the luxury to start from what is known. They must start with the needs of the people who come to them and then apply all the knowledge, information and skill they have to help resolve those problems. Of course, professionals must exercise great care not to promise more than they can deliver, but at the same time, they simply cannot settle for doing only those things that we know for sure. Clinicians live in a world of ambiguity and uncertainly. It is their job to use their experience, knowledge and skill to help resolve the problem with which they are confronted, nothing more or less.

The goal of clinicians is to improve the behavioral effectiveness or well being of their clients and the plain fact of the matter is that they now have at their disposal a number of treatments (such as psychotherapy) which lead to behavioral improvement for more than two thirds of their patients. Many widely accepted medical and surgical interventions do not even approach such a success rate.

Fourth, many psychological therapies concerned with transforming the person with the problem are aimed at building on the client’s strengths in order to help them cope more adequately or grow in the face of life’s vicissitudes; goals which are antithetical to one of the stated goals of EST advocates i.e. determining which treatment in what dosage is best for which specific problem. Helping our patients build buffering strengths as the path to the alleviation of symptoms really does not fit with the attitudes of those who believe that each patient has a specific disorder; with a specific underlying pathology that will then be relieved by a specific healing technique that remedies the identified deficits.
All such differences aside, the point is that our primary failure as a profession is not our lack of a solid research base for our interventions. Nor is it our failure to agree on the appropriate research paradigm for assessing treatment effectiveness. No, our true failure is our tendency to argue endlessly over such things without ever addressing the larger social ills that so plague our world today.

We are the science and profession that should be at the center of the action in a society in which at least 7 of the leading causes of death could be substantially reduced if people at risk improved just 5 habits (such as stopping smoking, losing weight, and so on); and in which approximately half of all causes of mortality are linked to social and behavioral factors. To take but one example, the Surgeon General recently announced that obesity has become our nation’s fastest rising public health threat affecting nearly one-third of the adult American population and is more detrimental to health than smoking and alcohol abuse. More than any science and profession on the scene, changing habits and life styles is the essence of our purpose. This is our “stuff!”

Why is psychology not front and center in the minds of our countrymen when the need is so great? Why have we not made addressing these matters our top priority and why are we not on the ramparts in Congress and in the media every day leading the discussion about how to address these pressing matters? Why do we spend our time and energy debating about how best to do science when the world starves for help? How long will it be before we realize that in terms of the survival of a profession, it is our social relevance that is the critical variable?

We still know so very little about the human animal and what makes him tick and some of our scientific colleagues are right about some of our practitioners being an embarrassment to any profession. However, the fact of the matter is that the major social and behavioral problems of people in our age do not include which brand of psychotherapy rests on the most solid scientific base; nor which kind of psychological outcome research has the greatest claim to scientific veracity; nor even whether the managed care industry can be convinced that psychological treatments are effective enough to warrant coverage in health insurance plans. Questions such as these are important to scientists and have great relevance to how the profession develops; but they miss the main point of what makes a profession valuable to any society: addressing the critical issues of importance to that society, whatever they may be. My personal favorite big issues are racism, poverty, hate, and the healing power of human love, but the list will vary from one society to another and from one time to another.

If we hope to flourish and fulfill our own promise, we cannot expect the world to wait indefinitely for what it needs from us while we indulge our fascination with our disciplinary navel lint. We need to be about the larger issues and the big questions befitting the great profession we profess to be: What is the best way to help people develop habits that they know they should practice but have trouble maintaining (sticking to a healthy diet, quitting smoking, exercising regularly, refraining from alcohol and substance abuse, and taking medication appropriately). How do we use our professional relationships and the increasing connectivity of our society to enhance learning, develop more responsible adults, and improve personal relationships? How can we tap the power of the Internet to expand and extend the use of psychological interventions for the 70-100 million Americans who now use the Internet to retrieve health-related information or the 90 % of US families who will have Internet access in less than 10 years (IOM, 2001, p. 31-32)? How do we help people optimize such attributes as trust, love, empathy and responsibility? How do we prevent school and family violence, or prevent war or make marriages last a lifetime or enhance sexual enjoyment? How do we prevent terrorism? The list is endless, and exciting. But this list is not where our profession is currently focused. Your list may differ somewhat from mine, but I am guessing you get the idea. We need to focus on what is important to the world in which we live that falls within our purview and we need to do so in a public, visible manner.

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