Yet, when I look around, I do not
see us claiming what is ours to claim. This, I think, is due to
our fear and anguish and our highly individualistic natures.
Perhaps most important it is due to our forgetting the values and
yearnings that brought us to the profession. Fear is being used
to get us to comply rather than to reflect, analyze, and organize
a coherent response.
The archetypal or collective power
of our role for our culture is enormous. If we forget this, just
tell a stranger what we do and watch the response. Often it is
one of fear mixed with wonder, because the role itself carries
the huge mystery and compelling curiosity of moving into the
deeper realms of life, for which I see a true hunger in our
culture. There is a yearning for connection with self, with
others and with life that the values of our material world don't
fulfill. For me, a central part of our task is to facilitate a
movement for our clients toward wholeness and the fullness of
whom one is, whatever the capacity of the client, whatever our
theoretical orientation. With managed care, it is a task we are
less and less able to accomplish.
Evolution of managed care
There were pluses to using the DSM
as the map; namely a burgeoning of our field and an increase in
access to psychotherapy. There were also many minuses in that it
entrenched the stigmatization of psychotherapy as being sought
only for mental illness. And, it devalued it as something one
would pay for oneself. And why would you, if it means that you
are mentally ill, if that is the map? It was not about
cultivating the value of working on oneself, but about weakness,
dysfunction, pathology. Also, it narrowed for us the map that we
were using to chart the territory of human well being and human
suffering, until we would forget . . . and begin to think that
the DSM wasn't just a map, but in fact the territory itself. We
have a nine hundred page book that describes for us "mental
illness." But we do not have one mutually agreed upon
sentence that describes mental health. Why do we as therapists
not notice this? Abraham Maslow was reputed to have once said
that there were really only three important questions in
psychology; namely, what is the healthy individual, what is the
healthy society, and how do we get there as soon as possible?
Psychology's values, managed
care's values . . . an unholy alliance
The values of managed care
fundamentally differ from those of psychology. We are being
encouraged to develop our primary relationship with the managed
care company rather than the client. From their perspective, the
relationship between therapist and client is tangential. Yet, the
most prevalent, consistent finding in outcome research is the
importance of the relationship, irrespective of theoretical
orientation.
For me, the world view of managed
care is essentially a fundamentalist one. There is an extreme
demand for conformity on the part of the therapist and
regimentation in working with clients. There is a strong focus on
pseudo-science and the language of science to legitimize their
reimbursement policies. Managed care views the person as a
machine and uses industrial, technological metaphor rather than
organic process metaphor to define what we do. We are
"providers," essentially technicians, who are being
required to dispense "units of treatment" to
"patients" in the proper "dosage." But, we
are not machines. We are living organisms. And we have internal
lives that have meaning and that guide and shape our external
lives . . . whether or not we acknowledge it. What's more, I am
not a "provider". The whole notion of
"generic-izing" our profession--renaming us, truly
devalues who we are and what we do. I am a psychologist and I
practice the art, craft, and science of psychology through
psychotherapy, organizational consulting, teaching and writing.
Managed care is asking us to turn therapy into manufactured white
bread. It all looks the same, it all tastes the same, there is
little texture, substance, aroma and nourishment. It doesn't fill
the soul.
Language, and who controls it, is
the central defining issue in the battle with managed care
because of what is happening historically at this juncture.
Currently western culture is at the cusp between two eras. For
the last several decades we have been leaving the modern era and
moving into postmodernism. There are profound and complex
implications for this vast cultural shift (too numerous to name
here), but the most central for therapists is the change in the
cultural view of the importance of language. In the modern era,
language was seen to merely describe reality, if used
"objectively." In the postmodern era, language is seen
to create reality and there is no such thing as pure objectivity.
New theories are emerging that reflect this change in eras. In
the more behavioral domain there is "solution oriented"
and "narrative" therapy and in the psychodynamic domain
there is the "inter-subjective" approach.
It is this pivotal shift that is
central for us to understand in our struggle with . Yet that is
the crux of what is happening to all of us.
So how do we invigorate the soul
of our profession? First we must remember our roots and shift to
a broader paradigm of psychological functioning. This is
essential. Then understand that it is through the replication of
ideas . . . how things are defined, described and repeated . . .
that attitudes, opinions and values change. Our market isn't
managed care--it is the general public. But how we are positioned
in the minds of the general public is problematic. Psychology
must come to people in a much more direct, personal and
non-stigmatized way. At a cultural level we must work to develop
the value of psychological understanding and awareness. This is
done through workshops, articles and lectures on issues outside
of "mental illness." It is done through developing
public relations campaigns that let people get to know us in
human ways. It is done through using research to shape public
policy in regard to its impact on psychological well being. It is
It is done through not
losing heart.
I truly love psychology. But I
believe we have lost our way and are in danger of losing much
more if we forget to remember our roots, to know our
responsibility and for each of us to find where we stand . . .
then to have the courage to act from that stance. Faith is a bridge built by each individual.
Spirit Bridge
- Healing-
- Metaphysical Religion
