Critique of Mainstream Clinical Psychology
The descriptions of critical versus clinical psychology suggest clear differences in emphasis; however, there are potential areas of overlap, such as the importance attached to the social context, and scientific practice could be used to highlight the effects of oppression. A critique is offered below of the main claims made by clinical psychology in terms of science, evidence based therapies, moving beyond diagnosis and incorporating social context. The analysis of the profession’s assertions will draw on themes from critical psychology, in particular issues of power and how it is used or misused.
Science is a central claim of the profession and clinical psychologists are expected to contribute to the evidence base through conducting their own research trials. Ironically, however, much analysis has shown that following doctoral training, the majority of clinical psychologists working in the NHS fail to conduct research or author publications (Eke, Holttum, & Hayward, 2012). This begs the question as to why are clinical psychologists being trained at great expense to a doctorate level and in research skills, if they are rarely used in practice. There are many possible answers, but one answer is that claims to science raise the status and power of the profession (Boyle, 2011).
There have been criticisms that clinical psychologists at times adopt oversimplistic models of science, are not modest enough in their knowledge claims and generate much data with little meaning (Smail, 2006). A key example of the adoption of the uncritical production of data is the use of Randomised Control Trials (RCTs). RCTs are considered the “gold standard” of research methodology. These types of studies require groups of patients who are randomised to one of two or more treatments or control conditions. The assumption of RCTs is that by controlling for all possible variables except for the treatment condition, any differences found between groups can be attributed to the treatment itself. However, there are significant criticisms of RCTs. Outside of psychological therapy, in areas such as drug trials, the power of placebo effects (people improving simply by thinking they are receiving the real treatment) and people realising they are in a control group rather than the real treatment, has been noted to have substantially undermined the results of RCTs (Kirsch, 2009). Placebo effects are hard to control in drug trials, and they are almost impossible to control for in psychotherapy research (Jopling, 2008). Who conducts or sponsors the trial also significantly biases the results (Perlis et al., 2005). There are many other critiques of RCTs in terms of inadequate control groups, not recording how many people declined to enter the trial, cherry picking of clients, or samples which are not representative of people seen in services, and basing research on diagnostic categories which lack validity (e.g., Lewis & Warlow, 2004; Rothwell, 2005). The flaws and complexities are often numerous and potentially devastating to the usefulness of the data. However, such data (particularly meta-analyses—combination of data from different studies) are often presented with little critical reflection, and go on to shape clinical practice and services.
The focus on RCTs is an example of professionals, including clinical psychologists, being too narrow in what constitutes knowledge, and such knowledge has not always been subjected to adequate scrutiny (Edge, Kagan, & Stewart, 2004; Ingleby, 1981; Morgan, 2008; Nightingale & Cromby, 1999; Rogers & Pilgrim, 2005). An unquestioning approach to professional expertise and scientific evidence often marginalises other forms of knowledge. This has occurred significantly in mental health services where lived experience is not given any or limited tokenistic credit or status (Beresford, 2013; Wallcraft, 2013). This is unfortunate as lived experience is often rich in detail of people’s lives in comparison to the abstract and sterile data of quantitative research papers. Though some clinical psychologists have acknowledged this and used qualitative methods, such methods are often seen as having less merit and status, including within the National Institute for Clinical Excellence (NICE).
Overall, the description “scientist practitioner” contributes to the status of the profession; however, there are concerns that such claims are erroneous and do not serve the people clinical psychologists are meant to help. Clinical psychology, at times, sees itself as objective, value free and neutral, whilst actually holding values and assumptions that maintain the status quo in society (Prilleltensky & Fox, 1997). Such a stance to research is likely to be oppressive, and there is a need for the profession to be clearer in its values, and reflect on whose interests are being served by research they are either conducting, or using in their theories and practice.