On the 7th July a series of articles in Psychiatry Times began, warning all mental health professionals of the growing dangers of tribalism in the mental health area, but psychiatry in particular. Specific interest groups are not just expressions of preference for treatment modalities or drugs to be prescribed, they are actually becoming “parties” that affect quality and scope of care for patients.
It is that “scope of care” that concerns me most. As the koroheke (“old man”) in my field I have been referred to as the “father” or worse, the “grandfather” of CBT and “mental skills” training in New Zealand. While it is true that I was “there” as CBT developed in the mid 1970s, I was also a critic from earliest days of “partisan” treatment approaches, seeing even then that once some clinicians got hold of a technique or approach, they can forget or deliberately ignore all facts that didn’t fit their model.
This is a very human problem, for we prefer the familiar and the simple, to the difficult and complex issues that stretch or break apart our preconceptions. Any system of diagnosis and treatment that does not sit with the multi-dimensional nature of the client/patient and their problems is dangerous to that patient for we are simply not “hearing them”.
First rule of any mental health therapy is to be sure of the facts whether you like them or not, whether they make you uncomfortable or make you relaxed! I have no problem with any clinician specializing, in fact I believe we need to do this as we age/mature… I do have major problems when we squeeze each patient/client into our treatment sausage machine where only our issues are seen as real issues… Existential and faith/spiritual crises are simply explained away by some “therapy tribes”, and that may be okay if that is acknowledged up front, but it’s not okay if the client/patient is made to feel these things are not scientific or helpful to them, and even aberrations in themselves…
Loss of perspective and ignoring of inconvenient information is a danger, and not just to the AI chatbot that has selective criteria for its programmed treatment approach. If we advertise our services as selective and specific then there is no argument – we only use CBT, we only use DBT, we only use “mental skills”, we only use drugs, …whatever it is, if we are tribal let’s dress, act and advertise as the shamans we are, but let’s not pretend we are being scientific or professional in our approach! Our clients deserve information up front to make their therapy path decisions. If we are tribal in our approach, not dealing with certain issues, let’s be clear about it, so all know.