SINÉAD NÍ CHAOLÁIN
This paper examines how a logical positivist paradigm has been central to the scientist-practitioner role in Clinical Psychology and its understanding and treatment of human distress. It outlines the potential limitations of such a paradigm and explores how professional ethics can be crucial in expanding an awareness of the importance of broader socio-political and cultural factors in human distress. At the same time, it notes how specific codes of ethics themselves can be rooted in western, individualistic values. It further explores how a narrow ethno-centric perspective has negatively influenced Psychology’s historical understanding of gender identity and sexuality, and its relationship to social issues such as poverty. It concludes by acknowledging the different perspectives in this area and calling for a more politically aware and engaged stance in Clinical Psychology, highlighting a need to explore this more clearly in Irish psychological research.
The origin and critiques of the logical positivist paradigm in psychology
The application of the scientific method to efforts to understand human behaviour and cognition1 in the late 19th century gave rise to the development of logical positivist scientist-practitioner models of training and practice. These have been criticised as over-concerned with scientific objectivity, removed from socio-political awareness and contribution, and as emphasising “individualistic, internal states and objective, value-free empirical research methods seeking universalist truths”2 (p. 258).
In his address as president of the American Psychological Association (APA), Zimbardo3 spoke to this, highlighting that the field of psychology had overvalued the pursuit of scientific study of individual behaviour. In noting George Miller’s (1969) APA presidential call to action for the profession to “give psychology away to the public” (p. 340), he identified four primary reasons he believed this had not occurred. He described an ‘excessive modesty’ held by the profession regarding what it could contribute to society, an ignorance as to who this public represented and how the study and practice of psychology could be ‘given away’. Finally, he described a lack of concern regarding the level of accountability to which the discipline should be publicly held. He asserted that “it is imperative that we convey the sense to the citizens of our states and nation that we are responsive to society’s needs, and, further, that we feel responsible for finding solutions to some of its problems”3 (p.341).
Rappaport4 highlights desperation on the part of psychology as a discipline to force itself into scientific models. He attributes this to a desire to be perceived as scientist practitioners, benefitting from the social advantages of this status, including financial gain, power, and perceived credibility or legitimacy. He indicates that these have little to do with knowledge and valuable contribution, and may, in fact be inappropriate and interfering. He advocates the use of social critique and a qualitative, interpretative approach as legitimate and, perhaps, more appropriate in developing an understanding and contributing towards the alleviation of concerning social issues. Parker5 highlights that, although improvement may be acknowledged, there has been “recognition by many psychologists over the years that there is something deeply wrong with the way that the discipline conceptualises its objects of study and the way it treats people” (p. 720). He argues that the application of objective psychological ‘knowledge’ to problems and social issues adds to these difficulties, and that, in this manner, psychology functions as a political entity governed and driven by its own value and disciplinary community, as opposed to challenging political discourse on such issues5.
The role of ethics in highlighting and obscuring socio-political influences on distress
The emergence of codes of ethics
Akhurst & Elwell6 highlight the importance of developing an understanding of the depth of historical, contextual and conceptual underpinnings of current ethical practice. They indicate that current ethical codes and regulatory structures were established in light of ethical breaches, challenges, and in response to events and changing normative values at a macro or societal level6. The APA, the largest representative organisation of psychologists internationally7, did not publish their first code of ethics until 19538. The British Psychological Society (BPS), founded in 1901, established a division concerned with professional conduct in 1948 and began to compile a first draft of an ethical code of professional conduct in 1954, by which time membership of the society had reached 22089. A ‘Standing Ethical Committee’ was established in 1957 to revise this code. The Psychological Society of Ireland (PSI) endorsed its first code of ethics at a General Meeting in 1978, with a revised and expanded edition not being published until 1991. This was not revised again until November 201010, a 19-20 year period of significant change within the Irish sociocultural context.
Absolutist codes of ethics and their limitations
Leach and Harbin cite Berry, Poortinga, Segall and Dasen7 as delineating three overarching perspectives in ethical guiding frameworks; relativism, absolutism and universalism. The APA Ethical Principles and Code of Conduct are generally grounded in an absolutist framework, that is, standards and values are applied across the discipline and societally irrespective of cultural context7. Pettifor11 highlights that this creates challenges cross-culturally, in terms, for example, of societies and cultures that value collectivism over individualism, or secular, as opposed to theocratic, values. He highlights various developments within psychological organisations to address multicultural challenges, such as the inclusion of the Guidelines on Multicultural Education, Training, Research, Practice, and Organisational Change for Psychologists by the APA in 2002. However, he argues that international guidelines remain dominated by western values. He argued this may therefore ill-equip practitioners working within systems that are not represented by such value systems. He argued it has yet to be demonstrated that these guiding codes do not, albeit perhaps unintentionally, enshrine ignorance and trivialisation of racism and cultural difference11.
In documenting the contribution of Kobi K. K. Kambon to African-centred psychology, DeReef Jamison indicates that Kambon rejected the universality of Euro-American cultural values and psychology12. Kambon argued that definitional systems, representing worldviews or “peculiar philosophical orientation to the world”13, are central to understanding the psychology of a cultural group. He referred to the application of a Euro-American worldview to the understanding of African culture as psychological oppression, as imposing a system that values individualism and materialism over collectivism and spiritualism. He further stated that this represents a system of social pathology that uses assessments of personality which represent “only measures of the degree to which other racial-cultural groups conform to norms that are defined and thus preferenced by European (Euro-American) culture”12. He argued that a repositioning of an African definitional and worldview system as central to African psychology is essential to correctively counter this oppressive framework. He highlighted a need for African psychologists to question and challenge cultural and philosophical underpinnings of their training12. Jamison and Keita Carroll, highlight the potentially highly influential role of psychology in the production of African-centred knowledge and frameworks for authentic and culturally-relevant understanding and interpretation of human experience and as key to cultural reclamation13.
ETHNOCENTRIC VALUES AND THEIR IMPACT ON PSYCHOLOGY
The oppressive influence of ethno-centric, predominately white, heterosexual middle-class male ethical and moral codified values has traditionally contributed to the pathologisation and oppression of non-heteronormative gender identity and sexual orientation. This is further reflected in individualistic normative understanding and approaches to treatment that do not take full consideration of the impact of systemic social disadvantage. The following section will explore the role of ethics in clinical psychology in relation to gender, sexuality and poverty.
Gender, sexuality and Psychology
The British Psychological Society acknowledged in 2012 that psychiatry, psychology and psychotherapy had played a fundamental role in “contributing to a long history of pathologising sexual and gender identities”14. Homosexuality was classified as a diagnosable and treatable mental disorder within the Diagnostic and Statistical Manual (DSM) until 1974, when it was de-classified by the American Psychiatric Association. This was followed by the APA in 1975, and the WHO in 199015. Same-sex sexual activity was only decriminalised in Ireland in 1993. This was following judgement by the European Court of Human Rights in Norris vs. Ireland (1988), which was later ratified by the Criminal Law (Sexual Offences) Act 1993. Following a referendum in May 2015, Ireland became the first state to approve same sex marriage by popular vote. The PSI, who have not, historically, frequently issued statements in relation to contemporary political issues, on this occasion contributed to social and political debate. They publicly expressed concern regarding the improper use and misrepresentation of psychological research within the debate; “Historically, psychological research has been used to justify the unjust treatment of minorities, and the PSI is committed to ensuring that psychological research is not used, inadvertently or otherwise, to repeat such injustices. The Psychological Society of Ireland is calling for those engaged in the ongoing public debate to do so with respect for the psychological and emotional impact on young people and families at the heart of the issue”16.
Tosh17 highlighted the continued reinforcement of binary views of gender, a pathological framework of understanding non-conforming gender identity and the encouragement of social exclusion of those who seek to challenge these “hegemonic and normative constructions of gender”17. Tosh17 highlights the significant criticism that treatment approaches that centre on prevention of homosexuality and transexuality have received, such as by Burke (1996), Lev (2005), Bryant (2008), Burleton (2008), Choe (2008), Queerty (2009) and Hegarty (2009)18. Aversion (conversion) therapy was deemed by the APA in 2009 as representing both inappropriate and unethical practice. The PSI Sexual Diversity and Gender Issues Special Interest Group in 2015, chaired by Dr Geraldine Moane, published ‘Guidelines for Good Practice with Lesbian, Gay and Bisexual Clients’19. This stated that aversion therapy represents “an approach based primarily on a religious ideology that all people should be heterosexual” and that extensive empirical research has demonstrated that it is “damaging to the mental health of LGB people who undergo it”19. They instead advocate the use of gay affirmative therapy, which draws upon an understanding of heterosexism, the institutional privilege of heterosexuality, and, through the development of a greater awareness of internalized homophobia, place integration with self as central20. Pyne highlights a shift in understanding of childhood gender non-conformity from pathological to being considered part of human diversity21. He maintains that this has manifested in a shift in the use of language by professionals, families and the general public, and a shift in focus of intervention from the individual child and the treatment of their sexuality or identity to examination of the social environment within which the child is embedded and developing. He highlights the implications of this paradigm shift for sexual health education, research, clinicians and availability of social support resources21.
Psychology and poverty
An individualistic and objective psychology, in research and practice, and the resulting lack of recognition of underpinning psychosocial and socio-political factors may also be traced in relation to poverty. The impact of this has traditionally been framed and addressed at an individual level. Pérez-Munoz and Martínez Arias describe poverty as a social issue, perpetuated, justified and even promoted by individual and normative attitudes and social structures, and as representative of a denial of basic human rights22. They advocate the need for the development of an expanded and systemic definition of poverty, and the acceptance of a shared social responsibility to address it, in terms of its impact but also in its prevention. Ross, O’Gorman, MacLeod, Bauer, MacKay and Robinson highlight that poverty has been associated with onset of mental health difficulties and is disproportionately experienced by marginalised groups, such as among sexual minorities, the elderly and among ethnic minorities, such as the Aboriginal community23. In highlighting the impact of poverty, in relation to inequities in access to health care, increased experience of physical and mental ill-health and psychosocial difficulties, Ramirez-Garcia, Balcazar and de Freitas describe inequality as one of the most complex and increasingly pervasive challenges to be faced in the 21st century24. Worton et al highlight a lack of acknowledgement in research and intervention afforded to the impact of economic disadvantage, family influence and community contexts on child development25. They highlight Prilleltensky’s assertion that wellness be equated with fairness, and advocate the use of community-based, primary prevention and mental health promotion to support the development of children and families in economically disadvantaged communities25. They further highlight the UNESCO ‘Better Beginnings’ model as exemplary25. Garbarino and Briggs stress that the UN Convention on the Rights of the Child represents a legally binding mandate, one of the fundamental principles of which is that quality of life outcomes for children not be determined by parental income or functioning26. However, they highlight that poverty is associated with poorer IQ, health, education and overall quality of life due to the detrimental impact on psychological development and access to educational opportunities26. This negatively impacts on the child’s access to ‘pathways to success’ and ability to attain better quality of life outcomes in adulthood. Additionally, experience of early psychological distress has been associated with poorer socioeconomic outcomes, such as lower family income, educational attainment and earnings in adulthood27, 28. McAra and McVie, in examining the impact of gender, poverty and vulnerability in youth violence, advocate that in order to address violence, poverty and the disempowerment experienced by those living in deprivation and disadvantage needs to be addressed at individual, community and policy levels29.
It should be noted that not all schools of psychology have been neglectful of these issues. The critical and community school of psychology has long highlighted the importance of broader social influence on the understanding and engagement with mental distress, such as David Smail30, whose work is described as having ‘exposed the damaging psychological effects of an increasingly competitive and unequal society’31. Paul Moloney stated in his 2013 book ‘The Therapy Industry’ that ‘the therapeutic outlook allows the more prosperous sections of society to put the yoke of responsibility for social problems (like impoverishment) straight upon the necks of the poor’32. In her review of ‘The Therapy Industry’, Dr Joanna Moncrief highlighted that, within this perspective, traditional individualistic talk therapy, may represent a diversion from the underlying social causes of discontent33. Of further note are organised movements within the UK, such as ‘Psychologists for Social Change’, who indicate an interest in applying psychology to policy and political action, and ‘Psychologists against Austerity’34, which may serve as templates for such mobilisations within psychology in Ireland.
It should also be noted that certain authors contest that attending to social influences, such as poverty, is of greater value than providing more psychological treatment. Flèche and Layard, for example, argue in their analysis of international data on ‘life satisfaction’ and socioeconomic variables that misery is caused more by the presence of ‘mental illness’ than poverty35. It is, however, beyond the scope of this paper to explore these alternative perspectives in more detail.
THE IMPORTANCE OF AN ENGAGED SOCIALLY AND POLITICALLY AWARE PROFESSION
Haeny highlights that, although the APA codes of ethics do not seek to place restriction on the private lives and values of psychologists, the public expression of opinion or positions within social and political spheres, particularly in relation to controversial or potentially divisive issues, may impact the individual’s professional relationships, and, potentially, the profession or discipline36. However, this effective neutralisation of the role and potential contribution of psychology to public discourse and social change has been challenged. This is particularly pertinent in relation to countering traditional structures or frameworks of power, in the promotion of social justice and empowerment of marginalised groups, and most particularly within critical community psychology. 2, 4, 24, 25, 30, 37 Prilleltensky (as cited by Fisher, Sonn & Evans) referred to ‘psychopolitical validity’, which advocated drawing into balance psychological and political factors, in both research and practice. This requires drawing focus to the negative impact of inequality within the multiple levels of power in societal structures, and the political forces of oppression, exploitation and discrimination they exert on vulnerable and marginalised groups within society2. Fisher, Sonn and Evans argue that to maintain an objective and neutral position renders psychology as disconnected from the influence of power in society and the issues of concern that warranted research and intervention in the first place2. This has traditionally been conceptualised, and interventions designed, at the individual or micro level, but power may be mediated through historical, social, cultural, economic and political meaning systems and contexts2. Ramirez-Garcia, Balcazar and de Freitas advocate a more in-depth understanding of the role of power, determined by social and historical circumstances, structural, such as gender, ethnicity and socioeconomic status, and personal factors, such as education, in the exacerbation and perpetuation of social and health inequality24.
This paper has examined the limitations of a narrow logical positivist perspective underpinned by individualistic western values in meeting the diverse needs of those in need of psychological support. It notes alternative perspectives on this issue, but highlights the vital importance and argues for greater contribution by Psychology in attending to broader social, political and cultural issues in its work.
The frame of reference and understanding underpinning this paper is best encapsulated by Fisher, Sonn and Evan’s concluding remarks, whereby they advocate for the contribution of psychology to the alleviation of social issues, in research and practice, through engagement with socio-political inequality, such as in relation to ethnicity, sexual orientation, gender identity, and poverty, as summarily addressed in this essay, assuming a proactive rather than reactive position within social change;
“While these may have been desirable states [objectivity and apoliticism] for some, the realities of the world in which we live—personally and professionally—do not match these ideas. The world is governed by power—access to resources, professional power, power differentials, power to name and prescribe, power to oppress (malignantly or benignly). If we try to ignore this power in the name of objectivity and professional scientist standing, we compromise our abilities to deal with the root causes of so many social issues. We become complicit in the maintenance of problematic social relationships and the reinforcement of imbalances that exacerbate negative processes and outcomes” (p. 265)2.
- Hothersall, D., (2003). History of Psychology; 4th Edition. McGraw Hill: New York.
- Fisher, A. T., Sonn, C. C., and Evans, S. D., (2007). The Place and Function of Power in Community Psychology: Philosophical and Practical Issues. Journal of Community and Applied Psychology, 17, 258 – 267.
- Zimbardo, P. G., (2004). Does Psychology make a significant difference in our lives? American Psychologist, 59 (5), 339 – 351.
- Rappaport, J., (2005). Community Psychology is (Thank God) More than Science. American Journal of Community Psychology, 35, 3/4, 231 – 238.
- Parker, I., (2015). Politics and “Applied Psychology”? Theoretical Concepts that Question the Disciplinary Community. Theory and Psychology, 25 (6), 719 – 734.
- Akhurst, J. E., and Elwell, C., (2014). Viewing ethics in a new light: Students’ reactions to an under-emphasised yet important component of CHIP. History and Philosophy of Psychology, 16 (1), 41 – 52.
- Leach, M. M., and Harbin, J. J., (1997). Psychological Ethics Codes: A Comparison of Twenty-Four Countries. International Journal of Psychology, 32 (3), 181 – 192.
- Smith, D., (2003). The First Code. APA January 2003 Monitor on Psychology, 34 (1), 63.
- The History of Psychology Centre, (2009). History of the British Psychological Society: Timeline 1901 – 2009. The British Psychological Society.
- The Psychological Society of Ireland, (2011). Code of Professional Ethics PSI: Revised November 2010. The Psychological Society of Ireland.
- Pettifor, J. L., (2004). Professional Ethics Across National Boundaries. European Psychologist, 9 (4), 264 – 272.
- Jamison, DeReef, F., (2016). Kobi K. K. Kambon (Joseph A. Baldwin): Portrait of an African-Centred Psychologist. Journal of Black Studies, 47 (6), 592 – 609.
- Jamison, DeR. F., and Keita Carroll, K., (2014). A Critical Review and Analysis of the State, Scope and Direction of African-Centred Psychology from 2000 – 2010. The Western Journal of Black Studies, 38 (2), 98 – 107.
- British Psychological Society, (2012). Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients. The British Psychological Society.
- Rodgers, G., (2013). The Lived Experience of Being Gay. Inside Out: IAHIP, 69.
- Psychological Society of Ireland (2015). Press Release: Psychological Society of Ireland President warns of the detrimental emotional consequences the Marriage Equality Debate may have, to coincide with the Marriage Referendum. The Psychological Society of Ireland.
- Tosh, J., (2011). ‘Zuck Off’! A commentary on the protest against Ken Zucker and his ‘treatment’ of Childhood Gender Identity Disorder. Psychology of Women Section Review, 13 (1), 10 – 16.
- Tosh, J., (2011). Academic Debate or Transphobic Hate? A response to ‘Zuckergate’. Clinical Psychology Forum, 221. The British Psychological Society Division of Clinical Psychology.
- Psychological Society of Ireland, (2015). PSI guidelines for good practice with lesbiangay and bisexual clients. The Psychological Society of Ireland.
- Rock, M., Carlson, T. S., and McGeorge, C., (2010). Does Affirmative Therapy training matter? Assessing CFT Student’s Beliefs about Sexual Orientation and Their Level of Affirmative Training. Journal of Marital and Family Therapy, 36 (2), 171 – 184.
- Pyne, J., (2014). Gender independent kids: A paradigm shift in approaches to gender non-conforming children. Canadian Journal of Human Sexuality, 23 (1), 1 – 8.
- Pérez-Munoz, A., Chacón, F., and Martínez Arias, R., (2015). An Explanatory Model of Poverty from the Perspective of Social Psychology and Human Rights. The Spanish Journal of Psychology, 18 (99), 1 – 12.
- Ross, L. E., O’Gorman, L., MacLeod, M. A., Bauer, G. R., MacKay, J., and Robinson, M., (2016). Bisexuality, poverty and mental health: A mixed methods analysis. Social Science and Medicine, 156, 64 – 72.
- Ramirez-Garcia, M., Balcazar, F., and de Freitas, C., (2014). Community psychology contributions to the study of social inequalities, well-being and social justice. Psychological Intervention, 23, 79 – 81.
- Worton, S. K., Caplan, R., Nelson, G., Pancer, S. M., Loomis, C., DeV. Peters, R., and Hayward, K., (2014). Better Beginnings, Better Futures: Theory, research and knowledge transfer of a community-based initiative for children and families. Psychosocial Intervention, 23, 135 – 143.
- Garbarino, J., and Briggs, A., (2014). An approach to assessing ‘accountability’ in implementing the UN Convention on the Rights of the Child: Implications for School Psychology. School Psychology International, 35 (1), 29 – 35.
- Egan, M., Daly, M., and Delaney, L., (2016). Adolescent psychological distress, unemployment, and the Great Recession: Evidence from the National Longitudinal Study of Youth 1997. Social Science and Medicine, 156, 98 – 105.
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- McAra, L., and McVie, S., (2016). Understanding youth violence: The mediating effects of gender, poverty and vulnerability. Journal of Criminal Justice, 45, 71 – 77.
- Smail, D., (2001). De-psychologizing Community Psychology. Journal of Community & Applied Psychology, 11 (2), 159 – 165.
- Moloney, P., and Faulconbridge, J., (2014). David Smail Obituary. Article published in The Guardian newspaper, 17/08/2014.
- Moloney, P., (2013). The Therapy Industry. The Irresistible Rise of the Talking Cure, and why it doesn’t work. Pluto Press.
- Moncrief, J., (2014). A yoke upon the necks of the poor? The Psychologist: 26 November 2014. The British Psychological Society.
- Psychologists Against Austerity (2015) [cited September 2018]. Available from: http://www.psychchange.org
- Flèche, S., and Layard, R., (2017). “Do more of those in misery suffer from poverty, unemployment or mental illness?” Kyklos 70.1: 27-41.
- Haeny, A. M., (2014). Ethical Considerations for Psychologists Taking a Public Stance on Controversial Issues: The Balance Between Personal and Professional Life. Ethics and Behavior, 24 (4), 265 – 278.
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Sinéad Ní Chaoláin, Ph.D., Dip. Humanistic and Integrative Counselling & Psychotherapy, Psychologist in Clinical Training, TCD/SPUH. firstname.lastname@example.org.