by Sarah E. Paul, M.A., Washington University in St. Louis
It should not be news to anyone that clinical scientists and training programs have a long way to go to achieve Diversity, Equity, and Inclusion (DEI) in clinical training, research, and practice. Nor should it be a surprise that the field of psychology has a reprehensible history of perpetuating systemic discrimination and oppression (Winston, 2020). What is less often understood—and even sometimes directly challenged—is the immense potential and responsibility of clinical scientists to advocate for social justice and incorporate such advocacy into our training.
Unfortunately, this potential and responsibility conflicts with the existing incentive structure of clinical science training programs. As clinical scientists, we are tasked with the dissemination of psychological science and evidence-based practice to our communities. Yet our manuscripts are littered with disclaimers that results cannot generalize to non-WEIRD (i.e., Western, Educated, Industrialized, Rich, and Democratic) populations, and our empirically supported treatments (ESTs) have been validated in predominantly white samples (Hall et al., 2020; Zane & Huang, 2016). Clinical students are often overwhelmed by research, clinical, course, teaching, and other responsibilities – trying to reach a certain clinical hour and publication count to be competitive for internship and postdoctoral positions. Principal investigators (PIs) have countless other responsibilities, and, even if well meaning, are incentivized to accept new graduate students with impressive CVs from unpaid research experiences more attainable for students with privilege. Departments want faculty members who will publish and bring in grant funding, and BIPOC faculty receive fewer grants because of systemic bias (Erosheva et al., 2020). Faculty applicants who succeeded in prestigious graduate programs and are able (financially, emotionally, mentally) to devote themselves to their research and other responsibilities are more attractive to hiring committees. Although diversity positively influences scientific innovation, BIPOC faculty members’ investment in diversity efforts is undervalued in hiring and promotion processes (Hofstra et al., 2020; Barber et al., 2020). For all the recent talk about DEI and diversity statements that have been updated on program websites, the existing incentive structure still dramatically favors members of dominant cultures whose economic and other privileges have helped add attractive lines to their CVs. It is unfortunate that the prevailing incentives and general modus operandi of our training programs do not yet align with the values most of us hold, and that change-making is often left up to the overworked individual to take on should they so choose.
Departments and training programs need to be structured to explicitly incorporate social justice advocacy. I have heard professors say that psychologists should not be advocates, because advocacy might somehow pollute the scientific rigor of one’s work. But who says advocacy and good science are mutually exclusive? Pure scientific objectivity, just like universally applying ESTs to all clients regardless of their culture, is an artifact of a Eurocentric, male-dominated scientific philosophy that is, frankly, out-of-date. As scientists, we question and challenge the accepted status quo. As therapists, we must question and challenge the idea that all clients should be treated the same, with the same diagnoses and interventions and approaches. We are cautioned against self-disclosure in therapy and against publicly posting to social media—what if a client discovers our political affiliation and history of protest? Well, what if? We exist—as scientists and therapists—in a messy, political world. We are not and should not be insulated from the messy and political. As scientists and therapists, we try to make the world a better place, and we would be doing a disservice to ourselves, our science, and our clients by not using our education and influence toward social justice.
Ideally, our training would involve education about ways in which the assessments, interventions, and diagnoses we use and provide are biased; training in the use of epidemiological, qualitative, and participatory action research methods; incorporation of political science and sociological theories such as critical race theory; and community outreach and engagement. To those who might believe such training would be impossible given that there are only so many hours in a day and years in graduate school, I say that programs adopting a scientist-practitioner-advocate model have already been accredited by the American Psychological Association for counseling psychology PhD programs (Mallinckrodt et al., 2014). Let us be more open-minded. We are clinical scientists, and we are tasked with helping our clients and advancing knowledge. Incorporating a social justice framework, which is entirely compatible with ethical therapy and rigorous research, would not only advance these goals but also strengthen our profession.
What can we do?
- Social justice advocacy training. Clinical science can take from the scientist-practitioner-advocate model to incorporate knowledge (sources of bias in assessment and therapy, forms of oppression, research designs such as epidemiological methods) and skills (empowering client self-advocacy, discussing political advocacy with clients, engaging with the community through public speaking) training throughout the curriculum.
- Encourage and advertise advocacy. Outside of a formalized curriculum, there are many ways individual students can take action. Due to the incentives noted above, some students may feel that they do not have time or that their mentors may not approve of such extracurricular activities. Therefore, it is important for students and faculty alike to discuss these opportunities and encourage engagement. Several national student organizations work to promote DEI in clinical science (e.g., BRIDGE Psychology Network, DiSSECT). As a member of Dismantling Systematic Shortcomings in Education in Clinical Training (DiSSECT), I can attest to the value of collaborating with peers across the country to learn about issues facing clinical psychology, disseminate our knowledge, and act toward system-level change.
- Institutional-level change to restructure incentives. System-level change is needed. Others have written about the many steps clinical science training programs can take toward antiracism, including, but not limited to, decolonizing curricula, holistically evaluating graduate student and faculty applicants and their contributions to DEI (e.g., UC Berkeley’s candidate evaluation tool), providing additional mentorship to BIPOC students and faculty (Diggs-Andrews et al., 2021; Martinez et al., 2018), and developing explicit systems of accountability for supervisors, trainees, and faculty to meet DEI goals (e.g., regular evaluations, written reflections; Galán et al., 2021).
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References
Barber, P. H., Hayes, T. B., Johnson, T. L., Márquez-Magaña, L., & 10, 234 signatories. (2020). Systemic racism in higher education. Science, 369(6510), 1440. https://doi.org/10.1126/science.abd7140
Diggs-Andrews, K.A., Mayer, D.C.G., & Riggs, B. (2021). Introduction to effective mentorship for early-career research scientists. BMC Proc, 15(7).
Erosheva, E. A., Grant, S., Chen, M.-C., Lindner, M. D., Nakamura, R. K., & Lee, C. J. (2020). NIH peer review: Criterion scores completely account for racial disparities in overall impact scores. Science Advances, 6(23), eaaz4868. https://doi.org/10.1126/sciadv.aaz4868
Galán, C. A., Bekele, B., Boness, C., Bowdring, M., Call, C., Hails, K., McPhee, J., Mendes, S. H., Moses, J., Northrup, J., Rupert, P., Savell, S., Sequeira, S., Tervo- Clemmens, B., Tung, I., Vanwoerden, S., Womack, S., & Yilmaz, B. (2021). Editorial: A Call to Action for an Antiracist Clinical Science. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 50(1), 12–57. https://doi.org/10.1080/15374416.2020.1860066
Hall, G.C.N., Berkman, E.T., Zane, N.W., Leong, F.T.L., Hwang, W.C., Nezu, A.M., Nezu, C.M., Hong, J.J., Chu, J.P., & Huang, E.R. (2020). Reducing Mental Health Disparities by
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Hofstra, B., Kulkarni, V. V., Galvez, S. M.-N., He, B., Jurafsky, D., & McFarland, D. A. (2020). The Diversity–Innovation Paradox in Science. Proceedings of the National Academy of Sciences, 117(17), 9284–9291. https://doi.org/10.1073/pnas.1915378117
Mallinckrodt, B., Miles, J. R., & Levy, J. J. (2014). The Scientist-Practitioner-Advocate Model: Addressing Contemporary Training Needs for Social Justice Advocacy. Training and Education in Professional Psychology, 8(4), 303–311.
Martinez, L. R., Boucaud, D. W., Casadevall, A., & August, A. (2018). Factors contributing to the success of NIH-designated underrepresented minorities in academic and nonacademic research positions. CBE—Life Sciences Education, 17(2), 1–10. https://doi.org/10.1187/ cbe.16-09-0287.
Winston, A. S. (2020). Scientific racism and North American psychology. In A. S. Winston (Ed.), Oxford Research Encyclopedia of Psychology. Oxford University Press. https://doi.org/10.1093/acrefore/9780190236557.013.516
Zane, N., & Huang, C. Y. (2016). Cultural issues in mental health treatment. In M. Gelfand, C. Y. Chiu, & Y. Y. Hong (Eds.), Advances in culture and psychology (pp. 113–155). New York, NY: Oxford University Press.
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).