Licence -- Professional or Poetic
Nov 16, 2014
Professional "human health service providers" (doctors, psychologists, social workers etc) often need to be "licensed" by "Government bodies" (like "State-government" -- or in Australia and New Zealand, a "central", Psychologists Registration Board(s)). If those licensed do not comply with the operating legislation they are open to "professional censure", or worse! Of course, they have an underlying primary obligation to their "client groups" -- who these are is open to some argument, but most would agree "patients" are one group who deserve, in many cases have a right to, respect, support and appropriate care, free from professionals' stigmatizing practices. Such professionals are expected to be guided by both "professional standards" and the "evidence base" -- relevant published research, but that research should be "current", and subject to "peer review". Treating professionals should take steps, as part of the process of obtaining "informed consent" from patients, to advise their patients of the limitations of the treatments available, in the light of those "peer reviews". Again, psychologists failing to do so are open to censure, workplace restrictions, but perhaps most importantly, complaints from patients, and patients' refusing to work with them. But how can patients know beforehand which psychologists they are best avoiding? There are signs -- and perhaps one of the most obvious is "Does this person engage in practices "for poetic license" that stigmatize those already subject to abuse and victimization? ... for what purpose? ... what's the person really trying to do? Oe is this person really just a self-serving psychopath?" A particularly ugly interchange that occurred on the US-based discussion list PsyLaw-L with Canadian psychologist Milan Pomichalek has brought this series of questions to mind. I hope you, too, will, think by the end of this that Dr Pomichalek deserves professional censure, workplace restrictions, and to be avoided, and shunned, by patients and clients.
Milan Pomichalek "promotes" ("proselytizes" might be a better word) psychodynamic psychotherapy. He presents as evidence for this view this series of papers [LINK] . There are major problems with these papers, however. Firstly, they are not "current". Secondly, they have not withstood "peer review" -- see the series of "papers" by James Coyne, Clinical Psychologist and Professor in the Department of Psychiatry, University of Pennsylvania, for example "Independent evaluation of the superiority of long-term psychodynamic therapy" -- this is just one "post" Dr Coyne provides regarding this claim, and he provides links to others' discussion of this claim on his site. I have several problems with several "points" Pomichalek attempts to make (but fails to do so) -- at best, the great majority of patients will never be able to financially afford to access Psychodynamic therapy, or Psychodynamic therapists -- the United States is in a crisis over lack of availability of psychotherapy of ANY description, and Psychodynamic therapy is by far the most expensive. New Zealand's "medical model", sole, private psychiatric hospital Ashburn Clinic had "the guts ripped out of it" when it lost New Zealand Accident Compensation Commission (ACC) funding for patients with histories of prior trauma, because it failed to justify the cost vs benefits of this form of treatment for patients there. Instead, Pomichalek argued cognitive behavioral treatments should be dismissed, not that they too don't have its limitations (which I have gotten into arguments over with such people as Steve Hayes, ACT researcher -- ALL treatments have their limitations, after all (see links at end of this post -- BUT, ACT and other forms of CBT (Pomichalek failed to identify or distinguish between any of them!!) have been demonstrated to be able to be made readily available, economically, to clients in need, including clients with histories and current presentations of having been traumatized -- the primary targets of this website.
In his online argument with me, Pomichalek simply posted the link to the story from the Otago Daily Times [LINK] about my own history of childhood sexual victimization -- this article was carefully written, not for an American audience of forensic psychologists, but for the ordinary citizens of Dunedin -- Pomichalek was trying to use the assumed stigmatizing power of my having retired, and no longer practicing as a psychologist, of being a victim of sexual abuse, to dismiss the arguments I was making -- both of us were excluded from that online discussion group. I have chosen to remain unassociated with the group -- in my view, 99 per cent of the group members are lazy, self-serving, clinical "wannabes" -- "want to be regarded" as having clinical sophistication and knowledge, but sadly never having done the real personal, academic, and professional work to really have that knowledge, maturity and professionalism. Pomichalek was attempting to ab-use something that was done humbly, sensitively, honorably, something I have every right to feel proud of having done, and attempting to pervert it into something I should be ashamed of, and portraying it as something to invalidate me, and other victims of childhood trauma, people who have never, "forgotten", "gotten over", their prior victimization, but have survived it, honored it, and honored others with similar experience. What was Pomichalek doing? He was using "poetic license" -- "the liberty taken by an artist or a writer in deviating from conventional form or fact to achieve a desired effect." -- deviating from the facts of his own ignorance of the variety of therapies available, and their respective evidence bases, objectively considered, to argue against what he saw as "my view" -- what he assumed to be an uncritical acceptance of "CBT" -- but, I have NEVER been of this view, at best I have been been a "fellow traveler" with CBT, regarding its appropriateness, and practicality, depending on individual circumstances -- Pomichalek's view seeks to deprive patients of therapy to which they are entitled. In the circumstances, his behaviour was grossly unprofessional, at best not even effective "debating" -- Do YOU really want to have anything to do with such an individual?
But WHY would an individual do such as Pomichalek did?? One of the most amazing, to me at the time, questions I have been asked is "Why do you want to be a psychologist?" I had always taken it for granted that all psychologists just want to help people "so we're all the same in that, aren't we?" Sadly, nothing could be further from the truth. When I was going through my own training, I had a wonderful supervisor whose view was "to be a good forensic psychologist, you have to be, first of all, a good clinical psychologist." It has only been in relatively recent years that I have discovered things like (i) most psychologists working in forensic settings in New Zealand, especially those working for "Corrections" (Prison / Probation & Parole) are NOT good clinical psychologists, and often have little or no ongoing clinical contact with their "clients"; (ii) similarly, psychologists in places like England, even if working as a "forensic psychologist" in a hospital setting, have NO clinical training or clinical experience prior to their current jobs. No, many go into such work for such "mundane" reasons as Money, Power, Prestige, etc etc -- things that, in themselves, really have very little to do with patients (except as "cash cows", "fodder", etc). Having put aside humanitarian motivations, other things are important, and other "personal qualities" -- two in particular being "fearless dominance" and "self-centred impulsivity" -- Pomichalek was determined to "get it over me", and was prepared to use anything he "had on me" to prove his dominance, his self-assumed "superiority", even if in his impulsivity he got it badly wrong. When confronted, and barred from the group, he again responded impulsively, and self-servingly -- he "apologised" to me, but CC'd it to the gatekeeper of the group, to get himself back into it. Sadly, these are sure signs of his having marked Psychopathic traits -- see relevant material by Skeem (2011) [LINK] and Stevens ( 2012) [LINK].
Sadly, this is the real license given to some individuals -- to use their Psychopathy to further their own interests, rather than that of patients. Just because someone is in an office of high standing, as a Public Servant, or as a "Professional", never assume they have any legitimate "moral high standing". Training for psychologists these days, especially in the United States, seems destined to cost patients even more as time goes on, as it seemingly encourages such behaviour, such "duplicity". What's really sad is that people like Pomichalek, clear psychopath, ever was able to make it past graduate school. At least he's in "good company" with the other psychopaths on PsyLaw -- though there are a couple of genuinely exceptionally humane people on the list.
Coyne, J. (2014a, March 24). Independent evaluation of the superiority of long-term psychodynamic therapy. Retrieved from http://blogs.plos.org/mindthebrain/2014/03/24/bambi-meets-godzilla-independent-evaluation-superiority-long-term-psychodynamic-therapy/Coyne, J. (2014b, June 10). Salvaging psychotherapy research: a manifesto. [LINK] Retrieved from http://blogs.plos.org/mindthebrain/2014/06/10/salvaging-psychotherapy-research-manifesto/
Skeem, J. L., Polaschek, D. L., Patrick, C. J., & Lilienfeld, S. O. (2011). Psychopathic personality bridging the gap between scientific evidence and public policy. Psychological Science in the Public Interest, 12(3), 95–162.
Stevens, G. W., Deuling, J. K., & Armenakis, A. A. (2012). Successful Psychopaths: Are They Unethical Decision-Makers and Why? Journal of Business Ethics, 105(2), 139–149. doi:10.1007/s10551-011-0963-1