Bureaucratic Therapy: The Impact of Doctoral Training on Our Clients

By Kimberly L. Rust, LCSW and Joshua B. Rust, PhD

Otherwise thoughtful policies can sometimes have a detrimental impact on the client-therapist relationship. Prescribed practicums and internships give doctoral students invaluable experience and help standardize an education in psychology across the country. But clients are not organizational roles, and they can suffer when a training period terminates.

I have had a private practice as a Licensed Clinical Social Worker since 2010, but in 2016 I began a doctoral program in psychology with the hopes of better serving the small town where I live, particularly families with children on the autism spectrum. I have found myself reflecting on the impact that short-term training sites have on clients. In my private practice there are children that I met at the age of five, struggling with kindergarten, who have returned to work through the transition to middle school. These families have told me that they wanted to come back because they knew me.

But things changed when I took up a short-term practicum as a prescribed part of my doctoral program. Such assignments artificially curtail therapeutic relationships. Some safeguards may be put in place, such as not assigning new clients in the last month or so of the student’s time at a site. However, even this is not always enough. For example, while I started seeing a client in December, by the time sufficient trust had been established I was only a month out from having to pass her on to someone else. Although such transitions are handled as carefully as possible, they are still a significant disruption in the client’s therapy, and a side effect of the bureaucratic nature of doctoral student training.

The sociologist, Max Weber, described modern bureaucracy in a way that resonates with my experience as a student clinician moving through a series of temporary roles (1978). Weber described modern bureaucracy as an “impersonal order” that can standardize and increase the efficacy of our institutions (1978, pp.215-16). Such organizations proceed “without regard for persons” in the sense that roles become modular or interchangeable, requiring us to become more responsive to offices than the individuals who happen to occupy them (Weber, 1978, p.975).

Doctoral students move through a series of such interchangeable roles. While this serves the needs of both the student and the site, the difficulty is, of course, that the psychotherapeutic relationship itself resists substitutions of this kind. Psychotherapy is inherently personal and irreducible to the logic of bureaucratic organization. In my private practice, clients have returned years later because they knew me. I had formed a unique relationship with these clients. In medical settings, bureaucracy is less concerning. You do not need to have strong rapport with your doctor to get accurately diagnosed with a physical health problem. However, psychotherapy requires a special type of connection, and therapeutic alliance has been robustly linked with outcomes (Flückiger, Del Re, Wampold, & Horvath, 2018). Although the structure of doctoral training is unlikely to change anytime soon, our field needs to think carefully about how to mitigate the effects of short-term training on the clients we serve.

References
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult
psychotherapy: A meta-analytic synthesis. Psychotherapy relationships that work, 3.
Weber, M. (1978). Economy and society: An outline of interpretive sociology. University of
California Press.

Graduate Student Voting Rights: What Do Our Presidential Candidates Think?

The APAGS Committee has proposed an APA Bylaws and Rules change that will allow for graduate student affiliate members of APA to vote in elections for the President-elect and Members of the Board of Directors, along with bylaws amendments and the distribution of seats on the APA Council of Representatives.

The APAGS Committee is bringing this proposal to Boards and Committees of APA this fall, and to the Board of Directors and the Council of Representatives next year. If the change is approved by Council, and then by the current voting members of APA, approximately 21,000 graduate student members of APA could be eligible to vote in 2020 and beyond.

We asked the five members currently running for APA President-elect the following question:

“Should APA Graduate Student members be given the privilege to vote on all association matters within APA after one year of membership?”

Here’s how they responded. You can learn more about the candidates here.

Armand R. Cerbone, PhD

“I strongly support APAGS in seeking voting privileges. Having organized graduate representation within my department, I know the importance of enfranchising graduate voices. As a faculty member introducing a course on homosexuality in 1983, I recruited at my expense a lesbian student to co-teach because we both understood I could not appropriately represent the experience of queer women. While the future affects all psychologists, it affects psychology students most. My campaign is about the future of psychology even more than our past. I will seek the critical input of APAGS in developing a 25/50-year vision plan for psychology.”

Jean Lau Chin, EdD

“Graduate students make up a significant portion of our APA membership. They should have a voice because they are the future of our profession. As APAGS, they have already demonstrated that their participation in governance has been meaningful and relevant, and that they have been responsible in providing important input on association matters. We need to view the vibrancy of our profession and association as one where we seek and value the perspectives of members along the entire spectrum of their career. Hence, I support giving graduate students the privilege to vote on association matters including elections after one year of membership.”

Steven D. Hollon, PhD

“APA is getting older and has trouble getting students to join and early career professionals to convert. The best way to excite new professionals entering the field is to give them the vote while they are still students and I would not make them wait the year. You join you vote. If we want students to invest in the discipline then we need to invest in them. We secure our future as an organization if we trust our future generations.”

Sandra L. Shullman, PhD

“Graduate students have an important voice to contribute to APA. I value their contributions and support their voting and representation. Voting is an opening invitation that can lead to greater engagement in APA, but we must couple voting with opportunities for leadership training/development; meaningful ways to give feedback to our discipline/profession; and encouragement to support/engage in advocacy, public policy and social justice initiatives. These experiences, along with the opportunity to vote, can build career-long engagement and commitment to APA’s future. As APA President, I would look forward to working with APAGS to turn this goal into successful action. www.SandyShullmanForAPAPresident.com #sandys4apaprez #sandy2020”

Susan Krauss Whitbourne, PhD

“As a long-time supporter of the work of APAGS, I am in favor of the proposal to grant voting privileges to graduate students in APA-wide elections. This step would represent an important way to ensure that APA reflects the concerns of those who are entering our discipline and also to provide graduate students with a voice in the future of the association. One of the key components of my presidential platform is that APA needs to reflect the interests of early career psychologists, and therefore this proposal is consistent with my own priorities to keep the association vital and flourishing.”

We thank all candidates for their openness to this proposed seismic shift in APA.

CARED perspectives: So what is this psychology diversity committee all about?

This blog post is a part of the series, “CARED Perspectives,” developed by the APAGS Committee for the Advancement of Racial and Ethnic Diversity. This series will discuss current events and how these events relate to graduate students in psychology. If you are interested in contributing to the CARED Perspectives series, please contact Lincoln Hill.

Engagement with diversity, cultural, and individual differences has become a core aspect of clinical training, supervision, and research in psychology (American Psychological Association, 2006). In this spirit of proactively interacting with diversity in its varied forms, many psychology departments have created dedicated “diversity committees.” While a name and general scope may be shared, diversity committees take many forms: from a student led forum to address graduate program concerns, to a faculty committee working towards recruiting diverse staff and students (Rogers & Molina, 2006). Diversity committees can be a positive vehicle of change, but also a burden on faculty and students with diverse identities who take on the invisible labor of serving on many such committees, and face greater expectations to do so than are placed on their majority group peers (Vasquez et al., 2006)

To better understand the inner-workings of diversity committees, I gathered the perspectives of four psychology graduate students who served on a diversity committee at their respective institutions. In particular, I asked these students to: reflect on the value in having a departmental diversity committee; to identify what was achieved through their committee’s work; and to share the extent to which student voices guided, were heard, or were marginalized by the fellow committee members. Below I offer a summary of their varied perspectives and some considerations for students and faculty considering developing a diversity committee within their department.

What is the value in having a diversity committee?

Dedicated space conducive to making change – a key prerequisite to undertaking any further work
Having an avenue for dialogue that doesn’t naturally occur between students, faculty, and staff
Ensuring accountability at the department level to operating in a manner consistent with principles of equity and diversity
Providing a sense of safety for students who have reservations about coming forward with their concerns
Addressing qualitative inclusion of diverse perspectives, experiences, and identities

What was achieved on the committee during your tenure?

Making faculty more aware of student concerns
Creating professional development opportunities
Developing workshops/brown bag lunches in response to current events
Inviting speakers with expertise in diversity topics
Developing events (e.g., diversity recruitment weekend) and tools (e.g., website re-design) to recruit more students from diverse backgrounds
Creating a survey to assess climate, student experiences and needs

How were student voices engaged on the committee?

Diversity committee formats varied greatly – from student led efforts to faculty committees with one designated student representative. Students on faculty committees indicated varied experiences. One reported receiving respect and useful professional guidance, while another reported not being “truly heard” by faculty. Perhaps as a result of these dynamics, some students reported that creating departmental change through the work of a diversity committee is a slow moving process, which may involve only surface level changes in the beginning. Several students commented on the value of models where they were able to hold separate meetings with their peers to amass a list of students’ perspectives and concerns, which they could report back to the faculty-led diversity committee. One student in particular indicated that this mode is effective because students often feel more comfortable bringing concerns forward to other students, as opposed to faculty.

While diversity committees are diverse in their form, tasks, operation, and membership, all students acknowledged the value in their existence and several expressed gratitude in being able to advocate for diversity at a higher level. As one student said, “diversity efforts take some trial and error to evolve for the better, but these programs are most valuable when we learn from and correct our mistakes.”

What do you think? We want to hear from you in the comments!

Have you been involved in a diversity committee? What the impetus was for establishing this committee? Was your committee initiated by students? Or staff/faculty? Has your committee filled a gap that was there prior to the committee starting up?

Have you found that individuals of color and those with other diverse identities have disproportionately taken on this work?

What’s your take on this topic?

Acknowledgments: A huge thank you to the students who shared their experiences for the purpose of this post!

References

American Psychological Association. 2006. Guidelines and Principles for Accreditation of Programs in Professional Psychology (G&P). Retrieved from: http://www.apa.org/ed/accreditation/about/policies/guiding-principles.pdf

Rogers, M. R., & Molina, L. E. (2006). Exemplary efforts in psychology to recruit and retain graduate students of color. American Psychologist, 61(2), 143.

Vasquez, M. J., Lott, B., García-Vázquez, E., Grant, S. K., Iwamasa, G. Y., Molina, L. E., … & Vestal-Dowdy, E. (2006). Personal reflections: Barriers and strategies in increasing diversity in psychology. American Psychologist, 61(2), 157.

Check out previous CARED Perspective posts:

Dear Me, Future Psychologist. Yours truly, Dr. Erlanger Turner

APAGS is thankful for all of the psychologists that participated in the Dear Me series for the gradPSYCH Blog. Considering the success of these posts, APAGS is expanding the series to include early career psychologists that have been doing amazing things since graduation.

We’ve asked early career psychologists to write a letter to their 16-year-old self. We hope you enjoy these letters and glean some wisdom and guidance as you decide whether to enter graduate school in psychology, as you navigate the challenges of graduate school, and as you make decisions about your career and life.

20160721_Erlanger_Earl_Turner_small

Dr. Erlanger “Earl” Turner is a licensed psychologist and assistant professor of psychology at the University of Houston-Downtown. He is also the Director of the Race and Cultural Experiences Research (R.A.C.E.) Lab, and often serves as a media psychologist. Dr. Turner writes a blog, The Race to Good Health, and has been quoted by numerous media sources on mental health, race relations, and cultural competency. Dr. Turner’s current research examines (1) correlates of ethnic minority health, (2) identifying mechanisms of help-seeking, and (3) developing interventions to improve utilization and adherence to psychological treatments. While in graduate school, he served as the APAGS Member-at-Large (Practice Focus) and was the first former APAGS member to be elected to an APA standing board. He was the 2017 Chair of the APA Board for the Advancement of Psychology in the Public Interest and is the first early career psychologist to serve as chair of BAPPI. Recently, he was elected as the first African American male to be president of the Society for Child and Family Policy and Practice (APA Division 37).

. For more information, please visit Dr. Turner’s website.

DEAR-ME

FROM THE DESK OF Erlanger Turner:

Dear Earl,

You have always been an introverted person with a comedic personality that only those close to you (e.g., family and friends) truly have an opportunity to witness. Who is to say that you have to share with the entire world the person God made you to be?

In life, you will face great challenges and maybe not experience much success. However, self-doubt will not push you towards achieving any goal in life. I know that one of your biggest fears is failure. Let that be the driving force in your life to keep running over any obstacle that you may face either personally or in your career. Growing up in Louisiana should not be your final destination nor your highest aspiration. Seek guidance from those who motivate you and always keep your mind on the powers that be to lead you to accomplish “your goals”.

As a first generation college student, you will have the chance to set the mark for your siblings and other family members to step out on faith. Don’t allow your internal conflicts and doubts determine how you live or what career you will pursue. Remember that it is great to help others, but always remember to do what is best for yourself. Pursuing a career in medicine will not be an easy task and you will face challenges as a Black man from the outside world.

As you move forward in life and work towards being the 1^st in your family to graduate from high school, keep these things in mind:

You control your destiny and what you accomplish in life. Don’t hold yourself to others expectations and stay focused on what makes you happy. In the midst of difficult challenges do not doubt the decisions you make. Those decisions will be the lessons you learn and will help others to recognize how experiences shape who you are as a person.

Being Black is beautiful! Don’t get caught up in the stereotypes that exist in society. You should love all the aspects of who you are. Each person is uniquely created and you should value your individuality as a person that is embedded within a community that is often perceived as not good enough.
You can be great at whatever you do in life. Remember that greatness is not defined by the lack of struggles but how you overcome those obstacles that you face. Set a goal and keep working towards it until you are satisfied.

In closing, “setting a goal is only your starting point. It’s the hard work that determines your final destination”.

–Erlanger A. Turner, Ph.D.

Editor’s Note: Dear Me, Future Psychologist is inspired by the Dear Me book series by Joseph Galliano. Special thanks to David A. Meyerson, Ph.D. for creating this series for the gradPSYCH Blog. Please check out other letters in this series:

“Therapy” and other Dirty Words: Addressing Cultural Stigma of Mental Illness in Diverse Communities

“Therapy” and other Dirty Words: Addressing Cultural Stigma of Mental Illness in Diverse Communities

By Mary Odafe

Therapy (noun; /ˈTHerəpē/) – a luxury service associated with the White middle-to-upper class. Based on this conceptualization of therapy, “in-group” members (i.e., fellow members of one’s own ethnocultural community) who engage in formal therapy are, by default, guilty of making the decision to forego traditional methods of healing, including (but not limited to): a) seeking wisdom from a community leader or elder, b) engaging in fervent prayer, “letting go, letting God,” or seeking counsel from a church leader, c) “keeping it in the family” or speaking with a trusted friend, or d) engaging in traditional or indigenous medicinal/healing practices. An in-group member who attends therapy might experience real or perceived stigma from their fellow in-group members, and the associated fear of being labeled as one of the following:

Crazy (adjective; /ˈkrāzē/) – A label frequently afforded to anyone with history of hospitalization or observable psychiatric symptoms. This term subsumes an array of symptoms associated with various clinical disorders including hallucinations, panic symptoms, obsessions and compulsions, delusions, cognitive distortions, etc.

Bipolar (adjective; /bīˈpōlər/) and/or Schizophrenic (adjective; /ˌskit-sə-ˈfre-nik/) – Often used synonymously with ‘Crazy,’ a label afforded to anyone who exhibits odd or abnormal behavior, paranoia, or distinct changes in mood or personality. This label is not exclusively used among lay members of society, but is also frequently designated by clinicians, who have historically overutilized these diagnoses among certain ethnic minority groups.

Depressed (adjective; /dəˈprest/) – A general succumbing to life’s stressors that signifies weakness or lack of faith, and manifests as sadness, laziness, irritability, and withdrawal from friends and family. Solution? ‘snap out of it’ or ‘pray it away.’

Suicidal (adjective; /ˌso͞oəˈsīdl/) – Descriptive of when one fully succumbs to life stressors and reaches a state of indifference about life. Synonymous with ‘giving up,’ or in some instances, ‘Crazy,’ this label is used to describe individuals who have “failed” to cope with life and are now making the decision to sin against God and betray their friends and family by taking their own life.

While these pseudo-definitions and colloquialisms are jarring and overtly offensive, this is the painful reality of many individuals of diverse ethnic background whose in-group members (e.g., family, friends, ethnocultural community) subscribe to antiquated beliefs about mental illness. When facing stigma from one’s own community, people may be less likely to seek professional help that could prove beneficial when administered by a culturally-sensitive clinician. Internalized stigma may also serve to magnify the intensity of one’s psychological distress by adding significant feelings of shame and embarrassment. Unfortunately, subscribing to or acting in accordance with stigmatizing beliefs about mental illness only serves to perpetuate the stigma and limits opportunities to evolve. In cases when individuals do not seek necessary help due to perceived stigma, the consequences may even be deadly.

Ethnic minority psychologists are in a unique position to bring about meaningful change in our various cultural communities. As culturally-sensitive advocates, we can all encourage change in the following ways:

It is first necessary to acknowledge the gravity of historical experiences with clinical research and services for marginalized ethnic groups (e.g., African Americans who were the unwitting subjects of inhumane research during the Tuskegee Syphilis Experiment from 1932-1972). At present, the challenge of effectively working with ethnic minority clients persists, as the large majority of evidence-based treatments were developed for use (and validated) with White middle-class Americans, failing to reflect growing trends of cultural diversity in the U.S. and Canada. In some cases, a healthy cultural paranoia in ethnic minority clients may be a reasonable response to unfamiliar techniques or practices. Aim for a more compassionate approach by working with thoughts of cultural mistrust, rather than combatting them.

Incorporate traditional cultural or faith-based practices, rather than dismissing them as harmful or ineffective. In some instances, these cultural practices can even be used as a gateway to introducing mainstream psychology paradigms. For example, after observing that spirituality was the main source of emotional coping for my older African American Veteran clients, we utilized Biblical scriptures as a means to spark therapeutic group discussions about acceptance and change.

Challenge cultural stigma by providing psychoeducation through simple conversation (at community forums, seminars, health fairs, church festivals, or just one-on-one with a friend or family member). Of particular importance is to ask questions just as often, if not more often, as you provide answers or information.

Recognize that the underlying emotion that often motivates stigma is fear: fear of the unknown, fear of exploitation, fear of judgement from one’s community, or an internalized fear of being “broken.” Consistent with current trends in psychotherapy, fear is combatted through education and exposure. In addition to those listed previously, consider ways to provide education and also increase exposure to the idea of mental health – through conversation, modeling, social media, research, teaching, and clinical practice.

I encourage you to reflect and develop your own ideas for challenging the prevalence of stigma in diverse cultural communities. By changing the conversation surrounding mental illness, we work to combat stigma which could ultimately change a life, or save one.

Additional Resources:

We want to hear what you think! Please share your thoughts on this topic in the comments section below.

Other posts in the CARED PERSPECTIVES series: