Policing Professionals

Marvin Hyman Ph.D.

All professionals are subject to regulation. Indeed, such regulation is one of the defining characteristics of professional status and is an integral  part of all aspects of professional life. Because regulation and policing are of such importance, they deserve continuing review and evaluation both by professional individuals and by professional organizations.  Therefore, it  will be the purpose of this article to consider the ramifications of  professional regulation, to think about its costs and benefits, and to relate these issues to professional psychology in general and psychoanalytic  psychology in particular.

At the time one achieves the status of professional, one subscribes to the ethical and moral standards which are a part of that status. These standards exist in the mind of the individual, in the "collective mind" of  the profession as a sociological entity, and in the mind of the society of which the profession is a part. For the individual, adherence to the standards is a matter of one's personal integrity.  One monitors one's own adherence and regulates one's behavior accordingly, supported by the unpleasant experience of guilt which follows upon departure from one's ethical principles.

Being a member of a profession includes the experience of being a part of  defined group and subject, therefore, to the experience of the group's shared standards of ethics and morality. As part of the group, a member of it is  regulated both by her own scrutiny of herself and by the scrutiny of the profession as a group. One adheres to the group's standards not only to avoid guilt, but also to avoid group censure.

In times past, society viewed professions as social organizations defined  by possession of a body of knowledge and skill, obtained through education, training, and experience, and by the intention to use that knowledge for the societal good rather than for personal gain. In return for the contribution  the profession made to the society it was accorded certain privileges, among  them the right to define its own standards of ethics and morality, the right to establish standards of education, training, and experience, and the right  to govern and regulate the members of the profession.

Because society  perceived the essentially altruistic, benevolent, and unselfish character of  the profession as a group, it granted the professional the right to substantial, but not excessive, compensation for his or her contribution. The society did not, therefore, seek to police and regulate those groups it determined to be professions. Such policing and regulation was, in contrast,  imposed upon crafts and trades people since  such persons were not defined by the attributes which defined professionals.

Since we no longer live, as professionals, in times past, it is instructive to observe the changes in the status of the professional, the forces which have created those changes, and the implications of those  changes upon professional regulation.  Having the right to regulate entails the possession of substantial power.  The power to regulate oneself includes the power to achieve a state of contentment or unease within and about oneself based upon the way in which one has met and achieved the standards of one's profession. The power to regulate the members of a professional group in the service of maintaining the group's moral and ethical standards is still another exercise of power, albeit over others rather than oneself. And, for those whose political or governmental status enables one to regulate professions of which one is not a  member, the exercise of such power becomes an end in itself. 

In the 1940's and early 1950's, psychology sought to establish a place  for itself in the healthcare world. Specifically, it sought to be recognized  as a profession equal to and autonomous of psychiatry. Psychologists thought  that since psychiatry was a profession recognized by society and since that  recognition included granting medical licenses, then the possession of a  license by psychologists would accord them the same status as psychiatrists  in the eyes of the society.  Now, psychologists throughout the United States  are licensed by the state in which they practice.

Along with the licensing came the policing and regulation of other aspects of professional life.  For example, at one time each professional considered it a personal  obligation to be as knowledgeable as possible about one's profession and to know and acquire the skills necessary to practice that profession competently and ethically. Also, the profession, as a group, maintained certain expectations for its members in regard to attending conferences, studying and writing books and articles on professional matters, and engaging in the myriad self-developmental activities which are continuing obligations of the active professional. 

Now, however, in many states “continuing professional education” has become one of the regulatory responsibilities of the state. Professionals are required to acquire additional knowledge and skill, at a certain pace, in a certain  amount, and of a certain content. Policing and regulation have passed out of the hands of the individual and the professional organization. 

The example of mandatory continuing professional education points to a  more overarching issue of the status of the professional. In simple terms, the question may be asked as to whether or not psychologists (and perhaps other healthcare professionals) can still consider themselves as  professionals. Certainly, the professions of which they are a part are no longer accorded the rights which professions once had nor are those professions perceived as possessing the attributes which once defined them.  Indeed, many, if not all professional organizations are seen mainly as guilds, trade associations, or unions, all possessing in common the venality ascribed to such groups as well as other self-promoting concerns. 

There are a number of reasons why psychology as a profession has undergone  such a radical change   in its own eyes and in the eyes of the society. One of those reasons has to do with power: political power, economic power, state power. For those who believe that power over healthcare is a governmental or industrial necessity, then power has to be taken from professionals and professional associations. One way in which this can be  accomplished is by demonizing professionals and the organizations to which they belong. Thus, government, health insurers, and health maintenance organizations collectively and individually characterize professionals as profligate in the application of their skills, greedy and corrupt in the pursuit of money, and dishonest in their dealings with both healthcare businesses and healthcare recipients. As part of this process,  psychologists have also been made into demons; little better morally or ethically than the proverbial “used car salesman.”  Can such demons be  trusted to regulate themselves? Can groups of such evil beings be allowed to  implement the ethical standards which they claim to have adopted and to which  they claim to subscribe? Thus, psychologists have been portrayed as no more trustworthy than the least ethical segment of our society and, therefore, in need of outside policing and regulation by government,  business, and the legal system. 

Psychologists are not without some measure of responsibility for the status they currently hold in our society. Those individuals who come, in increasing numbers, before the licensing boards, ethics committees, and the courts for violations of the basic ethical standards of their profession and of members of any decent society, validate the otherwise dubious claims of  those who would seek to denigrate the profession. When the professional organization of psychologists prints on the front page of its newsletter the  results of a survey reporting that 25 percent of professional psychologists admit to having had some sort of sexual relations with the recipients of their so-called services, can we be surprised that society has developed a good deal of skepticism about professionals and about the right of self-regulation? 

Still another way in which psychologists have shot themselves in their professional foot is the pseudo controversy over “empirically validated  methods of treatment.” Psychologists, having committed themselves to the “scientific” illusion that truth and reality can only be known through the application of probability theory, look askance at other means and methods of  knowing and condemn them out of hand. And so, we have the spectacle of one group of professionals pouring scorn on another group, all of which does nothing to enhance the profession in the eyes of other segments of society. 

The unhappy state of clinical psychology as a profession impinges upon those whose interest in psychology focuses on psychoanalytic education, training,  practice, theory, ethics, standards, and philosophy.  In the psychoanalytic  situation, the participants agree that both will suspend belief in reality  (whatever that is) and will seek to know solely through the use and  examination of the psychic reality of the participants. Further, the participants agree that the verbalizations of the participants (i.e., free  associations and analyst interventions) will address only those verbal contents from the viewpoint of the psychic reality (including matters of  payments and scheduling) since neither participant needs nor wants the other to investigate any other reality than the psychic one. Certainly, psychoanalytic investigation precludes acting upon psychic reality by either of the participants.

In the psychoanalytic collaboration, moreover, absolute privacy of and within the process is a desired ideal which may not, at times,  be completely attainable, but must always be sought and protected.  An additional characteristic of the psychoanalytic endeavor is the commitment of the parties only to the analyzing enterprise; not to any third party, not to whatever entity is funding that enterprise, not even to the well being of the participants. (I recall, as I write this, an analysand who spent the first two years of his analysis trying to get me to demonstrate that I wanted him to “get better,” as though he and I could know what  “better” was or that, at any given moment, we did not think that he was  psychically the best that he could be, or that he could not choose, if he wished, to be other than he thought he was.) 

As we review these and other characteristics of the psychoanalytic collaboration, we have to be struck by the fact that the psychoanalytic psychologist is even further removed from the demands of regulatory agencies than is his or her clinical psychologist colleagues. Indeed, we can recognize that the regulatory function of the APA’s “Ethical Principles of Psychologists” is, in substantial measure, inapplicable to the endeavors of the psychoanalyst who happens also to be a psychologist.  For many psychoanalytic psychologists, the everyday activities within the psychoanalytic consulting room violate that ethical code which applies to psychologists. 

For example, verbal reports of  abuses, threats, intentions to harm, etc. have to be treated as “thoughts  that have come to mind” in the associations of the analysand, and cannot,  therefore, activate “duties” which psychologists have to protect, to warn, and to report.  Thus, where the psychologist is ethically required to obey  the law, the psychoanalytic psychologist is ethically bound to function in a  manner which might be considered a violation of the law. In a like manner, some psychoanalytic psychologists consider the intrusion of  third parties (even ones that pay) completely destructive of the privacy requirement which is fundamental to the psychoanalytic work. Thus, it is  absolutely impossible to have the work of the analysis scrutinized through  record reviews, audits, or other encroachments so dear to the heart of  healthcare administrators. This is so in spite of the desire expressed by  some analysands for the analyst to cooperate with such intrusions. 

Psychoanalytic organizations, possibly because of their desire proactively to demonstrate the righteousness and scientific rectitude of the psychoanalytic enterprise, have increasingly rigidified and codified standards for education and training in an attempt to regulate in every detail how an individual  should develop him or herself into the creative artist that a psychoanalyst  is.  The result of such codification and rigidification of standards, of course, is the stultification of the professional development of the psychoanalyst and ignores the fact that creative and elegant artistry is essential to doing the  psychoanalytic work.

I have argued, in this article, that the benefits of policing and regulation that have overtaken psychology and psychoanalysis have been obtained at the cost of reducing the professional to the status of craftsperson. Further, such regulation has diminished the professional and the profession in the eyes of the public as well as those who engage in professional activities. In many instances and in many ways, the policing and the regulating have essentially destroyed the professional activities they were designed to  protect and improve.

I do not believe that the public is any better protected by the external and internal controls which have been imposed nor has the quality of services provided been enhanced. Yes, we have punished  miscreants, but we have not inculcated the internal sense of ethical obligation which is essential to the status of the professional. In brief, I think we have regulated the very life out of the experience of being a professional. 

Is there anything that can be done to alter the situation in a way that will preserve the benefits which regulation is supposed to bring and still not be achieved at the excessive cost of destroying the integrity of the  professional and the standing of the profession? My answer would be that we can. The approach would be to alter, in our own eyes and in the eyes of the society, the image of the professional and the profession.

If we were to  define our profession as one which belongs with the intellectual disciplines of philosophy, the arts, the humanities, etc., then we would not have to protect the public from our endeavors. The public would become our colleagues, and since they would share responsibility for the work, they would participate in a manner that served their own best interests.  Additionally, they would be in a position to protect themselves rather than having to rely on others. 

I realize that there are powerful forces which make this alternative highly improbable. Nonetheless, I believe that we have to start thinking about such alternatives if we are to survive in any manner with which we can ethically live.   

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