🚀 go-pugleaf

The movement towards practice guidelines, empirically validated
treatments, or what have you is at least in part a response to the growth
of managed care.  Right now, the medical profession presents a more united
front in arguing that psychological symptoms can be managed
cost-effectively using drugs.  Unless psychologists find some way of
arguing for the cost-effectiveness of their own interventions, they will
be left out of the reimbursement loop.

One possible response is, so what?  Psychological problems have never fit
perfectly into the medical model to begin with, and even certain
services that might influence important predictors of health such as diet
and exercise (e.g., nutritionist consultation, health club membership)
were not covered under most health plans even before the advent of
managed care.  Furthermore, if therapy is conceptualized as a
life-enriching experience, rather than simply symptom reduction, it
becomes more analogous to travel, art classes, etc. which are the
individual's own responsibility to pay for.

The net result is that clients for psychological services will be even
more disproportionately affluent than they are now.

It's probable that given different conceptualizations of what clinical
psychology is and does, not all clinical psychologists can get on board
the managed care boat.  So the question then becomes, should some be
allowed to board, or should everybody stay on shore?

A second question feeding into this debate about practice guidelines is
whether psychology is or should be a science.  (This is why so many
academic psychologists, who don't have practices and thus are less touched
by the managed care debate, are involved in the issue.)  It seems as
though psychology is divided on this in a way that few if any other
disciplines are.  For example, the argument that some self-proclaimed
scientists actually practice crappy science can certainly made in biology,
chemistry, or physics, yet people in these fields would not typically use
it as evidence that the field as a whole is not scientific.  The key
is nearly universal agreement on the philosophy and methods of each
discipline.

So what it comes down to is, we have two separate disciplines.  Rather
than fighting and trying to convince each other that we're right, people
who take a science based approach should split off and form a field called
"Behavioral Science."  "Psychology" could be retained for the more
humanistic approach.  As for creating separate organizations, we currently
have the APA and the APS, the latter of which was formed by
science-oriented folks, including non-clinicians.

(Incidentally, the Psychology Dept. here at USC just reorganized to
combine the neuroscience and cognitive faculty into one group, "Behavioral
and Brain Science."  A couple of clinicians went with them; the rest
became members of "Clinical Science."  The only difference between the
"scientificness" of the groups seems to this observer to be that BBS folks
use functional neuroimaging, whereas CS faculty use structural
neuroimaging, psychophysiology, and blood and tissue samples.  Go figure.)