Psychologists: Times have changed


Peter Baldwin, Ph.D., a Keene, New Hampshire-based clinical psychologist, saw the number of private practices increase during the 1980s. (photo by Kathryn Hardy)

By Ami Albernaz

Just a few decades ago, the working life of psychologists was dramatically different than it is today. At that time private practice was rare for psychologists and therapy was a longer-term, more analytical process.

Psychologists from throughout New England - all of whom have worked in the field for several decades and some of whom have recently ended or are nearing the end of their careers - recently were asked to reflect on the changes they have observed during their working years. Noted here are some of those changes, both within the profession and practice of psychology.

Most of the psychologists said that when they began working, private practices were rare. The overwhelming majority of the jobs within the field were found in hospitals, community health centers and universities, says Keene, New Hampshire-based clinical psychologist Peter Baldwin, Ph.D. "The very thought of leaving those agencies and striking out for private practice was very anxiety provoking," Baldwin says. Yet during the 1980s, along with many of the community health centers passing into state hands (from having been grassroots and autonomous), the number of private practices flourished.

A couple of psychologists noted changed interactions between the fields of psychology and psychiatry. Bernard Pellet, Ph.D., a Hartford, Connecticut-based child psychologist, says that the relationship between psychologists and psychiatrists has gradually improved since he completed his training in the late 1950s. "Initially, psychologists were the new kids on the block, and were criticized for not being adequately trained," he says. He adds that there was considerable competition, since "there was an overlap in doing individual psychotherapy, with the strength of psychologists being in using assessment instruments."

Marjorie Kettell, Ph.D., a professor at the Boston Graduate School of Psychoanalysis, predicts that the roles of psychologist and psychiatrist might overlap further, with psychologists eventually having the authority to prescribe medication. She notes that since expediency pressures brought on by managed care have already led to nurse practitioners being able to prescribe, extending this right to psychologists would be a positive development. "Nurse practitioners are wonderful people, but often aren't trained in psychology," Kettell says. "Psychologists are at least trained as to effects of medications."

The greatest changes in the minds of most of the psychologists, however, are those associated with managed care, namely an increasingly business-minded approach to treatment. Retired Massachusetts clinical and child psychologist Charles Hersch, Ph.D., says that on the whole, idealism has yielded some ground to financial concerns. "When I started out, you didn't consider yourself a businessman," Hersch says. "Now, the way I've heard it phrased is first, I'm a businessman, and then I'm a professional."

Some practitioners found the pressures resulting from managed care detrimental to the therapy process. With prescribed lengths of courses of treatment and more paperwork, the needs of individual clients are more likely to be overlooked, says Alayne Rabow, M.A., a retired family systems therapist in South Hero, Vermont. "Insurance companies started getting involved in a way where we were encouraged to treat the needs of the companies more than the needs of the person," she says. "They [insurance companies] are more money-oriented than client-oriented, and that bothered me."

The evolution of managed care within psychology has also helped give rise to narrower areas of expertise, as many psychologists have had to carve out niches for themselves in order to be picked up by health care providers. "There's a real investment of talent and energy to be picked up by an insurance panel, and to find a niche," says Baldwin. "Psychologists also realized that they had to market themselves."

Baldwin adds that such concerns led him, at the age of 67, to become a certified consultant with the American Society of Clinical Hypnosis.

Pellet, meanwhile, says that research has also made significant contributions to the growth of specialties within psychology and psychiatry. "Fields such as neuropsychology have been developed to a high degree," Pellet says. "You didn't have neuropsychology when I started working in the field [in the late 1950s]; there were psychologists who had some interest in organic brain damage."

Several clinicians also noted significant changes in the actual conducting of psychotherapy. Peter Rees, Ed.D, a semi-retired psychotherapist in Trenton, Maine, says the most striking change he has seen over the past few decades has been the shift from an analytical to a behavioral-oriented approach. "My training was in Boston in the early '60s, and the emphasis was psychoanalytic," he says. "Through the years, this approach has faded into the background. By and large, therapy is now much more oriented toward problem solving, a let's-get-down-to-the-issues approach. Instead of working through internal processes first and then behavioral, it's now the other way around."

Rabow adds that change in therapy also resulted from societal forces. "It became more difficult to get families in [for therapy]," she says. "I can't say when exactly this happened, but it was an evolution, not a revolution. Families went from being two-parent to one-parent, to having latch-key kids, and kids were more likely to be seen alone, rather than the families coming in together."

Along these lines, Connecticut therapist Barbara Bunk, Ph.D., adds that families nowadays tend to lead busier, more complicated lives. "Because of kids' busy lives, the inner life doesn't get addressed in families the same way [as it did a few decades ago]. I'm not saying that these aren't good families or good people, but the busy-ness of lifestyles adds to the complexity of meeting children's needs. We have to assess what's important, and make family time. We have to force ourselves to slow down, and that's not built into our lifestyles."

Hersch adds that he worries about what he sees as the increasing severity of problems facing children. "The kinds of problems kids have increased extraordinarily," he says, adding that in his first two decades of practice, from 1956 to 1975, very few children were hospitalized. "Now, hospitalization of children is commonplace," he says. "And there is little discussion about how to deal with it."

Finally, related perhaps to both the more demanding pace of life and the business pressures within the field, Kettell says that psychologists who are currently approaching retirement tend to stay in the workforce longer than in the past. "With the uncertain economy, more psychologists are postponing retirement," she says. "Some do love their work and want to keep going, but there is more of a need for economic security."

Psychologists: Times have changed (April 2003 Issue)

Psychologists: Times have changed
(April 2003 Issue)