Reflections on the Importance of Our Work as Clinical Psychologists
By Elizabeth A. Yeater, Ph.D.
Happy New Year!
I hope you had a happy, safe, and joyous holiday season. This is my first article in The Clinical Psychologist as President of the Society of Clinical Psychology (SCP). I wanted to begin this entry by introducing myself; it is my hope that I get to know more of you during the coming year! As incoming President of SCP, I follow on the heels of many illustrious psychologists, which is quite an honor, yet the role also feels, at times, like a daunting endeavor! As a graduate student at the University of Nevada, Reno (UNR), I never dreamed I would lead such a prestigious organization, especially one that I perceived to be the place where the most important conversations were happening in the field (I was a graduate student when the infamous Chambless list was released!). My training experiences, both at UNR and later under the mentorship of Richard McFall at Indiana University (IU) Bloomington, shaped irrevocably the clinical psychologist I am today. My mentors were quintessential psychological clinical scientists, and they imbued in me a true passion for clinical work, both within the research laboratory and the therapy room, work that would lead ultimately to a reduction in human suffering. That passion continues to fuel me today, in my research, as Director of Clinical Training at the University of New Mexico (UNM), as a clinical supervisor for a rather large group of doctoral students, and as the incoming President of SCP. In a word, I love being a clinical psychologist and have never regretted my career choice!
While I find most aspects of clinical psychology fascinating, three areas are my intellectual and emotional “bread and butter.” The first is my programmatic line of research. I have spent the past 18 years examining the cognitive, interpersonal, and behavioral risk factors for sexual victimization among college women. This basic work has informed my applied work; that is, the development of preventative interventions to reduce victimization risk among more vulnerable women. It seems like every other day we hear another media account of sexually violence, happening typically to children, women, and other marginalized groups, and committed most frequently by people who are in positions of power over the victims. Sadly, despite the development over many years of preventative interventions aimed at decreasing the prevalence of sexual violence, rates of victimization have remained steady over several decades. Moreover, these interventions, while reasonably effective at changing attitudes, have been relatively ineffective at changing behavior (Anderson & Whiston, 2005; Ellsberg et al., 2015) and have been implemented often as static, one-time preventive interventions with limited focus on the contextual and dynamical processes linked to victimization risk, which to date, remain relatively elusive. Several years ago, the country of Kenya developed a rape prevention program that targets reducing men’s sexual aggression as well as women’s self-defense skills. Older men mentor young men and model positive masculinity and respect for women. To date, rates of rape have decreased by 50% in Nairobi, Kenya. Kenya, a third world country with few resources, has been successful at accomplishing what the United States, with all of our resources, has been unable to do. We must do better to solve this public health problem – for our children, women, and other marginalized groups who are commonly the victims of sexual violence. In short, we need to transform our cultural context such that sexual violence is neither accepted nor permissible, regardless of environmental context.
When I have my clinical hat on, I supervise students who treat clients suffering from PTSD from sexual trauma (rape, child sexual abuse). Most of these clients wait many years before accessing treatment. Notably, the literature shows that less than half of women who experience an act of sexual violence meeting the legal definition of rape acknowledge their experience as such (Bondurant, 2001; Kahn, Mathie, & Torgler, 1994). Moreover, women who have difficulty labeling their experience appropriately experience greater difficulty recovering from the psychological sequelae of rape (Kahn et al., 1994; Bondurant, 2001; Littleton & Breitkopf, 2006). In our current sociopolitical climate, which I observe as not being particularly affirming to women (not to mention other marginalized groups), women who are victimized may be even more reluctant to come forward to report a sexual assault or to ask for help dealing with the effects of these violent acts. Some in the field have argued that there is a significant cost to our science and practice (and, hence, to victims themselves) when we fail to inquire about possible traumatic experiences (e.g., Becker-Blease & Freyd, 2006; Yeater, Miller, Rinehart, & Nason, 2012). Thus, to be silent about sexual violence is to support tacitly such acts; thus, it is incumbent upon us to inquire about possible acts of sexual violence among our clients. I communicate this often to the students that I supervise.
The second “bread and butter’ issue that intrigues me has to do with dissemination and implementation of the treatments that work into our communities and, consequently, to the people who need them the most. We have a good number of treatments that range from extremely effective (e.g., CBT for panic disorder) to moderately effective (e.g., CBT for depression) for a variety of disorders, and research that shows that psychosocial interventions are superior to psychotropic medications for a good handful of disorders (e.g., Hollon, Stewart, & Strunk, 2006). Yet, we know from the literature that practicing clinicians are not, on average, using those treatments. Some have argued that for clinical psychology to have a “place at the table” in health care, we need to demonstrate the relevance of what we do, including our treatments’ efficacy, effectiveness (i.e., generalizability), cost-effectiveness, disseminability, and reach (Baker, McFall, & Shoham, 2009). We have struggled to find a place at that table, partially, I think, because we disagree about some of the fundamental principles in clinical psychology, such as how to train clinical psychologists, what the aims and goals of treatment should be, and how much common factors versus the active ingredients of therapies account for treatment outcomes. Unlike the medical profession, which has a more unified and standardized way of training doctors, clinical psychologists are trained in programs that emphasize to greater or less degree, the importance of research and the use of empirically based interventions. I suspect that confusion about our own training goals and desired outcomes for clinical psychologists has contributed to what some have called the “poor public face of psychology” (Lilienfeld, 20121). That is, we need to do better educating the public about what it is that we do, how we do it, and the empirical basis for ameliorating psychological/behavioral problems. As noted by Lilienfeld (2012), the public face of psychology should not be Dr. Phil or Dr. Laura! We need to do better by draining our motes and getting out of our silos!
My third “bread and butter” issue pertains to diversity, broadly defined, including topics of gender, race/ethnicity, intersectionality, inclusion, and social justice. I live and work in a minority-majority state and direct a doctoral training program in clinical psychology that has a Multicultural Diversity Emphasis, as well as a host of other diversity-related training opportunities (including clients in our clinic). I often take where I live and work for granted, and in my daily context, appreciation for diversity is a given. I remind myself continually that this is not a given outside of my context, and many marginalized populations experience a variety of hardships, including (but not limited to) discrimination and health disparities (both mental health and medical treatment). The demographics of the United States are quickly changing and becoming more racially/ethnically diverse, yet the face of clinical psychology does not yet reflect that diversity. We need to do more to make our field more inclusive to those from diverse populations.
Anderson, L. A., & Whiston, S. C. (2005). Sexual assault education programs: A meta-analytic examination of their effectiveness. Psychology of Women Quarterly, 29, 374-388.
Baker, T. B., McFall, R. M., & Shoham, V. (2009). Prospects of clinical psychology: Toward a scientifically principled approach to mental and behavioral health care. Psychological Science in the Public Interest, 9, 67-103.
Becker-Blease, K. A., & Freyd, J. J. (2006). Research participants telling the truth about their lives: The ethics of asking and not asking about abuse. American Psychologist, 6, 218-226.
Bondurant, B. (2001). University women’s acknowledgment of rape. Violence Against Women, 7(3), 294-314.
Ellsberg, M., Arango, D. J., Morton, M., Gennari, F., Kiplesund, S., Contreras, M., & Watts, C. (2015). Prevention of violence against women and girls: What does the evidence say? The Lancet, 385, 1555-1566.
Hollon, S. D., Stewart, M. O., & Strunk, D. (2006). Cognitive behavior therapy has enduring effects in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285-315.
Kahn, A. S., Mathie, V., & Torgler, C. (1994). Rape scripts and rape acknowledgment. Psychology of Women Quarterly, 18(1), 53-66.
Lilienfeld, S. O. (2012). Public skepticism of psychology: Why many people perceive the study of human behavior as unscientific. American Psychologist, 67, 111-129.
Littleton, H. L., & Breitkopf, C. (2006). Coping with the experience of rape. Psychology of Women Quarterly, 30(1), 106-116.
Yeater, E. A., Miller, G. F., Rinehart, J. K., & Nason, E. E. (2012). Trauma and sex surveys meet minimal risk standards: Implications for Internal Review Boards. Psychological Science, 23, 780-787.