Passing for Normal: The Culture of Conformism in Clinical Psychology Training
A recent blog post by Dr. Bruce Levine at madinamerica.com contended that anti-authoritarian individuals are socialized out of the mental health professions, leaving these professions filled with authoritarian personalities. According to Levine, “most psychologists, psychiatrists, and other mental health professionals are not only extraordinarily compliant with authorities but also unaware of the magnitude of their obedience.” Levine argues that the prominence of authoritarians in the mental health field contributes to the labeling and oppression of patients who have anti-authoritarian traits. Levine’s post hit the sweet spot for me, and I want to offer an observation consistent with Levine’s. I believe that clinical psychology training fosters a professional culture that operates to establish conformity in the face of ambiguity.
Ambiguity is a term often used in the humanities. It can refer to something that is vague, or has more than one meaning. Human behavior, the subject matter of psychology, is inherently ambiguous. Its meaning is vague and multifaceted. When a stranger walks up to you on the street and asks “Do you have the time?,” how can you tell if the question is a request for information or a pick up line? Perhaps it is both. Not only that, but you may, in fact, choose to ignore one possible meaning in favor of the other, depending on your own interests. If the questioner is unattractive, you may well be inclined to blurt out a curt “10 am” and walk rapidly in the other direction, even if, especially if, you suspected the question was a come-on. Gender considerations are also pertinent. As a man, whenever I have been asked the time by a woman, I have been cautious about reading too much into the question. I knew that if I responded to a simple request for information as if it were a pick up line, my response could embarrass both the questioner and me.
In short, the things people do are ambiguous in at least four ways. They have multiple meanings. These meanings are challenging to discern, they may change, and they may be selectively foreclosed in order to regulate interpersonal relationships. When a student embarks on the study of clinical psychology, he or she is on the threshold of a colorful, shifting, wild world of personal meaning. How is one to interpret this person’s hostility, another one’s seductiveness, that one’s odd response to a research questionnaire, this one’s silence, that one’s history of abusive relationships, this one’s low IQ score, or anything else for that matter? An outsider might assume that if the student is to learn to respond adequately to this kaleidoscope of potential meaning, creativity might be in order. That outsider would be wrong.
In clinical psychology training, students are not encouraged to treasure the plenitude of meaning in human behavior or to value it as as the vital, beating, bleeding heart of psychology, but rather to target it as a threat. In research training, students are indoctrinated into the creed that human beings must be studied in a standardized fashion, and that individual variations are a source of error rather than illumination. Students often spend hours as graduate research assistants attaining “interrater reliability” by calibrating their ratings of ambiguous psychological phenomena to match those of their peers. In psychotherapy training, students who experiment with unorthodox methods or challenge the opinions of their supervisors are accused of poor judgment and are considered liability risks. Clinical psychology training imbues students with the implicit message that nonconformity is dangerous, a message drummed into them again and again through multiple channels in many different contexts. Rarely is that message spelled out explicitly. But it is there, clear as day.
I received an object lesson in conformity while attending a doctoral course in personality testing in which students used each other as testing subjects for practice. I was given the famous Rorschach Inkblot Test. During the Rorschach test, the subject is presented with a series of 10 cards showing intricately shaped blobs of ink and asked what each inkblot could be. These responses are programmatically coded and analyzed. In response to one card, I said that the inkblot looked like a “happy artist” with ideas exploding out of his head. One student who examined my response groaned “Ugh” and exclaimed, “You think that thing [the inkblot] looks human!?” No, I didn’t think it looked human. I thought it looked like an artist. I didn’t even say that the artist had to be from the planet Earth. Perhaps it was a Martian artist. I was grateful when the professor gently corrected my classmate, pointing out that my response was too creative and unconventional to be scorable. He decided to mail my Rorschach responses to the founder of modern Rorschach testing, John Exner, to see if Exner could figure them out. We never heard back. Despite my professor’s kindness, the underlying lesson was loud and clear. Don’t see things too differently than other people do. Or, if you do see things differently, don’t let on that you do. You will be branded as crazy, and there will be no place for you here. You had better learn to pass for normal.
Other instances of the pressure to conform in the face of ambiguity can be found in therapy training. As I mentioned above, the beginning therapist who works outside of the box will find instructors and even other students poised to criticize him or her for breaking the conventions of therapy. Worse yet, these conventions are often unstated and are portrayed as sheer common sense, rather than a set of clear principles with which a thoughtful person might sensibly disagree. Early in my training, I worked with a woman who hoped to resolve her conflicted relationship with her boyfriend. When she said she was puzzled because he argued with her often and she did not understand why, I conjectured that perhaps he felt insecure, and that arguing might be his way of protecting himself. I thought that my suggestion might help my patient understand their dynamic. My supervisor disagreed. He said I had a pathological “countertransference” to the patient that tainted my work. He said that I could not possibly understand the boyfriend’s motivations, as I had never met him. I restrained myself from asking the obvious question: if that were truly the case, wouldn’t it follow that since my supervisor was not meeting in person with my patient, he could not understand her, and wouldn’t that defeat the whole purpose of supervision? It didn’t make sense to me. What I gathered was the following: At some point in my supervisor’s own training, he must have internalized an unstated convention of the psychotherapy culture in which he was trained, a rule forbidding conjectures about the motivation of other people in the patient’s life. Because the convention was implicit, its rationale was unclear and was not open to dispute. All that mattered was that the supervisor lived and breathed this rule, so any deviation from it seemed to him to be off the wall. He had conformed in the face of the ambiguity of clinical work, and expected me to do the same.
Like the professor in my first example, the supervisor in the second was no bully, but a genuinely warm and caring individual. I liked both of them. Both, however, were unwitting agents of a powerful culture of conformity in the face of ambiguity. Imagine the trainee who achieves success in such a culture and then moves on to work with patients. That former trainee, now a licensed psychologist, faces a patient reminiscent of the therapist’s own disavowed nonconformity, sitting across the room asking for help. What is the likely shape that the conformist therapist’s help will take? Here is the solution to your problems, poor soul: Be more like me. Learn to fit in, like I did. Don’t stand out. See things the way people with common sense see them. Don’t be too creative. Learn to pass for normal, like me. The conformist therapist’s interventions will be shaped by an unexamined belief that conformity is a basic building block of good mental health. The patient will learn to get with the program, or drop out. The patient’s creativity, the heart of personal growth, will be stifled. S/he may seem to “get better” if better means to act more like others, but inside, something vital will perish. If the profession of psychology is to nurture unconventional people rather than normalize them, we must grow beyond our culture of conformity and foster our trainees’ creativity, rather than meeting it with anxiety and stigma.
-- Kyle Arnold
Today's guest contributor, Kyle Arnold, PhD, is a licensed psychologist in Brooklyn, NY and a member of the Society for Humanistic Psychology.