INTEGRATING SCIENTIFIC AND PROFESSIONAL TRAINING AT THE GRADUATE LEVEL

FORREST B. TYLER

Southrn Illinois University

Since World War I1 considerable thought and attention has been given to graduate training in psychology, with special emphasis on training in applied areas such as clinical. A major concern has been meeting both scientific and professional training goals which have been outlined and discussed at the Boulder the Stanford Conference (I3), and the Miami Conference (lo).

In spite of these conference ruminations, the devising of training programs to meet both scientific and professional training goals with some degree of adequacy and within a reasonable time period has proven difflcult. Theseimplementation difficulties seem to have stemmed in part from the fact that the academic-scientific aspects of training and the applied-professional aspects of training have seldom been inte- grated. That is, it has been assumed in setting up training programs that a student cannot be trained scientifically and professionally at the same time. The contrary assumption that it is possible to train simultaneously for both scientific and pro- fessional objectives has been used as the basis for developing one aspect of a graduate training program which is to be reported here.

Although the general nature of goals for applied psychology training has been discussed in the conference reports noted, few specific programs have been described in professional journals. Dawson(*) described a practicum training program at a state mental hospital, and Luchins has written extensivelyc6# 7 , about a “functional approach” to clinical psychology training. L ~ c h i n s ( ~ ) argues for a rather extended training period in which the student’s training is centered around “the structure and activities of a clinical installation”, and involves studying the institution and thereby contributing to its service goals. By conceptualizing the psychologist’s role as one of “student of behavior and of social processes, rather than as technician or diagnos- tician” he has to some extent broadened the goals of pract,icum-type training. A t the same time he has emphasized the importance of the student’s contributing to the service goals of the institution on an ongoing basis. In this latter regard his approach seems characteristic of professional training in most universities and service agencies in its focus on the actual performance of psychological services. Further, the empha- SG seems to be on the performance of the service per se as important, rather than on the performance of the service as of value in developing a skilled professional practi- tioner. One somewhat contrasting view has been presented by H ~ l z b e r g ( ~ ) in his discussion of research training during the clinical psychology internship. He empha- sized the importance of providing equal status and belongingness in its own right to research in relation to more traditional professional activities such as diagnosis.

The present effort to train for both scientific and professional goals in one con- text involved an intensive summer program organized around an advanced graduate course in abnormal psychology.’ Although clinical psychology has grown in status, its Siamese twin of earlier days, i.e., abnormal psychology, has been looked on with less favor. It is still retained as an undergraduate and graduate course and st.ill required for admission to a number of graduate schools(11), yet it has almost dis- appeared as a professional entity. There is agreement that all clinical psychologists must have familiarity with this area of knowledge; however, relatively little at- tention was given to it at the Boulder or San Francisco conferences. At universities the “abnormal” course has characteristically been taught in the academic setting and supplemented with more-or-less systematic trips to a nearby mental hospital.

‘This program is conducted at Anna State Hospital, Anna, Illinois and is jointly sponsored by that hospital and Southern Illinois University. It is financed primady by Illinois Mental Health Fund grant 2911 to the hospital with some support from Umversity funds.

INTEGRATING SCIENTIFIC AND PROFESSIONAL TRAINING AT THE GRADUATE LEVEL 1 li

These trips-and the course-have ordinarily been sandwiched into an already busy schedule and been of necessity somewhat disjointed and “unreal”.

Until recently the present writer shared this general disinterest in abnormal psychology. This perspective came to be re-examined only under the pressure of supervising this summer training program designed for pre-intern clinical students who had a minimum of one academic year of graduate training. An important rationale underlying this program has been that by increasing the interest of students in hospital work, the psychological services programs in Illinois state mental hospi- tals will be benefited in the future. Consequently, no immediate service return to the hospital has been necessary to justify the program. Consistent with this orienta- tion, the training grant obtained to support the program included funds for hiring a supervisor for the trainees. Thus the service functions of the hospital staff were not materially interfered with by the necessity of supervising practicum students, but neither were they substantially augmented by the presence of the students.2

The resulting position of having a group of students in the midst of a hospital setting for two months with unlimited oportunities to observe, explore, ask questions, and otherwise learn at leisure, seemed to offer unlimited possibilities. Since there was ample time available, it was felt that a fairly ambitious goal could be set for the program. That goal was the systematic exploration of both scientific and professional perspectives about a representative group of descriptive, explanatory, and manage- ment problems in the field of psychopathology. As noted, traditional abnormal psychology courses are academically oriented. Clinical practica, on the other hand, are often dominated by the pressure to “be clinical” and suppress scientifically learned cautions about the adequacy of measuring instruments, validity indices, etc., in order to make decisions about the cases being seen. Here the purpose was to help the students develop a perspective which included an awareness of the reality of human pathology and existing methods of treatment, plus an awareness of scientific methods and the limits of scientific knowledge about all behavior, including that which we call pathological. In other words, it was hoped to aid the student to work out some basis for incorporating both scientific and professional perspectives without compartmentalizing them and becoming a “professional clinician” on one day and a “scientist” on the next.@) Once this goal was formulated i t then became evident that the program could be of value to general psychology students, whose interests were limited to theory and research, as well as to clinical students, whose interests included professional service as well as scientific psychology. Presumably, a broad perspective on psychology as a base for further learning should be as valuable to the general psychologist as to the clinical psychologist. Consequently, the program was opened to general psychology students, too.

As to the practicum functions of the program, all student case workups and diagnostic tests were filed as part of the hospital records and could be referred to for professional purposes if desired, yet the students had no active responsibility for making decisions about patients. Information obtained by students was treated professionally, as i t would have been had it been gathered by any hospital staff member, but the students were not required to solve actual case ((problems”. Such an arrangement retained the reality of professional responsibility for competent assessment and reporting, but relieved the student of the pressure of professional responsibility for decisions about the care and treatment of the patient. Further, since no service demands had to be met, there was freedom to modify the nature and amount of any such professional work consistent with the needs and desires of the student. General psychology students (required to have only a minimal knowledge of the Wechsler scale and of report writing) could do a limited amount of clinical-

*In spite of the fact that this program was “in principle” self-contained, it should be evident to any reader that ten inquisitive graduate students and one all-too-human superviaor could acquire real nuisance value when dropped suddenly into the midat of ongoing hospital routines. A great deal of credit for success of this program belongs to Dr. R. C. Steck, Superintendent of the Anna State Hospital, and to his professional staff for their cooperation and support.

118 FORREST B. TYLER

type practicum activities with the more modest goal of familiarizing themselves with such an approach to data gathering. Thus they would have a better under- standing of the nature of clinical assessment and would also acquire skills useful to them in interacting with patient (or other) research subjects. In addition, the general psychology student was guided in working out a research pract.icum, which included the exploring of possible research problems as well as research techniques for study- ing theoretical (or other) problems in the understanding of pathological and normal behavior. Clinical students could do more clinical case studies, and more extensive diagnostic studies, and could give more thought to understanding the nature of pro- fessional clinical work. However, they too were encouraged to think about research and explore research possibilities.

Although the summer program could have been organized around other didactic courses, none seemed quite as appropriate as an advanced course in abnormal psy- chology, particularly since the stimulation of the hospital environment seemed most likely to lead to questions about that area. Consequently, the course focused on the immediate setting, which a course in personality or advanced clinical would not have done, yet it was not as narrow nor as specialized as a diagnostic testing or therapy course would have been. In attempting to attain a broad perspective on the field of psychology via the medium of abnormal psychology, all aspects of the course were considered. Beginning with selection of textbooks, it was felt that books should be used which represented the traditional ciinical service, or procedural evidence, or orientation to pathology. In addition, the orientation stemming from an adher- ence to traditional experimental criteria-what Rychlak (12) calls validating evidence -should also be represented. A choice of procedural evidence based texts was readily made since the diagnostic procedures of the hospital itself are based on the Diagnostic and Statistical Manual for Mental Disorders of t,he American Psychiatric Association“) and since each professional hospital staff member is provided with a copy of Modern Clinical Psychiatry by Arthur P. Noyes and Lawrence C. Kolb@). These texts seemed adequately to represent the procedural evidence perspective on abnormal psychology and at the same time to provide the same framework for the student as for the hospital staff member.

The provision of a text or texts to provide a more validating evidence based perspective on abnormal psychology was less easy. Eysenck’s(3) Handbook of Ab- normal Psychology seemed most clearly to meet that criterion, although there may well be many psychologists who doubt that “a!l roads lead to support” for Eysenck. The book provides students with a better acquaintance with English research than they would otherwise get, although this acquaintance is provided a t times a t the expense of equally relevant American research. In spite of these limitations, the book provides a very valuable collection of research studies on important descriptive, differential, and explanatory problems in the area of pathology. It also provides useful critiques of these studies from the perspective of generally rigorous validating evidence standards. Finally, it contributes greatly to defining the status of knowledge and research in the areas covered, and points clearly to important unanswered questions (from the validating-evidence perspective) about the nature and nurture of human pathology.

Formal class sessions took the form of presentations (by the supervisor, his assistant, or one of the students), plus discussions and questioning. Since the pro- gram was not defined in terms of the usual classroom time segments, meetings and discussions could continue at length as enthusiasm and interest warranted. It was also possible to break up into smaller units as different foci of concern developed. A topic could be explored further through observation or interaction with patients, or through reading. It could also be terminated briefly, without guilt or concern, as boredom and disinterest or active opposition to continuing became evident.

Topics included classification of disorders, various therapies (i.e. , shock therapy, drug therapy, psychotherapy, etc.) , cognitive disorders, the psychoneuroses, schizo- phrenia, the affective disorders, motivational and “ego-function” abnormalities,

INTEGRATIXG SCIENTIFIC AND PROFESSIONAL TRAINING AT THE GRADUATE LEVEL 119

etc. An attempt was made to cover representative topics and to bring to bear as many different points-of-view as possible on each topic. For example, consideration of the topic of the classification of mental disorders began with direct contact with patients themselves, a t first on the hospital grounds in informal conversation. An early and natural outgrowth of such interactions was a concern with why these per- sons were hospitalized and why “labelled” as they were. Throughout the summer the students (and supervisors) attended regularly the four-times-a-week intake diagnostic staff meetings which served to diagnose tentatively and to provide recom- mendations for disposition of all incoming patients. These meetings provided an impetus to study and to understand the rationale for diagnosis, the nature of the generally accepted diagnostic schemata used, the nature of the personality and of the particular pathological problems of each patient, and the critical determinants in making different diagnoses. Inevitably, questions arose about the current medical disease concept,ioiis of pat,hological processes and the utility of the attendant classi- fication system. Eysenck’s (a I chapter on classification, and the alternatives to present day systems t,hat. he has advocated, provided a markedly different reference point from which to view the problems of diagnosis. Since even Eysenck’s factor-analyzed scheme is based primarily on symptomatic material, the question of the adequacy of symptoms as a base for classification was raised. The alternative perspective of traditional psychology in studying human behavior was presented. Specifically, the not,ion of S-O-R (stimulus - organism - response) models was considered, as was the tendency of psychologists to incorporate stimulus data and organism data (inferred from a knowledge of the organism’s history of environmental conditioning) into their thinking about the determinants of any responses. The contrast between this approach and that of relying on response data or symptoms in classifying pathology was then noted arid discussion directed toward possible systematic incorporation of more data, especially stimulus data and conditioning data, as a basis for more effective classification of pathological disorders. Thus i t was possible through focus on a specific problem in pathology to bring together apparently unrelated concep- tions (e.g., traditional S-O-R conceptions and diagnostic classification systems for hospital patients) and thereby to increase understanding of both the conceptual systems discussed and the problem itself.

A wide range of topics was covered, but always from the focus of abnormal psychology. Each topic was analyzed in such a way as to provide for a broad per- spective on various aspects of pathological behavior, and to provide for a wide range of information-both theoretical and research-on that topic. It was hoped thereby to enable the student to assimilate information from both validating-evidence perspectives and from procedural-evidence perspectives without the device of com- partmentalization and “changing hats” back and forth from professional to scientific. This goal was accomplished in part by beginning with the assumption that pro- fessional and scientific goals can be achieved together. Neither the practicing pro- fessional nor the researching scientist has all the answers about psychopathology, and neither is out of contact with reality. Both are competent and have something to offer; both are human and have limitations. Their competencies and limitations can best be identified if they are neither revered nor rejected, but if the knowledge they offer is brought to bear in a straightforward way on problems of concern-in this instance those of abnormal psychology.

REFERENCES 1. AMERICAN PSYCHIATRIC ASSOCIATION. Committee on Nomenclature and Statistics of the Ameri- can Psychiatric Association. Diagnostic and statistical manual for nzental disorders. Washington, D. C . : American Psychiatric Association, 1952.

2. DAWSON, J. G . A practicum training program. Amer. Psychologist, 1957,1B, 532-535. 3. EYSENCK, H. J. (Ed.) Handbook of Abnm+,Psychology. New York: Baaic Books, Inc., 1961. 4. HOLZBERG, J. D. The role of the internsbp in the research training of the clinical psychologiat.

5. KELLY, G. I itch too. Amer. Psychologzst, 1955,10, 172-173. J . consult. Psychol., 1961, 25, 185-191.

120 FORREST B. TYLER

6. LUCHINS, A. S. A functional approach to clinical psychology. J . genet. Psychol., 1956, 89, 153- 163. 71 -LUCHINS, A. S. A Functional Approach to Training in Clinical Psychology. Springfield, Ill.:

8. NOYES, A. P. and KOLB, L. C. Modern clinical psychiatry. Philadelphia: W. B. Saunders Com- Charles C. Thomas, 1959.

Danv. 1958. 9: &MY V. C. (Ed.) Training in clinical psychology. New York: Prentice-Hall, 1950.

10. ROE, ANNE, GUSTAD, J. W., MOORE, B. V., ROSS, S. and SKODAK, MARIE. (Eds.) Graduate

11. ROSS, S. Educational facilities and financial assistance for graduate students in psychology:

12. RYCHLAK, J. F. Clinical psychology and the nature of evidence. Amer. Psychologist, 1959, 14,

13. STROTHER, C. R. (Ed.) Psychology and Mental Health. Washington, D. C.: American Psychologi-

Education in Psychology. Wahington, D. C.: American Psychological Association, Inc., 1959.

1961-62. Amer. Psychologist, 1960, 16, 800-823.

642-648.

cal Association, 1956.

AN OBVERSE FACTOR ANALYTIC STUDY OF VALUES IN PSYCHOLOGISTS, PSYCHIATRISTS, SOCIAL WORKERS AND NURSES

MATTOX A. BAILEY LEON WARSHAW AND JACOB COHEN

Veterans Administration, New York Regional O&e New York University

PROBLEM Recent 7 s 9 v lo, 14* 1 6 ) suggest that the patient-therapist re-

lationship is of considerable importance in therapeutic outcome and that this re- lationship is strongly influenced by the therapist's values, needs and orientation. This study investigates the values for human happiness held by the three major mental health professions (psychology, psychiatry and social service) and by nurses to discover whether identifiable types emerge.

METHOD The Cassel (2) ego strength &-sort was administered to 13 clinical psychologists

(9 males and 4 females), 12 psychiatric social workers (6 males and 6 females), 3 male psychiatrists, and 11 nurses (1 male and 10 females). This test consists of 60 items which the subjects were instructed to arrange according to how important they considered each item to be for "happiness in the human being". The pattern for arrangement was a fixed normal distribution in 11 step intervals. This test pro- vides for correlation with typical adults and five other scale keys which were derived from factor analytic R-technique studies by the author of the test. These scales were designated ego status, social status, goal setting, mental health and physical status. A high scale score indicates strong unfulfilled needs and/or striving, and low scale scores indicate dormant, fulfilled or undeveloped needs and /or striving. The cor- relations with typical adults are considered by the test constructor as over-all ego strength. Utilizing &-methodology, each subject was correlated with every other subject over the 60 items and with the typical adult norms to form a 40 X 40 factor matrix. The data in this matrix were analyzed by simple cluster analysis('') and by factor analysis. The factor analysis was accomplished by centroid extraction and quartimax r ~ t a t i o n " ~ ) using the IBM 650 computer.' In addition to the correlations, the Q-sorts were scored on the five scales provided in the test manual. The relation- ship between the factor types that emerged and Cassel's scale scores were investi- gated through the analysis of variance, repeated measurements within groups, as outlined by Edwards", p. 284) with individual differences in means tested by Dun- can's New Multiple Range Test ( L P. 136).

'The authors are grateful to E. L. Struening for performing this analysis and IBM Watson Scientific Computing Laboratory, for the use of their facilities.