19.6 PUTTING IT...together

Operating Within a Larger System

At one time, clinical researchers and professionals conducted their work largely in isolation. Today their activities have numerous ties to the legislative, judicial, and economic systems, and to technological forces as well. One reason for this growing interconnectedness is that the clinical field has reached a high level of respect and acceptance in our society. Clinicians now serve millions of people in many ways. They have much to say about almost every aspect of society, from education to ecology, and are widely looked to as sources of expertise. When a field becomes so prominent, it inevitably affects how other institutions are run. It also attracts public scrutiny, and various institutions begin to keep an eye on its activities.

BETWEEN THE LINES

In Their Words

“I think John Hinckley will be a threat the rest of his life. He is a time bomb.”

U.S. Attorney, 1982

“Without doubt, [John Hinckley] is the least dangerous person on the planet.”

Attorney for John Hinckley, applying for increased privileges for his client, 2003

When people with psychological problems seek help from a therapist, they are entering a complex system consisting of many interconnected parts. Just as their personal problems have grown within a social structure, so will their treatment be affected by the various parts of a larger system—the therapist’s values and needs, legal and economic factors, societal attitudes, technological changes, and yet other forces. These many forces influence clinical research as well.

The effects of this larger system on an individual’s psychological needs can be positive or negative, like a family’s impact on each of its members. When the system protects a client’s rights and confidentiality, for example, it is serving the client well. When economic, legal, or other societal forces limit treatment options, cut off treatment prematurely, or stigmatize a person, the system is adding to the person’s problems.

665

InfoCentral

PERSONAL AND PROFESSIONAL ISSUES

Like everyone else, clinicians have personal needs, perspectives, goals, and problems, each of which may affect their work. Therapists typically try to minimize the impact of such variables on their interactions with clients—called countertransference by Freud. However, research suggests that, to at least some degree, personal therapist issues inf luence how clinicians deal with clients.

666

BETWEEN THE LINES

33 Years Later

Currently 59 years of age, John Hinckley is a patient at St. Elizabeths Hospital in Washington, DC. A federal judge has granted him furlough privileges, including 17-day visits to his mother’s home in Virginia each month. When away from his mother’s house during these visits, he is required to carry a GPS-equipped cell phone.

Because of the enormous growth and impact of the mental health profession in our society, it is important that we understand the profession’s strengths and weaknesses. As you have seen throughout this book, the field has gathered much knowledge, especially during the past several decades. What mental health professionals do not know and cannot do, however, still outweighs what they do know and can do. Everyone who turns to the clinical field—directly or indirectly—must recognize that it is young and imperfect. Society is vastly curious about behavior and often in need of information and help. What we as a society must remember, however, is that the field is still putting it all together.

BETWEEN THE LINES

Psychological Research and an Important Court Decision

To arrive at a decision in the case of Graham v. Florida (2010) the U.S. Supreme Court cited a large body of psychological research on the unformed character and cognitive limitations of adolescents and their special vulnerability to external influences. The court ruled that individuals under 18 years of age cannot be punished with life in prison without parole, except in cases of homicide.

BETWEEN THE LINES

Recent TV Series Featuring Psychological Profilers

NCIS

NUMB3RS

Dexter

The Mentalist

Without a Trace

Criminal Minds

Criminal Minds: Suspect Behavior

Law and Order: Criminal Intent

Law and Order: Special Victims Unit

Waking the Dead (British television series)

Wire in the Blood (British television series)

SUMMING UP

  • LAW AND MENTAL HEALTH The mental health profession interacts with the legislative and judicial systems in two key ways. First, clinicians help assess the mental stability of people accused of crimes. Second, the legislative and judicial systems help regulate mental health care. p. 636

  • CRIMINAL COMMITMENT The punishment of people convicted of crimes depends on the assumption that individuals are responsible for their acts and are capable of defending themselves in court. Evaluations by clinicians may help judges and juries decide the culpability of defendants and sometimes result in criminal commitment.

    If defendants are judged to have been mentally unstable at the time they committed a crime, they may be found not guilty by reason of insanity and placed in a treatment facility rather than a prison. “Insanity” is a legal term, one defined by legislators, not by clinicians. In federal courts and about half the state courts, insanity is judged in accordance with the M’Naghten test, which holds that defendants were insane at the time of a criminal act if they did not know the nature or quality of the act or did not know right from wrong at the time they committed it. Other states use the broader American Law Institute test.

    The insanity defense has been criticized on several grounds, and some states have added an additional option, guilty but mentally ill. Defendants who receive this verdict are sentenced to prison with the proviso that they will also receive psychological treatment. Still another verdict option is guilty with diminished capacity. A related category consists of convicted sex offenders, who are considered in some states to have a mental disorder and are therefore assigned to treatment in a mental health facility.

    Regardless of their state of mind at the time of the crime, defendants may be found mentally incompetent to stand trial, that is, incapable of fully understanding the charges or legal proceedings that confront them. These defendants are typically sent to a mental hospital until they are competent to stand trial. pp. 636–645

  • CIVIL COMMITMENT The legal system also influences the clinical profession. Courts may be called upon to commit noncriminals to mental hospitals for treatment, a process called civil commitment. Society allows involuntary commitment of people considered to be in need of treatment and dangerous to themselves or others. Laws governing civil commitment procedures vary from state to state, but a minimum standard of proof—clear and convincing evidence of the necessity of commitment—has been defined by the Supreme Court. pp. 645–649

    667

  • PROTECTING PATIENTS’ RIGHTS The courts and legislatures significantly affect the mental health profession by specifying legal rights to which patients are entitled. The rights that have received the most attention are the right to treatment and the right to refuse treatment. pp. 649–651

  • OTHER CLINICAL–LEGAL INTERACTIONS Mental health and legal professionals also cross paths in four other areas. First, malpractice suits against therapists have increased in recent years. Second, the legislative and judicial systems help define professional boundaries. Third, lawyers may solicit the advice of mental health professionals regarding the selection of jurors and case strategies. Fourth, psychologists may investigate legal phenomena such as eyewitness testimony and patterns of criminality. pp. 651–655

  • ETHICAL PRINCIPLES Each clinical profession has a code of ethics. The psychologists’ code includes prohibitions against engaging in fraudulent research and against taking advantage of clients and students, sexually or otherwise. It also establishes guidelines for respecting patient confidentiality. The case of Tarasoff v. Regents of the University of California helped to determine the circumstances in which therapists have a duty to protect the client or others from harm and must break confidentiality. pp. 656–657

  • MENTAL HEALTH, BUSINESS, AND ECONOMICS Clinical practice and study also intersect with the business and economic worlds. Clinicians often help to address psychological problems in the workplace, for example, through employee assistance programs and stress-reduction and problem-solving seminars.

    Reductions in government funding of clinical services have left much of the expense for these services to be paid by insurance companies. Private insurance companies are setting up managed care programs whose structure and reimbursement procedures influence and often reduce the duration and focus of therapy. Their procedures, which include peer review systems, may also compromise patient confidentiality and the quality of therapy services. pp. 658–659

  • TECHNOLOGY AND MENTAL HEALTH The remarkable technological advances of recent times have affected the mental health field, just as they have affected all other fields and professions. In particular, these advances have contributed to new vehicles and triggers for psychopathology, new forms of psychopathology, and various kinds of cybertherapy. pp. 660–662

  • THE PERSON WITHIN THE PROFESSION Mental health activities are affected by the personal needs, values, and goals of the human beings who provide the clinical services. These factors inevitably affect the choice, direction, and even quality of their work. p. 664

Visit LaunchPad

www.macmillanhighered.com/launchpad/comerabpsych9e to access the e-book, new interactive case studies, videos, activities, LearningCurve quizzing, as well as study aids including flashcards, FAQs, and research exercises.

668