I want to send all my Division 42 colleagues good wishes at this holiday season.  I have been absent from all of your lives for almost five years now.  And I have chosen to remain silent while I observed the continuing evolution of the profession I love and that we share.  At the time of my leave taking, I had felt myself feeling increasingly alienated and marginalized - feeling less and less connected to the visions of the future most of my colleagues were embracing.  I have hated the deformations of practice forced on us by the government and by third party payers.  I have hated the medicalization of the profession. I felt impotent to make any further difference.  I gave up and stopped trying to influence what we were becoming, for I no longer felt among you.  In recent days, I have reconsidered my decision and found myself wanting to speak up at least one more time.  You will find what has motivated me and the thoughts I have marshalled at the end of this article.  I hope at least a few of you read it.

To my Division colleagues:

I withdrew from any participation in APA or the affairs of its Divisions in 2003 and fell silent.  While I sometimes watch the various interchanges that occupy the time and interest of those on the listserv, I have not been moved to comment. Four weeks ago, though, I contemplated ending my silence for reasons I will share with you in time. And now I am indeed doing so. 

Many former and present students of mine and some of my colleagues in my community and in APA and Division governance know how much I have hated and scorned my sense of what my precious profession is
mindlessly becoming. Unfortunately, the transformations are partly my doing. I helped shape what we have become, and I feel the great oppression of personal guilt for having occupied various leadership positions and having prodded professional psychology - particularly its  subdivision that is now labeled “clinical psychology” - into embracing what from my perspective is now proving to be a toxic identity and a failed mission.

In various governance positions during the 1990s - in APA Divisions and at the level of APA’s central governance, then - my beliefs and my evolving present posture rapidly and dramatically altered as the real
implications of the very transformations of our calling I had helped craft came to me with a clarity shared only by a few. By late in the last decade, it became unbearably apparent that I was indeed in a lonely minority, that my reversal of perspective, my cries of warning, and my attempts to change the wrong-headed momentum of professional evolution were about as effective as King Canute shaking his fists and crying out against the waves crashing on the shores of his kingdom.

I got tired of seeing irritated looks on the faces of my APA governance colleagues when I spoke, of having it become increasingly difficult to get my concerns placed with ample time for explication on meeting agendas, and of having to hear whispers of “there he goes again” when I argued futilely for what mattered to me. As a result, in 2003 I withdrew from any further involvement in APA affairs, came fully home to my wife
and family, to my friends, to my students, and to my clients, and I chose to fall silent in all public arenas, surrendering my last foolish hopes to matter any longer as a figure in the creation of the history or of the
future of professional psychology. 

To review that history we share briefly, in the late 1950s and on into the 60s, for the first time significant numbers of applied psychologists whose educational careers and a large array of waiting jobs had been financed by the federal government, poured out of the nation’s universities and  into the VA, clinics, hospitals, mental health inpatient and outpatient settings, and, yes, even into independent practice. Before, psychology was a research/academic enterprise. Since then, all has been changed, and the tide is still flowing. Most of us who were the early entrants into careers as applied psychologists received our skill training in some kind of medical setting, and most had as their conceptual models of what troubled the lives of the clients we were to serve some map created by those who believed in “mental health and illness” and in “psychopathology.” Most attempted to label the distress they viewed with the DSM I and soon thereafter with the DSM II. I really do not think that these textures have altered a great deal over the past 50 years.  It appeared to those of us who found ourselves in leadership positions of the new and emerging profession in the 50s and 60s - as this wave of fresh doctorates continued to roll out in exponentially increasing numbers and to seek places in the fabric of society - that the future of the profession depended without question on all of us drawing ever closer to the dimensions and prerogatives of medicine in our own models and activities and even more importantly, to attach ourselves to existing funding mechanisms available within society organized to pay for medical services - health insurance reimbursements and payments for health care available under a variety of publicly financed programs.  Failing to do so, we believed, would result in the regression of the profession and in its inability to thrive and to become accepted by the public. 
Since then, we have fought first for licensing legislation; then for inclusion in Medicare, Medicaid, and private insurance reimbursement provisions; then for hospital privileges; and now for prescribing privileges. We have made the DSM IV our bible. As early as 1964, we formally declared ourselves to be a “health service profession,” and presently our leadership is preparing to seek that psychologists be recognized as a form of “primary care physicians” and want us to be included as such in hospital staffing and in HMO structures. And in doing my volunteer work for APA and its Divisions and in helping to shape lobbying and policy initiatives, I am ashamed to acknowledge that on into the early 1980s I was one of the prime architects of this ongoing madness. Indeed, I remember a long-range planning meeting in Washington in 1982 when I had an “inspiration” and said, “I think we could expand our opportunities if we could secure permission to prescribe psychoactive medications. It’s not rocket science. There’s no reason that psychologists couldn’t master the necessary relevant areas of biology, anatomy,  physiology, and pharmacology as well as or even better than physicians.”

I will never forgive myself for that comment. Freud, in his monograph The ego and the id, has a little section devoted to “those who are wrecked by success.” I think of the profession of psychology often from this perspective when I review the journey we have made and what has become of us. “Psychology” means the study of souls. But we have lost our souls. The ever quickening pace of the medicalization and mechanization of the profession has been driven by three dynamics: the public and our profession’s naive commitment to what the philosophers of science call the reductionist fallacy (a belief that troubled human experience and behavior can and need somehow to be addressed at the level of genetics and neurobiology), the enormous capitalist greed and corporate profits that can be garnered by this view as shared alike by big pharmaceutical companies and the leadership of the nation’s HMOs, and the playing out of old and ongoing tensions between psychology’s scientists and its practitioners.

The former have always had contempt for the activities of the latter and have believed that unless we who practice rooted our practices firmly in what they labeled as “empirically validated” intervention strategies, then we were nothing short of conducting ourselves as charlatans. In the current capitalist landscape with its yearning to contain health care costs so that corporate profits could rise ever higher, the desire to limit health care only to that which is “empirically validated” spills over into the practice of psychology as well as that of medicine and thus advantages a subset of our scientific colleagues. The latter, unfortunately, have always bought into the reductionist fallacy and now use as the “best” tactics for putting the seal of approval on on various intervention strategies the double blind research design. This is the design adopted for bringing drugs to market and is - to use the words of our psychologist scientists - the “gold standard” for evaluating effectiveness. Other forms of gathering and evaluating information about what we do are valued far, far less - including the rich years of research on the nonspecific factors in any therapy, the nature of the therapist/client relationship, and the importance of empathic connectedness and the working alliance.

I am saddened that CSPP-Los Angeles, the campus where I have been teaching for 34 years, now has a curriculum that contains a course on “empirically validated treatments.” I understand the political necessity for the campus to do so, but I see this as another movement along a track that has increasingly made me ashamed to be a psychologist.  What are we becoming? We are losing the capacity to relate to our clients on a human level, person to person. We trivialize them. We engage with them from a subject/object disconnection which interferes with what Martin Buber described as the “I-Thou dialogue” so essential to healing. We “diagnose” them and attempt to reduce “symptoms.” We believe almost everyone should be evaluated for possible psychopharmacological interventions. We treat the stream of our experiencing in the therapy session as if it were dangerous (“You have to keep your countertransference in check!”) rather than the richest possible source of inspiration about the nature of the troubles of the person with whom we sit and about the conversations we might have with that person that could promote healing. We use DSM IV labels to stigmatize and dehumanize clients (“I have to see my borderline at 3:00 this afternoon”) and to organize our trivial research studies. And if you add into that bad mix the evil we do to ourselves and our clients in the name of “risk management” at the behest of our malpractice insurance carriers, then we are succeeding in murdering most of the humanity that by right needs to be alive in the consulting room. We have even taught our students to believe that it is unethical ever to hug or even to touch a client, for example, and that it is probably unethical - a “boundary violation” - to engage in the most trivial forms of therapist self-disclosure - empirical data about the possible importance of such things in fostering the therapeutic alliance to the contrary notwithstanding.

These developments which are esteemed as representing the “best” in the ongoing march of the profession, have left me feeling ashamed to be a psychologist and brooding about seeking the Adult Education credential from the State of California’s Department of Education - thereby altering my professional identity while still permitting me legally to offer services to the public under a different rubric. This after 49 years of independent practice! The lemming like march of my colleagues also has made me feel content that I am aging and probably will not be able for many more years to go on engaging with my personal way of rising to teaching and psychotherapy challenges, all the while sadly watching the decay of the calling I love with its desiccation of the treatment encounter. It is disgusting to me that what the “standard of care” is becoming in the field feels not only personally odious, but, I believe,
is increasingly harmful to those who seek care from us as well. My infirmity and death in the years ahead will certainly liberate me somewhere in the flow of my future, ending my having to bear witness to that which is so personally hateful to me, or so I have mused to myself and my wife and to a few psychologist friends who understand. 

Four weeks ago, as I noted, I changed my mind about continuing my silence. This change of mine came about in a mysterious fashion. I had some free time between clients. I wanted something to read, but I was too lazy to go to the waiting room to look for and grab one or another magazine I might not yet have perused. The only reading material in my office was the most recent issue of The American Psychologist. I sighed. When I picked it up, I saw to my dismay that it was the November annual awards issue, typically vanity press, an issue stuffed with puffery about a variety of colleagues who had convinced other colleagues to advance them into some kind of recognition by our national association. I flipped through the pages in irritation, but I was desperate. My eyes fell on “Award for Distinguished Professional Contribution to Applied Research.” given to Bruce E. Wampold, Ph.D., Professor of Psychology at the University of Wisconsin, Madison. As was his prerogative, Dr. Wampold had made an address at the 2007 convention about his research, and a version of his address was printed in the AP following his citation and his biography.
“Ah...,” I thought. “I’ll scan through this one. I need to see what our damned scientific colleagues are up now to and if this is another piece extolling how manualized treatments that trivialize the healing relationship will rescue the purity of the profession, conform to the needs of third party payers, and insure that our clients receive the ‘best possible care.’” I was prepared to read, to curse, to withdraw even further into my sense of futility, and at the same time to pick holes in the methodology and underlying assumptions that were leading to the irritating text I was sure would follow.  Instead, what I read was riveting - an offering titled, “Psychotherapy: The Humanistic (and Effective) Treatment.”

To my wonder, I found myself following the text with passionate attention. Its words made me so proud again to be a psychologist. The narrative represented to me the absolute best of what we have been trained to be. I felt new pleasure in the scientific training I had received in graduate school. The experience was inspiriting. It totally turned my head and lifted my sour mood. It gave me back hope. It filled me with envy, wishing I had Dr. Wampold’s methodological and mathematical competencies and that it would have been
I who had written the work.  Here was a scholar who was being recognized by our national association. His submission sums up years of his having carried out meta-analyses of the corpus of research on psychotherapy process and outcomes. He is also a thinker who embeds his comments on understanding psychotherapy and its change processes into a frame that makes wonderful reference to the varieties of ways we humans seek change: medical interventions and spiritual healing among others.

If you read nothing else in the weeks ahead, please pull out your APs for November and read the article. In Wampold’s narrative, you will see how much the outcome of what we do is rooted in how well we can make a human connection with our clients and our capacity to possess and to convey a frame of reference of some kind about the intended work ahead - a frame that makes sense to us and that can be shared with the client so that it makes sense to the client as well and offers hope and the possibility of change to them. And perhaps most of anything we must connect person to person so that we secure from them an engagement into undertaking the mutually shared and understood project of their transformation. It is the therapist’s capacity to generate the engagement that provides the foundation on which all becomes possible regardless of what the therapist believes he or she is doing.  Wampold acknowledges that the possibilities of change are rooted as well in other yet to be discovered variables that describe the human connection between therapist and client and that the further teasing out of the complexities of such human engagement provide the directions for future research. But the characteristics I have enumerated above as the elements of change far outweigh the power and benefits to be had by the client from our pursuing any particular “orientation” or supposedly employing what any of us believes to be the “best interventions” for particular “conditions,” the use or nonuse of pharmacological agents, and the other variables we have misguidedly insisted were the active ingredients of the work we need to undertake when a new client appears. 

I have always believed and taught that the therapist was the therapy and have so experienced the nature of our calling over almost 50 years of my own practice, and I have come to the same view from having supervised the efforts of generations of psychologists entering the profession or who are already my colleagues in practice but want a consultation about this or about that from time to time. It is beyond wonderful to see in black and white empirical justification for my beliefs, beliefs so scorned by others. If the quiet voice of sound science seems to be moving us in humane directions, maybe there is hope for me yet. Maybe what I have believed and that for which I have been an advocate will not gutter out like a spent flare. Maybe the intellectual textures and the false models of the present era represent a kind of temporary insanity in the profession driven by the worst textures of our contemporary culture: the hunger for the “quick fix,” the growing disconnection between humans in all spheres of life, the profits to be made by medical and pharmacological firms through providing trivial forms of care, and the “need” to “contain health care costs” by rationing care, disempowering those who need it, and placing many of us who want to be of service in structures where what we are to do is dictated by others who always have their eye on the “bottom line.”

In the 1930s, the psychologists in Germany rushed to focus their research on studies that would prove the racial superiority of members of the supposed “aryan” race. The beauty of what it means to prize all humans and the universality of the simple meaning of being human became lost until millions were killed in war or were purposely exterminated during WW II. Today, in spite of the supposed objectivity of the march of our
psychological science, those who pursue science, after all, are always themselves human beings and always carry out the enterprise embedded in a culture carrying rewards for thinking and acting in certain ways. I
believe it is indeed true that fish do not know of the existence of water until they are without it. I also believe the water in which all psychologists are presently swimming is quite polluted, but too few of us
are calling any attention to that fact. I want to salute Dr. Wampold for the clarity of his vision, and I hope you will yourselves.  The formal reference is: Wampold, B. E. (2007). Psychotherapy: the humanistic (and effective) treatment. American Psychologist, 62, #8, 857-873.