The Surprising Truth About Addiction

Change is natural. You no doubt act very differently in many areas of your life now compared with how you did when you were a teenager. Likewise, over time you will probably overcome or ameliorate certain behaviors: a short temper, crippling insecurity.

For some reason, we exempt addiction from our beliefs about change. In both popular and scientific models, addiction is seen as locking you into an inescapable pattern of behavior. Both folk wisdom, as represented by Alcoholics Anonymous, and modern neuroscience regard addiction as a virtually permanent brain disease. No matter how many years ago your uncle Joe had his last drink, he is still considered an alcoholic. The very word addict confers an identity that admits no other possibilities. It incorporates the assumption that you can't, or won't, change.

But this fatalistic thinking about addiction doesn't jibe with the facts. More people overcome addictions than do not. And the vast majority do so without therapy. Quitting may take several tries, and people may not stop smoking, drinking or using drugs altogether. But eventually they succeed in shaking dependence.

Kicking these habits constitutes a dramatic change, but the change need not occur in a dramatic way. So when it comes to addiction treatment, the most effective approaches rely on the counterintuitive principle that less is often more. Successful treatment places the responsibility for change squarely on the individual and acknowledges that positive events in other realms may jump-start change.

Consider the experience of American soldiers returning from the war in Vietnam, where heroin use and addiction was widespread. In 90 percent of cases, when GIs left the pressure cooker of the battle zone, they also shed their addictions—in vivo proof that drug addiction can be just a matter of where in life you are.

Of course, it took more than a plane trip back from Asia for these men to overcome drug addiction. Most soldiers experienced dramatically altered lives when they returned. They left the anxiety, fear and boredom of the war arena and settled back into their home environments. They returned to their families, formed new relationships, developed work skills.

Smoking is at the top of the charts in terms of difficulty of quitting. But the majority of ex-smokers quit without any aid—neither nicotine patches nor gum, Smokenders groups nor hypnotism. (Don't take my word for it; at your next social gathering, ask how many people have quit smoking on their own.) In fact, as many cigarette smokers quit on their own, an even higher percentage of heroin and cocaine addicts and alcoholics quit without treatment. It is simply more difficult to keep these habits going through adulthood. It's hard to go to Disney World with your family while you are shooting heroin. Addicts who quit on their own typically report that they did so in order to achieve normalcy.

Every year, the National Survey on Drug Use and Health interviews Americans about their drug and alcohol habits. Ages 18 to 25 constitute the peak period of drug and alcohol use. In 2002, the latest year for which data are available, 22 percent of Americans between ages 18 and 25 were abusing or were dependent on a substance, versus only 3 percent of those aged 55 to 59. These data show that most people overcome their substance abuse, even though most of them do not enter treatment.

How do we know that the majority aren't seeking treatment? In 1992, the National Institute on Alcohol Abuse and Alcoholism conducted one of the largest surveys of substance use ever, sending Census Bureau workers to interview more than 42,000 Americans about their lifetime drug and alcohol use. Of the 4,500-plus respondents who had ever been dependent on alcohol, only 27 percent had gone to treatment of any kind, including Alcoholics Anonymous. In this group, one-third were still abusing alcohol.

Of those who never had any treatment, only about one-quarter were currently diagnosable as alcohol abusers. This study, known as the National Longitudinal Alcohol Epidemiologic Survey, indicates first that treatment is not a cure-all, and second that it is not necessary. The vast majority of Americans who were alcohol dependent, about three-quarters, never underwent treatment. And fewer of them were abusing alcohol than were those who were treated.

This is not to say that treatment can't be useful. But the most successful treatments are nonconfrontational approaches that allow self-propelled change. Psychologists at the University of New Mexico led by William Miller tabulated every controlled study of alcoholism treatment they could find. They concluded that the leading therapy was barely a therapy at all but a quick encounter between patient and health-care worker in an ordinary medical setting. The intervention is sometimes as brief as a doctor looking at the results of liver-function tests and telling a patient to cut down on his drinking. Many patients then decide to cut back—and do!

As brief interventions have evolved, they have become more structured. A physician may simply review the amount the patient drinks, or use a checklist to evaluate the extent of a drinking problem. The doctor then typically recommends and seeks agreement from the patient on a goal (usually reduced drinking rather than complete abstinence). More severe alcoholics would typically be referred out for specialized treatment. A range of options is discussed (such as attending AA, engaging in activities incompatible with drinking or using a self-help manual). A spouse or family member might be involved in the planning. The patient is then scheduled for a future visit, where progress can be checked. A case monitor might call every few weeks to see whether the person has any questions or problems.

The second most effective approach is motivational enhancement, also called motivational interviewing. This technique throws the decision to quit or reduce drinking—and to find the best methods for doing so—back on the individual. In this case, the therapist asks targeted questions that prompt the individual to reflect on his drinking in terms of his own values and goals. When patients resist, the therapist does not argue with the individual but explores the person's ambivalence about change so as to allow him or her to draw his own conclusions: "You say that you like to be in control of your behavior, yet you feel when you drink you are often not in charge. Could you just clarify that for me?"

Miller's team found that the list of most effective treatments for alcoholism included a few more surprises. Self-help manuals were highly successful. So was the community-reinforcement approach, which addresses the person's capacity to deal with life, notably marital relationships, work issues (such as simply getting a job), leisure planning and social-group formation (a buddy might be provided, as in AA, as a resource to encourage sobriety). The focus is on developing life skills, such as resisting pressures to drink, coping with stress (at work and in relationships) and building communication skills.

These findings square with what we know about change in other areas of life: People change when they want it badly enough and when they feel strong enough to face the challenge, not when they're humiliated or coerced. An approach that empowers and offers positive reinforcement is preferable to one that strips the individual of agency. These techniques are most likely to elicit real changes, however short of perfect and hard-won they may be.


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The New Sex Scorecard (page1)

Get out the spittoon. Men produce twice as much saliva as women. Women, for their part, learn to speak earlier, know more words, recall them better, pause less and glide through tongue twisters.

Put aside Simone de Beauvoir's famous dictum, "One is not born a woman but rather becomes one." Science suggests otherwise, and it's driving a whole new view of who and what we are. Males and females, it turns out, are different from the moment of conception, and the difference shows itself in every system of body and brain.

It's safe to talk about sex differences again. Of course, it's the oldest story in the world. And the newest. But for a while it was also the most treacherous. Now it may be the most urgent. The next stage of progress against disorders as disabling as depression and heart disease rests on cracking the binary code of biology. Most common conditions are marked by pronounced gender differences in incidence or appearance.

Although sex differences in brain and body take their inspiration from the central agenda of reproduction, they don't end there. "We've practiced medicine as though only a woman's breasts, uterus and ovaries made her unique -- and as though her heart, brain and every other part of her body were identical to those of a man," says Marianne J. Legato, M.D., a cardiologist at Columbia University who spearheads the new push on gender differences. Legato notes that women live longer but break down more.

Do we need to explain that difference doesn't imply superiority or inferiority? Although sex differences may provide ammunition for David Letterman or the Simpsons, they unfold in the most private recesses of our lives, surreptitiously molding our responses to everything from stress to space to speech. Yet there are some ways the sexes are becoming more alike -- they are now both engaging in the same kind of infidelity, one that is equally threatening to their marriages.

Everyone gains from the new imperative to explore sex differences. When we know why depression favors women two to one, or why the symptoms of heart disease literally hit women in the gut, it will change our understanding of how our bodies and our minds work.

The Gene Scene

Whatever sets men and women apart, it all starts with a single chromosome: the male-making Y, a puny thread bearing a paltry 25 genes, compared with the lavish female X, studded with 1,000 to 1,500 genes. But the Y guy trumps. He has a gene dubbed Sry, which, if all goes well, instigates an Olympic relay of development. It commands primitive fetal tissue to become testes, and they then spread word of masculinity out to the provinces via their chief product, testosterone. The circulating hormone not only masculinizes the body but affects the developing brain, influencing the size of specific structures and the wiring of nerve cells.

But sex genes themselves don't cede everything to hormones. Over the past few years, scientists have come to believe that they too play ongoing roles in gender-flavoring the brain and behavior.

Females, it turns out, appear to have backup genes that protect their brains from big trouble. To level the genetic playing field between men and women, nature normally shuts off one of the two X chromosomes in every cell in females. But about 19 percent of genes escape inactivation; cells get a double dose of some X genes. Having fall-back genes may explain why females are far less subject than males to mental disorders from autism to schizophrenia.

What's more, which X gene of a pair is inactivated makes a difference in the way female and male brains respond to things, says neurophysiologist Arthur P. Arnold, Ph.D., of the University of California at Los Angeles. In some cases, the X gene donated by Dad is nullified; in other cases it's the X from Mom. The parent from whom a woman gets her working genes determines how robust her genes are. Paternal genes ramp up the genetic volume, maternal genes tune it down. This is known as genomic imprinting of the chromosome.

For many functions, it doesn't matter which sex genes you have or from whom you get them. But the Y chromosome itself spurs the brain to grow extra dopamine neurons, Arnold says. These nerve cells are involved in reward and motivation, and dopamine release underlies the pleasure of addiction and novelty seeking. Dopamine neurons also affect motor skills and go awry in Parkinson's disease, a disorder that afflicts twice as many males as females.

XY makeup also boosts the density of vasopressin fibers in the brain. Vasopressin is a hormone that both abets and minimizes sex differences; in some circuits it fosters parental behavior in males; in others it may spur aggression.

Sex on the Brain

Ruben Gur, Ph.D., always wanted to do the kind of psychological research that when he found something new, no one could say his grandmother already knew it. Well, "My grandmother couldn't tell you that women have a higher percentage of gray matter in their brains," he says. Nor could she explain how that discovery resolves a long-standing puzzle.

Gur's discovery that females have about 15 to 20 percent more gray matter than males suddenly made sense of another major sex difference: Men, overall, have larger brains than women (their heads and bodies are larger), but the sexes score equally well on tests of intelligence.

Gray matter, made up of the bodies of nerve cells and their connecting dendrites, is where the brain's heavy lifting is done. The female brain is more densely packed with neurons and dendrites, providing concentrated processing power -- and more thought-linking capability.

The larger male cranium is filled with more white matter and cerebrospinal fluid. "That fluid is probably helpful," says Gur, director of the Brain Behavior Laboratory at the University of Pennsylvania. "It cushions the brain, and men are more likely to get their heads banged about."

White matter, made of the long arms of neurons encased in a protective film of fat, helps distribute processing throughout the brain. It gives males superiority at spatial reasoning. White matter also carries fibers that inhibit "information spread" in the cortex. That allows a single-mindedness that spatial problems require, especially difficult ones. The harder a spatial task, Gur finds, the more circumscribed the right-sided brain activation in males, but not in females. The white matter advantage of males, he believes, suppresses activation of areas that could interfere with work.

The white matter in women's brains is concentrated in the corpus callosum, which links the brain's hemispheres, and enables the right side of the brain to pitch in on language tasks. The more difficult the verbal task, the more global the neural participation required -- a response that's stronger in females.


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The New Sex Scorecard (page2)

Baron-Cohen was "bowled over" by the results. The more testosterone the children had been exposed to in the womb, the less able they were to make eye contact at 1 year of age. "Who would have thought that a behavior like eye contact, which is so intrinsically social, could be in part shaped by a biological factor?" he asks. What's more, the testosterone level during fetal life also influenced language skills. The higher the prenatal testosterone level, the smaller a child's vocabulary at 18 months and again at 24 months.

Lack of eye contact and poor language aptitude are early hallmarks of autism. "Being strongly attracted to systems, together with a lack of empathy, may be the core characteristics of individuals on the autistic spectrum," says Baron-Cohen. "Maybe testosterone does more than affect spatial ability and language. Maybe it also affects social ability." And perhaps autism represents an "extreme form" of the male brain.

Depression: Pink -- and Blue, Blue, Blue

This year, 19 million Americans will suffer a serious depression. Two out of three will be female. Over the course of their lives, 21.3 percent of women and 12.7 percent of men experience at least one bout of major depression.

The female preponderance in depression is virtually universal. And it's specific to unipolar depression. Males and females suffer equally from bipolar, or manic, depression. However, once depression occurs, the clinical course is identical in men and women.

The gender difference in susceptibility to depression emerges at 13. Before that age, boys, if anything, are a bit more likely than girls to be depressed. The gender difference seems to wind down four decades later, making depression mostly a disorder of women in the child-bearing years.

As director of the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University, Kenneth S. Kendler, M.D., presides over "the best natural experiment that God has given us to study gender differences" -- thousands of pairs of opposite-sex twins. He finds a significant difference between men and women in their response to low levels of adversity. He says, "Women have the capacity to be precipitated into depressive episodes at lower levels of stress."

Adding injury to insult, women's bodies respond to stress differently than do men's. They pour out higher levels of stress hormones and fail to shut off production readily. The female sex hormone progesterone blocks the normal ability of the stress hormone system to turn itself off. Sustained exposure to stress hormones kills brain cells, especially in the hippocampus, which is crucial to memory.

It's bad enough that females are set up biologically to internally amplify their negative life experiences. They are prone to it psychologically as well, finds University of Michigan psychologist Susan Nolen-Hoeksema, Ph.D.

Women ruminate over upsetting situations, going over and over negative thoughts and feelings, especially if they have to do with relationships. Too often they get caught in downward spirals of hopelessness and despair.

It's entirely possible that women are biologically primed to be highly sensitive to relationships. Eons ago it might have helped alert them to the possibility of abandonment while they were busy raising the children. Today, however, there's a clear downside. Ruminators are unpleasant to be around, with their oversize need for reassurance. Of course, men have their own ways of inadvertently fending off people. As pronounced as the female tilt to depression is the male excess of alcoholism, drug abuse and antisocial behaviors.


The Incredible Shrinking Double Standard

Nothing unites men and women better than sex. Yet nothing divides us more either. Males and females differ most in mating psychology because our minds are shaped by and for our reproductive mandates. That sets up men for sex on the side and a more casual attitude toward it.

Twenty-five percent of wives and 44 percent of husbands have had extramarital intercourse, reports Baltimore psychologist Shirley Glass, Ph.D. Traditionally for men, love is one thing and sex is...well, sex.

In what may be a shift of epic proportions, sexual infidelity is mutating before our very eyes. Increasingly, men as well as women are forming deep emotional attachments before they even slip into an extramarital bed together. It often happens as they work long hours together in the office.

"The sex differences in infidelity are disappearing," says Glass, the doyenne of infidelity research. "In my original 1980 study, there was a high proportion of men who had intercourse with almost no emotional involvement at all -- nonrelational sex. Today, more men are getting emotionally involved."

One consequence of the growing parity in affairs is greater devastation of the betrayed spouse. The old-style strictly sexual affair never impacted men's marital satisfaction. "You could be in a good marriage and still cheat," reports Glass.

Liaisons born of the new infidelity are much more disruptive -- much more likely to end in divorce. "You can move away from just a sexual relationship but it's very difficult to break an attachment," says Rutgers University anthropologist Helen Fisher, Ph.D. "The betrayed partner can probably provide more exciting sex but not a different kind of friendship."

It's not that today's adulterers start out unhappy or looking for love. Says Glass: "The work relationship becomes so rich and the stuff at home is pressurized and child-centered. People get involved insidiously without planning to betray."

Any way it happens, the combined sexual-emotional affair delivers a fatal blow not just to marriages but to the traditional male code. "The double standard for adultery is disappearing," Fisher emphasizes. "It's been around for 5,000 years and it's changing in our lifetime. It's quite striking. Men used to feel that they had the right. They don't feel that anymore."




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Teens and Sex

While the media bombards us with alarming statistics about the number of teenagers having sex, few reports shed light on what might encourage teens to become sexually active in the first place. Three studies offer some insight into sexually active teens: environment, age of partner and perceived family support may affect young people's decisions to have sex.

In a study presented at a meeting of the American Public Health Association (APHA), researchers at the University of Kentucky followed 950 teenagers at 17 high schools in Kentucky and Ohio from 9th to 11th grades. They found evidence that teens who have intercourse tend to think their friends are too, even if they're not. "You're 2.5 times more likely to have sex by the 9th grade if you think your friends are having sex -- whether or not they really are," says Katharine Atwood, assistant professor at the Kentucky School of Public Health. Plus, teens tended to overestimate how many of their friends were sexually active. Only 33 percent of kids in the study had had sex by the 9th grade, but 31 percent said that most or all of their friends had had sex. "If you can persuade them that fewer are having sex than they think," she says, "that can have a significant impact on their behavior."

Among young girls, a partner's age is a risk factor for sexual activity. "The younger the girl is at the age of first intercourse, the more likely she is to have a much older partner," says Harold Leitenberg, Ph.D., a professor of psychology at the University of Vermont. His study, published in the Archives of Sexual Behavior, found that of 4,201 girls in 8th through 12th grades, those who lost their virginity between ages 11 and 12 tended to have partners five or more years older. For girls who had sex later in adolescence, the partner's age disparity was much smaller. Early sexual initiation was also associated with a number of behavioral problems. "Ignoring the age of the partners, the earlier a girl was when she first had intercourse, the greater her risk of suicide attempts, alcohol use, drug abuse, truancy and pregnancy," Leitenberg says.

The good news is that while teen sex may not be wholly preventable, the health risks it involves can be reduced through communication within the family. More research presented at the APHA meeting showed that frequent parent-child discussions about sex and its dangers may prevent teenagers from engaging in risky sexual behavior. Researchers at Emory University questioned 522 sexually active African-American adolescents about the openness and support that their families provided. Adolescents who felt that their families were more supportive were less likely to have unprotected sex, and thus were at a lesser risk for pregnancy and disease. Read More..

To Become a Psychologyst

Are you thinking of becoming a psychologist? Many students have written to me, asking various questions about what the process entails. I therefore offer the following advice.

Preface

In the state of California (USA), where I am licensed, the term psychologist is protected by state law (Business and Professions Code Sections 2900-2918). This means that only a person who has passed the state licensing exams, and who therefore has a psychologist license, may call himself or herself a psychologist.

Also, California law requires that to become a psychologist a person must have a doctoral degree in either psychology or education.

To find the Board of Psychology in your state (or Canadian province) to learn its requirements for licensure as a psychologist, use this link: Association of State and Provincial Psychology Boards

Yet, when students ask me the question, “How do I become a psychologist?” they aren’t really asking so much about the licensing process as about the educational process of getting a doctorate in psychology. (During the course of his or her doctoral education, a student will receive supervised clinical training and experience as well. It’s a long process. So if you’ve come to this page looking for some secret tricks about how to be a “psychologist” and impress your friends, you’ve come to the wrong place.)

Therefore, in what follows, even though there are other degrees and other fields of study that relate to mental health (such as psychiatry, social work, marriage and family therapy, counseling, and education, I will focus strictly on the educational process relating to doctoral level psychology. And, because California law reserves the title psychologist to a licensed practitioner, I won’t be discussing fields of psychology such as social psychology, developmental psychology, cognitive and experimental psychology, biological psychology, or industrial-organizational psychology which are unlicensed and usually focus on teaching, research, or corporate consultation.

Note that according to psychology licensing law in California, psychologist is a generic term; there is technically no such thing in California as a “child psychologist” or a “neuropsychologist,” or a “criminal psychologist.” If you want to practice psychology with children, for example, you can specialize academically in child psychology, but your license will be simply “psychologist.” So, regardless of your intended specialty, you will have to follow the same basic path to your license as any other person aspiring to be a psychologist. Of course, locations outside California may have other laws about the practice of psychology—or no laws at all.

In California a person can, however, become licensed as an educational psychologist. Unlike the license for a “psychologist,” which requires a doctoral degree, the license for an “educational psychologist” requires only a master’s degree in psychology, educational psychology, school psychology, or counseling and guidance. Such a person is authorized to perform (a) educational evaluation, diagnosis, and test interpretation limited to assessment of academic ability, learning patterns, achievement, motivation, and personality factors directly related to academic learning problems; (b) counseling services for children or adults for amelioration of academic learning problems; and (c) educational consultation, research, and direct educational services. (See Business and Professions Code Sections 4986.10 and 4986.20)

Beginning in High School

First, let’s be honest here. The study of psychology is not for everyone; if it were, it would be a video game, not a profession. And so, in a society in which many high school graduates cannot even spell the word psychology, the requirements to become a psychologist can seem almost impossible. But the discipline, dedication, and academic requirements are no more difficult than those of any other profession.

In addition to recommending that you use the advice and resources of your school’s guidance counselor in regard to planning your junior high school and high school courses, I can offer four other suggestions.

First, in regard to general academics, I suggest that you prepare for a career in psychology by the basic high school science courses: chemistry, biology, physics, and mathematics—and, of course, psychology, if your school offers it. Science courses teach you to think logically, and they give you important insight into how the physical world “works.” Mathematics teaches you analytical thought, and it prepares you for the statistics courses that are necessary to understand all the research that is fundamental to the field of psychology. You should also become very good at writing and should develop excellent grammar, spelling, and punctuation as well as keen analytic thought.

To improve your grammar and writing skills, pay attention in English classes and study Strunk and White’s timeless classic, The Elements of Style.

And keep your grades up; you will be competing for entrance into college with other students who have perfect 4.0 GPAs.


Your high school grades will be important primarily for your being accepted into college. Once you get into college, your undergraduate grades will be important for your being accepted into graduate school.

So, if you want to become a psychologist and your high school grades are not that good, all is not lost. Through hard work and discipline you can improve your study skills and earn better grades in college. And, if your current grades are not good enough for you to get accepted into a university, you can apply to a junior college (AKA community college) to prove yourself and then transfer to a university.

HOW TO GET GOOD GRADES?

On the behavioral side, take your assigned readings seriously, pay attention in class, and complete your assignments carefully. If you need to learn how to concentrate and focus your mind, start Autogenics Training. On the psychological side, DESIRE to get good grades more than you desire any human desire. More than dating, partying, or having fun. Period. Because your future depends on it.


Second, to be a really good mental health professional, you must develop an early interest in what motivates people; courses in the humanities, such as history, sociology, art, literature, and religion, will be helpful. Language courses will also be helpful. And, if you’re especially ambitious, begin reading Sigmund Freud’s Psychopathology of Everyday Life, a small but classic work on the nature of the unconscious.

Third, I suggest you interview a local psychologist. Look in your local Yellow Pages and call up a few psychologists. You will probably get an answering machine or service, so leave a message explaining that you are a student and ask to be granted some time for an office interview (without charge). At the end of the message, give some good times during the day and evening to call you back. (And make certain that you’re available at those times every day to take any calls.) Don’t be surprised if not everyone calls you back—just tell yourself that when you get to have a practice you will be more courteous. If you don’t hear anything within a week, call back and leave another message—politely. Be persistent. Call a third time, if necessary. If you get really desperate, offer to pay for the interview. If anyone does return your call and offers you some time, you can make an appointment to ask some direct questions about the day-to-day experiences of the profession so that you might be able to decide whether it really suits you. Don’t try to do this the easy way by asking e-mail questions over the Internet; psychology is all about face-to-face interactions, so you had better get used to this early on.

Fourth, around your junior year of high school you should begin to think about which undergraduate universities you might want to attend. Look at their admissions requirements and begin to work toward satisfying them. Ask your guidance counselor for help with this. You might also visit the APA Resources for Students page.

College

Your college track should have a heavy load in psychology courses as well. In fact, many graduate programs in psychology require an undergraduate major in psychology as a prerequisite for graduate study in psychology. So even in your first year it wouldn’t be too early to identify some graduate programs you might be interested in attending and contact them to find out what exactly they require for admission. Ask about majors and minors, required courses, minimum GPA, and any other issues specific to you. It’s also time to begin to grapple with courses in statistics.

Since psychology is heavily involved with research (hence the reason for studying statistics), it can help you to get to know a professor who conducts psychological research; offer to work as an assistant. This experience will be looked at favorably when you apply for graduate school later; if you apply to a university graduate program, this experience will be essential.

This process of finding a mentor really depends on your own resourcefulness. One approach would be to identify a professor who conducts research on a subject that interests you; another approach would be to find a professor who is simply a decent person, regardless of his or her field of research. You can begin by taking as many courses as possible from that professor; then you can arrange for some office visits for additional discussions; and then you can offer to do some volunteer work on research. Like all relationships, it has to start slow and cautiously and then grow through unfailing proof of your humility, reliability, and dependability. You can ruin everything by making excuses, breaking promises, or acting with conceit or arrogance.

Finally, you might need to take some specialized graduate school entrance exams, such as the GRE. A well-rounded education can help to prepare for such exams, so, as in high school, take as many humanities courses, especially literature (for the writing skills), as you can.

Graduate Degree: PhD or PsyD?

After you have completed your undergraduate degree, there are two different types of graduate level degrees you could pursue. A Ph.D. (Doctor of Philosophy) is the classic psychology degree necessary to become a psychologist; the Ph.D. places an equal emphasis on research and clinical training according to the traditional Boulder Model [1] of psychological education. A core element of the Ph.D. is the dissertation, an original piece of scientific research. An empirical dissertation is generally composed of four sections: an in-depth review of the scientific literature to date; a description of the measures and methodology involved in the data collection; a technical analysis of the data; and a comprehensive discussion of the results. A theoretical dissertation can introduce a novel theoretical concept and need not involve any data collection.

A Psy.D. (Doctor of Psychology) is a newer professional degree, offered by the professional schools of psychology, and it emphasizes clinical practice with only a minimum of research training. It requires a dissertation (or a “project”) that is usually practical (such as designing a treatment program), but it can be theoretical.

Either of these degrees will take a minimum of about five years to complete.

In general, in the academic world, the Ph.D. is preferable to the Psy.D.; in the world of clinical practice, both degrees have about the same status and functionality.

Clinical Psychology or Counseling Psychology?

You will also have to decide if you want to pursue studies in clinical psychology or counseling psychology. For more information, see my page on Psychology: Clinical or Counseling or ...?.

Graduate Schools: University or Professional?

You will have two choices of graduate schools: university graduate programs and professional schools.

University programs are highly competitive (something like 6 applicants accepted per year from over several hundred applications). Your application will be helped by excellent grades and some previous research experience—preferably, a published paper, if only as a co-author.

Professional schools are easier to get into, but they are very expensive. You will have to take out enormous student loans, or you might try to work while studying—perhaps even studying part-time. Also, many professional schools offer primarily the Psy.D. degree, reserving the Ph.D. (if they offer it at all) for a few, select students.

My advice in regard to making these decisions is to apply to many different programs. The application process, of course, is time-consuming and can become almost a full-time job for a few months. You will need to research the various programs, get their admissions requirements, take the GRE examinations if required, get application forms and fill them out, and pay the application fees—and travel to admissions interviews. You will receive many rejections, so be prepared, but the acceptances will help to shape your future choices.


Common Questions

1.Where do psychologists work, and how much money will I make as a psychologist?

2.I was wondering if a career in psychology allows one to pay back student loans and lead a comfortable living?

3.How much time does it take to get a graduate degree and become a psychologist?

4.I would like to make a career change and become a psychologist. I already have a bachelor’s degree in [economics, chemistry, engineering, etc.]. Will I have to go back to school to get another undergraduate degree?

5.I have been working in [my] field for 7 years now, and I am 25 years old. My question is would it be worth it to change fields at my age and go into child psychology? I am not worried about the money. I am worried about the age thing though. It is something I would really like to consider, and I am also aware that there are many people a lot younger than me getting into the psychology field. I am just wondering if you think waiting this long to go to school for a new field is a good idea? My heart says just do it, but the fear of failing, when I already have a steady career, seeps through. One other thing what do you think the oldest age to get into the psychology field should be?

6.I am certain that I assist people with their problems for self-satisfaction and this is the real reason why I’d like to study psychology; later finding a profession where I am able to help people all day, thus satisfying my needs. Is this a wrong reason to get into your field (i.e., does this become an issue when I make this my living)? I understand we all have selfish reasons for all that we do, but is this what motivates you and others in your field or is there something I seem to be missing?

7.Is it hard to live up to the example of being a good psychotherapist? I read about so many abuses. How do I know I won’t end up doing that same sort of thing?

8.Is psychotherapy a requirement for studying psychology?

9.How do I become a [child psychologist, school psychologist, neuropsychologist, criminal psychologist, etc.]?

10.Recently I have been told that if I want to go into practice all I need is a MA because of insurance and HMO restrictions on patients being reimbursed for visits to psychotherapists with a PhD. Does the same apply for PsyD holders? While I want to achieve the highest degree in the field that trains me to become the best possible psychotherapist I can be, I also know that PsyD programs are very expensive. Is it worth it financially to go for the PsyD over the MA? Will I make more money overall with the PsyD cancelling out the extra money it takes to get through three more years of school?

11.I want a low-stress high-paying job where I can help people. Do you think psychology is the right career for me?

12.iranked your website not at its best because you really elaborated your answeres [about becoming a psychologist] instead of specificly giving one, making it confusing for a person like me to readilly find what i need.

13.Can a personal psychiatric disorder disqualify me from becoming a psychologist?

14.Will a very old felony DUI conviction matter in the licensing process? I don’t want to put in great time, monies and effort to discover this later.

15.Can a high school dropout become a psychologist?

16.Can a school’s accreditation have any affect on my becoming a psychologist?

17.I am planning towards doing graduate studies by distance learning (via the internet) with a U.S.A. university. Will this provide me with as recognizable a training as if I were attending the university as a resident student?

18. have a degree from another country. How can I become a psychologist in the US?

19.I am currently a . . . PhD student in social psychology. . . . in [an] applied-only (i.e., no clinical) program. . . . I have my eye on an academic career but have begun to toy with the idea of possibly looking into a private practice/counseling operation somewhere down the line. To my knowledge, [my school] is not accredited by the American Psychological Association, not to mention my program is heavily research oriented. My question is this: would it be possible, if I really decided to pursue the matter, to become a certified counselor with a non-clinical PhD (from an non-APA accredited school)? It would seem the cards are stacked against me. I have heard that through supplementary clinical courses some psychologists with non-clinical PhDs do manage to get certified by state boards. It sounds difficult, but I am curious as to how one might proceed. . . .

20.Can you recommend any schools in [my area]?

How much time does it take to get a graduate degree and become a psychologist?

It could take you forever (well, almost) if you do not complete every requirement (such as your doctoral dissertation) on time. But, in general, college should take four years, and graduate school (for a PhD or PsyD) should take about five years.

Then, to get your psychologist license (in California) you will have to study for and pass the licensing exams, which in California are the National Examination for Professional Practice in Psychology (EPPP) and the California Psychology Supplemental Examination (CPSE). The EPPP is administered in a multiple-choice format and asks difficult questions from such domains as psychotherapy, statistics, research methodology, test construction, psychological assessment, learning theory, developmental psychology, physiological aspects of psychology, social psychology, and industrial-organizational psychology. The CPSE is a 100 question multiple-choice examination that, as of February 1, 2006 replaced the California Jurisprudence and Professional Ethics Examination (CJPEE) which previously (as of January 1, 2002) replaced the Oral Exam; the CPSE focuses on California laws and regulations relating to the practice of psychology and the Ethical Principles and Code of Conduct of the American Psychological Association. The failure rate of each exam is about 50%, and some individuals can spend several years just trying to pass both exams. Passing the exams does not require that you be extraordinarily gifted, however; it just requires considerable dedication and discipline—qualities often lacking in today’s educational system.

In case you’re wondering, I became a psychologist as a mid-life career change. I earned three masters degrees (MA in Religious Studies; MSE in Counseling; MS in Psychology) between my BA (English Literature) and my PhD (Clinical Psychology); I finished the PhD in four years. I published part of my doctoral dissertation in a peer-reviewed, APA scientific journal. I completed a one year Post-doctoral Fellowship in Health Psychology, and then I passed both the EPPP and the old (pre-2002) Oral Exam on the first attempt.

Where do psychologists work, and how much money will I make as a psychologist?

Psychologists work in all kinds of settings and institutions, and the salary varies accordingly.

If you work for a university, professional school, or community college in teaching or research, your salary will depend on that institution’s pay grade for faculty. The same applies if you work for a hospital, or a government agency (such as the Veterans Administration, the military, law enforcement, or the penal system) or a community agency. Salaries vary depending on experience, tenure, and geographical location and can range from an entry level of about $30,000 to an administrative level of well over $100,000.

In private practice, your income will depend on how many days you work each week, how many clients you have each day, and what you charge for each session. Just multiply the number of client hours by your hourly fee. You could make a bundle with a full-time practice of full-fee clients. Also, if you become famous and have a TV show or make movies, you can make millions. But if you see a lot of lower-fee clients, such as in managed care, or if you have only a part-time practice (because a full-time practice can be difficult to maintain), or if you spend a lot of your time maintaining a free, public-service website without advertising, your income will not be as high as a full-time, full-fee practice. And remember that, regardless of how much money you take in, you have to subtract from it all your expenses: office rent; time spent on paperwork, phone calls, and free services; insurance; continuing education; etc. If your prime concern is money, then consider another career. Competency in any career in the human services depends on the depth of your heart, not the size of your brokerage account.

I would like to make a career change and become a psychologist. I already have a bachelor’s degree in [economics, chemistry, engineering, etc.]. Will I have to go back to school to get another undergraduate degree?

Not necessarily. Everything depends on the graduate program to which you apply. Some of the more high-profile programs may require that you have an undergraduate degree with a major in psychology. But other programs may only require that you have taken a few prerequisite undergraduate psychology courses. The only definite answer, then, can come from each program to which you might want to apply. So locate some graduate programs and then do some research to learn what they require. (When I made my career change, even with all my previous degrees, I had to take undergraduate courses in statistics, developmental psychology, personality, and abnormal psychology in order to get into my PhD program.)

Is psychotherapy a requirement for studying psychology?

To answer this question, I must make two important distinctions.

First, we must distinguish academic psychology (teaching and research, for example) from the clinical applications of psychology (as in psychotherapy and counseling). Second, we must distinguish between the concept of required and the concept of necessary. If something is required it means that without it a task cannot be accomplished. Necessary can be used to mean “required,” but it also can be used to mean “something so advisable that without it the task cannot be accomplished very well.”

Therefore, we can say that it is never required that a person receive psychotherapy in order to study or work in academic psychology. Nor is psychotherapy any more necessary for someone studying academic psychology than for someone studying nuclear physics, for example.

Many universities or schools that teach clinical applications of psychology, however, require that their students receive psychotherapy in order to graduate; usually (in California) the requirement is about 45 sessions of psychotherapy. But note that the licensing boards which administer clinical licenses do not require that a candidate receive psychotherapy; these boards require only a minimum academic degree and a minimum number of hours of supervised clinical training.

So, even if personal psychotherapy is an academic requirement only by some schools, we can still ask philosophically if personal psychotherapy is necessary to practice clinically. My answer is “Yes.”

To practice clinically, a person must be able to understand the factors which are motivating the client, especially those factors which interfere with the client’s progress. No one can do this unless he or she has been in psychotherapy and thoroughly understands the process of psychotherapy from the perspective of the client. In addition, the psychotherapist or counselor must understand his or her own desires, biases, and weaknesses so as not to get “trapped” in them when trying to do clinical work.

The objection to this view usually comes from psychotherapists who do cognitive-behavioral therapy. They will claim that the work is very “mechanical” and problem-focused and does not depend on insight into unconscious motivations. If the psychotherapist does not have any “problems” to be “fixed,” they claim, then personal psychotherapy is a waste of time.

But those who respect the unconscious know that even if unconscious functioning is ignored it still is at work motivating us in every little thing we do. Unfortunately, even 45 hours of psychotherapy is far from adequate to achieve the depth of understanding necessary for good clinical work. This is why there is such a difference between mediocre psychotherapists and the really good ones who have been through a rigorous personal psychodynamic psychotherapy or psychoanalysis.

And finally, the really sad thing is that even bad therapists can make a lot of money, because the clients never know what they are missing.

I want a low-stress high-paying job where I can help people. Do you think psychology is the right career for me?

No. Become a plumber. Just about anyone will pay you a small fortune to unclog a stopped-up toilet, but only a few will pay you more than pocket change to unclog a mind stopped up with confusion, self-indulgence, and unconscious hostility. (Please understand, though, that I say this to be clear and realistic about the sort of world in which you will be practicing—should you actually become a psychologist—not to be harsh.)

iranked your website not at its best because you really elaborated your answeres [about becoming a psychologist] instead of specificly giving one, making it confusing for a person like me to readilly find what i need.

You, too, might want to become a plumber, although even there you might have to learn how to spell.

In all seriousness, psychology may not be the right career for you. In fact, a good psychologist is a bit like the detective Sherlock Holmes: always inquisitive, always observant, taking nothing for granted, and always making connections between remote and seemingly unimportant facts. The truth is not just handed to you without effort.

(And I hope I haven’t offended any plumbers, because, in all seriousness, they, too, have to do a lot of thinking and planning. But I probably have offended some of those bad “therapists” out there.)

In any event, I don’t say any of this to be cruel. You just have to understand that good psychology demands that you not avoid the dark, ugly truth that everyone wants to avoid; and it’s all done in the hope of leading others to the healing they want but, in their confusion, still secretly fear.

How do I become a [child psychologist, school psychologist, neuropsychologist, criminal psychologist, etc.]?

First of all, note that, as I said above, the psychologist license (at least in California) is a generic license that does not distinguish specialties, so terms such as “child psychologist,” “neuropsychologist,” and “criminal psychologist,” if not actually illegal, are technically misleading. Such terms can imply to the general public that a specialty has been licensed, when, in fact, it hasn’t.

Secondly, note that in California there is a license for an educational psychologist, but persons with such a license need only a master’s degree, provide services specifically related to academic learning problems, and are governed by the Board of Behavioral Sciences, not the Board of Psychology. So many of the things I say on this page about how to become a psychologist may not even apply to you if your interest is school psychology.

Finally, in regard to criminal psychology, a person who studies this field may end up working as a police officer, for example, and would not need to be licensed as a psychologist. So many of the things I say on this page about how to become a psychologist may not even apply to you if your interest is criminal psychology.

Nevertheless, psychologists do specialize in child psychology, school psychology, criminal psychology, and neuropsychology. So what are you to do if you want to become a psychologist with one of these specialties—or any other specialty?

Well, most graduate programs in clinical psychology or counseling psychology have certain core courses that everyone has to take; but then they leave room for various elective courses. So you have to make sure that the program you choose has elective courses in your intended area of specialty. And, if you are really serious about your education, you should also take workshops and seminars outside the curriculum, at your own expense, for additional training. Then, when it comes time for your internship, you need to select an internship that offers clinical training in your specialty interest.

Remember, though, that regardless of your specialty during training, you will still have to pass the same National Examination for Professional Practice in Psychology (EPPP) licensing exam that every other applicant must take. You will be required to answer questions from such domains as psychotherapy, statistics, research methodology, test construction, psychological assessment, learning theory, physiological aspects of psychology, developmental psychology, social psychology, and industrial-organizational psychology. So be careful not to get trapped in the illusion that you can focus just on your special interest and ignore other aspects of psychology.

Finally, after you become an established professional, you might want to apply for a diplomate (pronounced DIP-low-mate) in your specialty; a diplomate is a sort of professional stamp of approval offered by certain professional organizations to those candidates who have a history of professional accomplishments and can pass a rigorous examination. Many organizations also offer Fellow status to members as a reward for years of exceptional, dedicated service to the field.

Can a personal psychiatric disorder disqualify me from becoming a psychologist?

Not necessarily. So let me explain.

Consider for a moment the field of aviation. A pilot’s “license” really has two parts to it: the pilot certificate, which documents the holder’s competence in flying certain types of aircraft, and the medical certificate, which documents the holder’s current physical health and physical ability to fly in general. And so, even though a person may have high technical and experiential qualifications as a pilot, certain physical conditions and illnesses can automatically disqualify that person from medical clearance to fly. But psychology is nothing like aviation.

Any license to practice psychologically in the field of mental health—psychologist, MFT, LCSW—represents the successful completion of a series of professional requirements, such as an academic degree, a clinical internship, personal psychotherapy, and the licensing exams themselves. As long as you can complete each requirement along the way, regardless of any physical or psychiatric disability, you most likely can get a license to practice.

Of course, some psychiatric disorders will in themselves prevent you from meeting your requirements. A lack of concentration because of depression will interfere with your academic work. A severe personality disorder will result in conflicts with professors and clinical supervisors. Deep unconscious conflicts can prevent you from completing your personal psychotherapy. Intense anxiety or personal insecurity can prevent you from passing the licensing exams. And so on. Thus, unlike a medical disqualification in aviation, “disqualification” in psychology usually results from self-disqualification because of the effects of the disorder, not from the mere fact of the disorder itself.

Nevertheless, in California, the Business and Professions Code (Section 2960.5) does say that “The board may refuse to issue any registration or license whenever it appears that an applicant may be unable to practice his or her profession safely due to mental illness or chemical dependency.”

And, once you do get your license, you have to be careful that your emotional state does not interfere with your ability to practice competently. Someone with recurring depression or mania, for example, has to be very careful to suspend his or her practice if symptoms become serious enough to adversely affect clinical judgment. If you make any grave blunders in this regard, and if your licensing board finds out about it, then your license can be suspended or revoked.


Will a very old felony DUI matter in [my state’s] licensing process? I don’t want to put in great time, monies and effort to discover this later.

You should ask the Board of Psychology in your state about its regulations; everything varies state-by-state.

In California, the Business and Professions Code (Section 480.a.1) says that a board may deny a license regulated by the code (and that includes the psychologist license) on the grounds that the applicant has been convicted of a crime.

However, the code also states the following (480.b):

Notwithstanding any other provision of this code, no person shall be denied a license solely on the basis that he has been convicted of a felony if he has obtained a certificate of rehabilitation under Section 4852.01 and following of the Penal Code or that he has been convicted of a misdemeanor if he has met all applicable requirements of the criteria of rehabilitation developed by the board to evaluate the rehabilitation of a person when considering the denial of a license under subdivision (a) of Section 482.


So, at least in California, conviction of a crime does not necessarily disqualify someone from licensure as a psychologist. It all depends on the circumstances. And only the Board of Psychology can determine how it will act in any particular case.

Can a school’s accreditation have any affect on my becoming a psychologist?

Your school’s accreditation may have an effect on your ability to receive a state psychologist license, and getting a license is a key part of becoming a psychologist. Problems can occur in either of two ways.

Accreditation can become an issue for you (a) if you receive your degree in one state and then move to another state to take the licensing exams, or (b) if, after having received your state psychologist license, you move to another state and ask to be licensed there. If your school, at the time you attended it, was nationally accredited by the American Psychological Association (APA), then you shouldn’t have any problems. But if your school had only a regional accreditation, then the board of psychology in the state to which you move may declare that your academic training was deficient by its standards, and you would therefore have to retake some courses, or take additional courses, or receive additional training, that fulfill(s) the state’s requirements for a psychologist license.

In California there are also schools called Unaccredited California Approved Schools. These schools, which have neither a national nor a regional (WASC [Western Association of Schools and Colleges]) accreditation, have been “approved” by the California Bureau for Private Postsecondary and Vocational Education (BPPVE). Although the California Board of Psychology can grant a psychologist license to a graduate from such a school, other restrictions could occur. State law mandates the following disclosure statement to all applicants to such schools:

“Prospective students should be aware that as a graduate of an unaccredited school of psychology you may face restrictions that could include difficulty in obtaining a teaching job or appointment at an accredited college or university. It may also be difficult to work as a psychologist for some federal government or other public agencies, or to be appointed to the medical staff of a hospital. Some major managed care organizations, insurance companies, or preferred provider organizations may not reimburse individuals whose degrees are from unaccredited schools. Graduates of unaccredited schools may also face limitations in their abilities to be listed in the National Register of Health Service Providers or to hold memberships in other major organizations of psychologists.”

I have a degree from another country. How can I become a psychologist in the US?

Everything depends on the laws in the state to which you intend to move. The board of psychology in that state will have to examine your credentials. It may or may not recognize your degree or any license you already have. It may require you to take the psychology licensing exams, and it could also determine that you need to take additional courses or receive additional training before you can sit for the exams.

Therefore, all you can do is contact the board of psychology of that state and ask for guidance. Here’s a link that will allow you to find any of the state or provincial boards in the US and Canada: Association of State and Provincial Psychology Boards.

Recently I have been told that if I want to go into practice all I need is a MA because of insurance and HMO restrictions on patients being reimbursed for visits to psychotherapists with a PhD. Does the same apply for PsyD holders? While I want to achieve the highest degree in the field that trains me to become the best possible Psychotherapist I can be, I also know that PsyD programs are very expensive. Is it worth it financially to go for the PsyD over the MA? Will I make more money overall with the PsyD cancelling out the extra money it takes to get through three more years of school?

If your primary interest is money, then become a plumber. Haven’t you ever heard the joke about the man who writes out a check to his plumber and says, “Good heavens, you charge more than my doctor.” The plumber responds, “Yes, I know. I used to be a doctor.”

Now, in all seriousness, your question gets to the fact that in many managed-care systems the reimbursement is about the same for masters level practitioners as doctoral level practitioners. So, in such circumstances, what is the point of getting a doctorate, whether it be a PhD or a PsyD?

Well, there isn’t any way to answer that question without offending somebody. So, I will just tell a story (a true story, mind you) and let people take offense as they will.

A man was attending a public event. The man sitting next to him suddenly caught his attention and said, “I have been biting my tongue, but I just have to tell you. How long have you had that blemish on your face? You should get it looked at, because it’s skin cancer. It’s benign, but you should have it removed.” The man who spoke up, of course, was a dermatologist.

So, our friend went to his managed-care medical office. The masters level physician’s assistant who examined him looked at the blemish and said, “It looks like a mole to me. Nothing to worry about.” Our friend, however, insisted that he be seen by a dermatologist. So, eventually a dermatologist came into the room. He looked at the blemish. “Yup, skin cancer. It’s benign. When shall we take it out?”

Now, physician’s assistants can make a lot of money. So is it really worth while to take on the educational expense of becoming a doctor? Does this story have any relevance to psychology? You decide.

I have been working in [my] field for 7 years now, and I am 25 years old. My question is would it be worth it to change fields at my age and go into child psychology? I am not worried about the money. I am worried about the age thing though. It is something I would really like to consider, and I am also aware that there are many people a lot younger than me getting into the psychology field. I am just wondering if you think waiting this long to go to school for a new field is a good idea? My heart says just do it, but the fear of failing, when I already have a steady career, seeps through. One other thing what do you think the oldest age to get into the psychology field should be?

I began my career change into psychology in my early thirties, so 25 is still young. In fact, students with some serious life experience make better and more mature students. So you needn’t hesitate about your age.

Assuming that you already have a bachelor’s degree, the education for a doctorate in psychology will take about 5 years, and it will take about two more years after that to complete your post-doctoral training hours and study for—and pass—the licensure exams. Therefore I would say that the oldest age to get into the psychology field would be about 7 or 8 years before you die.

I am planning towards doing graduate studies by distance learning (via the internet) with a U.S.A. university. Will this provide me with as recognizable a training as if I were attending the university as a resident student?

Your first concern should be about the school’s accreditation. See the question above for more information about this.

Aside from accreditation, in psychology, unless you intend to pursue an academic career in teaching or research, the general prestige of the school you attend isn’t necessarily all that important. The critical issue, then, isn’t simply in getting a degree, it’s in whether the classes you take are acceptable to the agency that will issue a license to practice clinically. In the US, the Board of Psychology of each individual state makes that decision in regard to the psychologist license, and if it finds that any aspect of your education is not up to its standards, then it will not allow you to sit for the licensing exams. Before you commit to any degree program, then, you should have some idea of where you would like to practice clinically, and you should then contact the appropriate licensing agency to determine its policy about distance learning courses. Do this now just to avoid any problems later. Some Internet companies will do anything—even lie—to get your money.

For example, a large part of clinical training involves supervised clinical experience, so be sure that any program you attend makes provision for that training—and make sure that such training will meet the requirements of the licensing board in the state in which you intend to practice.

In general, it is important to understand that even though training in psychology does require considerable intellectual skills, the clinical work itself is far more than an intellectual process. It demands a profound emotional connection between two people, and it’s impossible to acquire this training from a textbook alone.

Can you recommend any schools in [my area]?

No. That’s really a matter for your own research.

I am certain that I assist people with their problems for self-satisfaction and this is the real reason why I’d like to study psychology; later finding a profession where I am able to help people all day, thus satisfying my needs. Is this a wrong reason to get into your field (i.e., does this become an issue when I make this my living)? I understand we all have selfish reasons for all that we do, but is this what motivates you and others in your field or is there something I seem to be missing?

Yes, we all have to look after ourselves to a basic extent. If no one is going to give us shelter and food, then we have to earn the money to provide these things for ourselves. So, if you have to work for a living, you may as well do something you enjoy.

The practice of psychology, however, does put a twist on all this. A psychotherapist must work very intimately with the unconscious desires of another person, and it can be very easy for the psychotherapist’s personal desires to contaminate the desires of the client. That’s why the great psychoanalyst Jacques Lacan taught that the analyst’s only desire should be to help the client get close to his or her own unconscious and should ask nothing of the client but fair payment for a job well done.

The prerequisite for such intense work is personal psychotherapy—the more intense the psychotherapy, the better—so as to become familiar with your own personal unconscious issues. Most “bad therapists” are caught up in their own pride and ego because they are blind to them, and they do considerable damage to their clients as a result.

Therefore, if you believe you have a gift for psychology, then pursue it and let your own personal psychotherapy show you if you really have what it takes. If you can face your own inner darkness and grow from it, and can tolerate what is missing in life by not trying to use perversions to hide from yourself, then blessings to you.

I was wondering if a career in psychology allows one to pay back student loans and lead a comfortable living?

The answer to your question is simple, but not very satisfying: “It depends.” That is, if you take a position in a university or hospital or government agency, your career will be like any other career in its ability to pay off loan debts. If you choose a career in private practice, however, finances can be extremely unpredictable, because in a private practice you will be self-employed. If you have a good sense of business and marketing, you might do very well. You will, of course, have to struggle with competition from all the other mental health providers in your area, and you will have to contend with meager compensation from managed-care insurance companies. So remember that, as in any self-employed field, everything will depend on your own motivation and integrity.

Is it hard to live up to the example of being a good psychotherapist? I read about so many abuses. How do I know I won’t end up doing that same sort of thing?

The answer to your question is simple, and very satisfying: “Personal psychotherapy.” The more rigorous and the more intense your personal training psychotherapy is, the better you will be as a psychotherapist. You get what you pay for—and so will your clients.

Can a high school dropout become a Psychologist? If so, could you please tell me what are some of the things that I could do to obtain this. My love of human behavior as always been profound, but I never knew how to get myself motivated. Now that I have reached the age of 19, I feel it is my time.

Let’s look at it backwards. To get into a graduate school to get your Ph.D. or Psy.D., you first have to have an undergraduate degree and good undergraduate grades. But to get into an undergraduate program, you have to have a high school degree with good grades. So, if you don’t have a high school degree now, you can get your GED. Then, if you can’t get directly into an undergraduate program, you can at least get into a junior college to prove yourself with an AS degree. With good grades there, you can transfer to a BA or BS program. Once you get into an undergraduate program and demonstrate good grades, it won’t matter if you had to get a GED because you dropped out of high school years ago. In fact, it can even be a plus for you to demonstrate good college performance in spite of having dropped out of high school. It will show your profound dedication. And that will help you get into a graduate program.

I am currently a . . . PhD student in social psychology. . . . in [an] applied-only (i.e., no clinical) program. . . . I have my eye on an academic career but have begun to toy with the idea of possibly looking into a private practice/counseling operation somewhere down the line. To my knowledge, [my school] is not accredited by the American Psychological Association, not to mention my program is heavily research oriented. My question is this: would it be possible, if I really decided to pursue the matter, to become a certified counselor with a non-clinical PhD (from an non-APA accredited school)? It would seem the cards are stacked against me. I have heard that through supplementary clinical courses some psychologists with non-clinical PhDs do manage to get certified by state boards. It sounds difficult, but I am curious as to how one might proceed. . . .

The only way to proceed is to look carefully at the laws of the state in which you intend to practice.

For example, California does not have “certified counselors.” Your three options in CA would be (a) an LCSW (Licensed Clinical Social Worker) which requires a master’s degree in Social Work along with a specified number of hours of supervised clinical training; (b) an MFT (Marriage and Family Counselor) which requires a master’s degree in Clinical Psychology along with a specified number of hours of supervised clinical training; and (c) a Psychologist license, which requires a doctoral degree in Clinical Psychology or Counseling Psychology or Educational Psychology along with a specified number of hours of supervised clinical training.

To practice clinically in CA, therefore, even if you had a doctoral degree in Social Psychology, you would have to get at least an MA in Clinical Psychology or Social Work, you would have to accrue the required hours of supervised training, and you would have to pass the licensing exam. (Some graduate schools offer advanced-standing entry for students who already have graduate degrees in related areas.)

Keep in mind also that, when you apply to sit for a licensing exam, courses from an out-of-state non-accredited school can be rejected by a licensing board, and you will have to retake those courses from an accredited school before the board will let you sit for the exam.

So, check the laws, contact the respective licensing boards for each type of license, and proceed from there.


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Beoming a Nonsmoker

Many individuals become nonsmokers every day without professional help and with only the desire to achieve their goal of finding freedom from an overpowering—and, at its psychological core, self-destructive—habit. For, despite the glamor attributed to it by the tobacco and advertising industries, smoking does nothing to enhance life and everything to pollute and defile it.

As you set out to become a nonsmoker, you will discover two things: smoking involves an addiction to nicotine, and it involves a pattern of habitual behaviors.

1.

For some individuals, the nicotine addiction can be overcome simply through “will power,” while for other individuals nicotine patches or nicotine gum may be of help.

The nicotine addiction actually uses a deceptively simple, yet lethal, “trick.” Most persons start smoking during a stage of identity formation or crisis in which they feel psychologically empty within themselves and want some way to make themselves feel accepted by the world around them. For example, adolescents who have seen adults smoking will believe that if they start smoking then they, too, will appear powerful and glamorous.

But once the nicotine gets into your body, it enslaves you to a continuous need for it. Like a deadly parasite, nicotine takes over your body so that you value this deadly chemical more than anything else in life, more even than life itself. So there you are, helpless and cowering in a cold doorway, damp with rain, desperately sucking the illusion of life out of a reeking cigarette. And all the while you’re thinking to yourself, in your bleak emptiness, “This is life?”

2.

Overcoming habitual behaviors involves deliberate, repeated attempts to break old patterns—patterns that make cigarettes seem like “old friends” whose absence causes life to feel flat and empty.

There can be many reasons, some completely outside your awareness, that keep you hanging on to those old enemies in friends’ clothing. Some individuals, for example, have such a profound unconscious sense of despair and self-loathing that smoking aptly serves a dark wish for self-destruction. In the face of difficulties like these, psychological help may be needed.


And remember—many persons who successfully become nonsmokers will have had at least one setback, because “just one puff” easily rekindles old patterns.


Reasons For Becoming A Nonsmoker

Ask yourself why you want to quit smoking. Write down your five most important reasons on an index card. Review these reasons several times a day, especially when you’re tempted to reach for a cigarette. In fact, tape a card to your cigarette pack. Below are some suggestions:

•

It will reduce my chances of getting lung cancer.
•

It will reduce my chances of developing heart trouble.
•

It will help to remedy my heart trouble.
•

It will reduce my chances of developing circulatory problems.
•

It will help to remedy my circulatory problems.
•

It will reduce my chances of developing emphysema.
•

It will help to remedy my emphysema.
•

It will increase my immune response to colds, flu, and other diseases.
•

I’ll be a more productive worker or athlete.
•

It will help me cut down on drinking.
•

I will be setting a good example for children.
•

I will breathe more easily and won’t have morning cough or phlegm.
•

My senses of smell and taste will improve.
•

It will help lower my blood pressure.
•

I will have more energy.
•

I will feel more liberated and self-assured.
•

I will feel more in command of my life.
•

I will be part of an increasingly nonsmoking society.
•

Environmental Tobacco Smoke (ETS) can damage my unborn baby and increase the risk of spontaneous abortion (miscarriage).
•

Environmental Tobacco Smoke (ETS) can damage the health of my children.




Have you ever heard someone say, “My wife wants me to stop smoking. Even my four year old daughter wants me to stop smoking. I really love them, but I just can’t quit”? Well, as hard as it sounds, this man is really choosing to set his own pleasure above the health of his family. So ask yourself: What kind of love is this? Where is the “love” in an unconscious wish to destroy himself and his family?



Preparing for Quit Day

It can help greatly to plan deliberately for a “Quit Day,” whether several weeks or only a few days away. This planning will prepare you psychologically to break old habits, and it will make smoking more focused and more difficult until the Quit Day arrives. Here are some suggestions:

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Repeat to yourself, several times a day, your reasons for wanting to become a nonsmoker.
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Don’t do anything else when you smoke except focus on the sensations of smoking.
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When you feel the urge to smoke, delay lighting up so as to focus your mind on what you are trying to accomplish.
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Keep a record of every cigarette you smoke, and review it daily.
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Change to brands that have less nicotine.
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Smoke fewer cigarettes.
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Smoke less of each cigarette.
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Inhale fewer puffs of each cigarette.
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Cut back on the coffee you drink.
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Refuse any cigarettes offered to you.
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Allow your ashtrays to fill up without emptying them.
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Stop carrying matches and lighters.
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When you can, avoid situations that trigger your urge to smoke.
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Brush your teeth after every meal and notice how “fresh breath” feels.
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Start exercising regularly.
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Let people know that you will be quitting smoking.
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Enjoy picturing yourself mentally as a nonsmoker.
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Mentally imagine the “rewards” you will receive by being a nonsmoker.




How often were you criticized and humiliated as a child by your parents? How often did you then condemn yourself for being worthless and inadequate? And how often do you reach for a cigarette out of unconscious anger as a secret wish to carry out that condemnation?

Coping With Withdrawal Symptoms

Smoking withdrawal symptoms include: cravings; tension, anxiety, irritability, and restlessness; numbness in arms and legs; dizziness; coughing; and hunger.

Some symptoms are related specifically to nicotine withdrawal, while other symptoms are the result of your body returning to a healthy state and recovering from your habitual abuse of toxic cigarette smoke. If you stop smoking by using nicotine patches or nicotine gum, you may not experience all the symptoms described.

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You can stop a craving by focusing your attention on something else. Cravings usually last for only a couple minutes, so an attention diversion need only be immediate and consistent, not complicated.
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Muscle tension, anxiety, irritability, and restlessness can be reduced by using a variety of relaxation techniques such as Progressive Muscle Relaxation or Autogenics.
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You may feel tingling sensations or numbness in your arms and legs. These sensations usually indicate improved circulation taking place as a result of your body experiencing freedom from the poisons in tobacco smoke.
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You may at times feel dizzy or lightheaded. These sensations usually mean that more oxygen is getting into your brain now that the carbon monoxide associated with smoking is no longer present.
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Some people find themselves coughing more after quitting smoking than before. The reason for this is that the cilia that line the lungs are working to clean out all the tars and other debris in your lungs.
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Increased hunger is a common withdrawal symptom. To avoid weight gain, it is important to exercise regularly, drink lots of water, and have plenty of low-fat foods available for snacks and meals.


Visualization Technique

In general, changing unwanted behavior involves three basic steps:
1.

You must know how ugly the behavior is and how much damage it causes to yourself and to others.
2.

You must regret the damage caused by the behavior.
3.

You must know the benefits of new and different behavior.

It isn’t sufficient, however, that you “know” these things intellectually; you must know them by feeling them in the depths of your heart.

So here’s how to do it.

Practice the following procedure at least twice a day until you no longer need it:

First, enter a state of relaxation. This is important because the next two steps (if done properly) will arouse considerable anxiety, and you need to be able to reduce that anxiety again. You may use any form of relaxation you prefer, such as Progressive Muscle Relaxation. If you have no prior practice with relaxation techniques, try this simple breathing exercise:


Begin a process of deep breathing, exhaling to a mental count that is twice as long as you inhale. With each breath cycle, increase the duration. For instance, inhale counting, “One,” exhale counting, “One, Two.” Inhale counting, “One, Two;” exhale counting, “One, Two, Three, Four.” Go up the scale to six counts in, twelve counts out. Then reverse: six counts in, twelve counts out; five counts in, ten counts out; and so on, down to one count in, two counts out.


Second, create a negative mood state in which you visualize the harmful and disgusting effects of the unwanted behavior. For example, smell the stench of the smoke on your clothes and body; see the stains on your fingers and teeth; notice your shortness of breath and coughing; visualize the poisons coating your lungs and other internal organs. Then relax.

Third, contemplate how miserable and wretched your life will be if you do not change your behavior. For example, see yourself wheezing for breath and dying of cancer. Imagine your children suffering from their own addictions because of your negative influence. Then relax.

Fourth, create a positive mood state in which you visualize the beneficial effects of new, healthy behavior, all the while your anxiety from the previous step begins to dissolve. For example, see yourself as calm and confident as a non-smoker, relaxed and able to concentrate, free of frustration and tension, a positive influence on others. Relax.

Fifth, reinforce your positive mood with positive statements of validation. Repeat them several times. Create your own, or select from the following examples.
• I have no need for cigarettes. I am no longer a slave to an addiction. I have no need for cigarettes.
• When grounded in quiet relaxation, I can work calmly and confidently. My mind will not wander. My self-confidence will not be bothered by small mistakes.
• I approach all tasks with a calm focus on the matter at hand. I do not lose my concentration by distractions. I act with discipline and resolve.
• I respect my own body. I can present myself to others with respect and dignity. I will listen to and respect others.
• I can remain calm, relaxed, and composed in any situation.
• My calmness and patience can result in compassion and understanding. I can get along well with anyone. I will return kindness to any insult.
• My experience of peace and calm is not threatened by anything outside myself. I have no need for rivals or jealousy. I wish peace and good to all persons.
• There are no “good” days or “bad” days. I can do what needs to be done at all times. I uphold my promises and value my word.

Sixth, conclude with a simple closure to the relaxation session. Take a few deep breaths and affirm that “I feel supremely calm.”

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Spirituality and psychology

In his masterful play, Man and Superman, George Bernard Shaw turned the classical images of heaven and hell upside down. He described hell as a place of complete satisfaction, where all desires are freely fulfilled. Personal responsibility had no place in hell. It did in heaven, though, a place for the “masters of reality,” and curiously enough the place where souls were free to go when they finally got sick of hell.

This is a provocative metaphor, though, being a metaphor, it is not to be taken literally in a metaphysical sense. But it is a good metaphor for how we live our life in this world. It is also a metaphor that I can’t help but agree with, for through my daily life in San Francisco I am constantly reminded that there has to be more to life than hedonism and exhibitionism.



This concept of “a hell that you can leave when you get sick of it” aptly describes psychological change as well. Many people cling to their own psychological “hell,” no matter how painful it may be, because the discipline of health is even more fearful. But eventually, if they catch only a glimpse of sorrow for the mess they’re in, they can get sick of it all and decide to cross over to “reality.”


Therefore, though an atheist, not a theologian, Shaw nevertheless made a brilliant discovery: a spiritual life is also a practical life. Yet such practicality does not depend on knowledge so much as understanding.

Too many persons today, however, concern themselves with knowledge, whether it be intellectual or carnal, and in doing so they sidestep the concept of understanding. Why? Because understanding involves “standing under something,” and that something is the law. Not the Law of the Old Testament, and not the local penal code either. It’s the law of lack and limitation, the agony of being itself, as it stands on the brink of redemption through divine love. All the pages of knowledge flap uselessly in the swirling gusts that blow along that ridge.



Every child born into this world is born into a pre-existing social world of language, science, technology, art, literature, and so on. But even more profound than the mystery of the sum total of all this factual information is the mystery of the child’s own body. The child finds itself literally at the mercy of biological processes—eating, vomiting, defecation, urination, bleeding, sexuality, and death—that it can neither control nor comprehend. And so the child will feel—rightly so—that the world “knows” something that he or she does not know. Right from the beginning, then, the child is located in a profound emotional space of “not knowing.”

It’s an awkward and uncomfortable place to be. And so we all devote considerable energy to overcoming the feeling of “not knowing.” We might seek out intellectual knowledge through formal education. We might engage in scientific research. We might join country clubs, gangs, cults, cliques, or any other social organization that purports to offer some secret “knowledge.” We might seek out “carnal knowledge” through the body of another person and attempt to locate the psychological agony of our bodily mystery in the pleasure—or pain—of the other. Or we might create our own fantasy worlds—with thoughts and images of sexuality, heroism, revenge, or destruction—in which we can “figure it out” on our own so as to possess the knowledge and recognition we so desperately crave.

Nevertheless, all the “knowledge” in the world is nothing but a thin veil that hangs over the dark anguish of “not knowing.” Standing before the veil, knowing the secret truth of our “not knowing,” we feel confused, disgusted, weak, and useless.


Subject to such a law of lack and limitation, we have only one hope: to understand the soul.

Psychologically speaking, soul, to paraphrase the brilliant French psychoanalyst Jacques Lacan,[1] is something—alien to the mundane—that empowers us to bear what is intolerable and lacking in the human world.[2]

In this modern world, though, much of our society has lost its sense of soul. In the desire for diversity it’s all too easy to misunderstand life by confusing acceptance with tolerance, paganism with divinity, idolatry with holiness, and vanity with love.

And with the loss of soul many of us today have also discarded the concept of sin—that is, that functional narcissism in all of us which serves the self, rather than others. So, instead of making life’s decisions according to personal responsibility, we make decisions according to personal convenience. Anything today seems to be acceptable if it makes life look easier. And yet sin—in its psychological sense—is what blinds us to the realization that there’s more to see in life than what the world shows us. As such, sin pulls us away from the love of God. Sin may be convenient, but it’s just not practical.



Saint Augustine said that “Sin is the punishment of sin.” This makes perfect sense if you understand that the human world is nothing but a mass of psychological defenses—pride, anger, competition, social status, take your pick—which protect us in our blindness, the blindness that results from an ignorance of soul. All defenses originate in childhood as ways to assist survival, but carried on unconsciously into adulthood those same defenses—the ones that once protected us—lead us into nothing but the repeated punishment of psychological and social dysfunction.

Don’t misunderstand this. We are all basically good. But goodness takes work—lots of work. Hard work. And self-denial. For without our denying the pride of self and its defenses, true love, the most exquisite and pure love imaginable, remains invisible. Along the path of least resistance—the path of sin, the easy way, the way to hell—love is nowhere to be seen, for it remains banished behind the thorny hedges of psychological defenses.

And what is true love, if not to give of yourself to save others—even those who hate you— from their blindness?


So hell, too, the place where responsibility and discrimination are absent, is its own punishment. It is startling to realize that the two most powerful diseases of the modern age—cancer (unrestrained reproduction of certain cells) and AIDS (indiscriminate destruction of the body by its own immune system)—should be such potent metaphors: our social “dis-ease” is that of irresponsible growth and a lack of discrimination.

Although most cases of AIDS and some forms of cancer are directly related to personal behavior, when someone gets cancer or AIDS we are all responsible. The tragedy here is that culture has the capability of “infecting” its individual members with defensive ideals that have lost any sense of meaningful direction.

And so we, as individuals, would do well to pay attention to sin today while remembering that crossing the barrier between sin and spirituality is a simple matter of personal choice, with complete freedom to go in either direction. Psychology, at least in the U.S., has too often been preoccupied with the pursuit of happiness,[3] and it has missed the point about helping individuals understand life and find a personally meaningful—and practical—sense of direction. Psychology in itself, of course, cannot offer any meaning to life,[4] but it can help individuals disentangle themselves from the snare of illusory social identifications that keep us trapped in blindness and pull us backwards into self-destruction.

I can offer no proof of God, nor can I prove that souls exist or that spirituality is anything more than a figment of our imaginations. But look at it this way: If you value spirituality, what do you have to lose? Mediocrity. What do you have to gain? Everything. But the proof of love is simple:


Additional Resources

Notes:

1. Jacques Lacan, “A Love Letter.” In Mitchell, J. & Rose, J. (Eds.), Feminine Sexuality: Jacques Lacan and the école freudienne. (New York: W. W. Norton [paperback], 1985). See p. 155:
“And yet I fail to see why the fact of having a soul should be a scandal for thought—were it true. If it were true, the soul could only be spoken as whatever enables a being . . . to bear what is intolerable in its world, which presumes this soul to be alien to that world. . . .”

2. Please note that the psychological meaning of “soul” is one thing, whereas the theological meaning (and welfare) of the soul is a matter for religion, which can be a transcendent step above spirituality. That is, some spirituality, in its aspiration for a “oneness” with the universe, often inadvertently becomes a oneness with sin as well. Religion, if its spirituality seeks a moral responsibility to the divine, can transcend moral relativism. Sadly, though, some individuals make their religious practices into mere intellectualism lacking in spirituality.

3. Jacques Lacan, “The signification of the phallus.” In Écrits: A selection, trans. Alan Sheridan (New York: W. W. Norton, 1977). See p. 287:
“In any case, man cannot aim at being whole (the ‘total personality’ is another of the deviant premises of modern psychotherapy), while ever the play of displacement and condensation to which he is doomed in the exercise of his functions marks his relation as as subject to the signifier.”

4. Lacan, at least, did not attempt to subvert religion like Freud, nor did he try to “psychologize” religion like Jung and Rank. Lacan simply respected the fact that psychoanalysis could say nothing meaningful about religion. See “The subversion of the subject and the dialectic of desire in the Freudian unconscious.” In Écrits: A selection (Alan Sheridan, Trans.). New York: W. W. Norton, 1977, p. 316:
“We [psychoanalysts] are answerable to no ultimate truth; we are neither for nor against any particular religion.”

5. I found this quote in The Ascent of Mount Carmel by Saint John of the Cross, Book Two, Chapter 17, no. 5. (The English translation is my own.) Saint John refers to it as “a frequently quoted spiritual axiom.” Saint Bonaventure, in his Commentaria in Quatuor Libros Sententiarum attributes the quote to Pope Saint Gregory the Great (see Opera Omnia S. Bonaventurae, Ad Claras Aquas, 1882, Vol. 1, p. 254), though the quote may actually have its origin in a letter (Epistle 111) by Saint Bernard of Clairvaux.


Lacan:
Lacan Related Papers provides links to numerous Lacan-related papers.
The Lacanian School of Psychoanalysis in the San Francisco Bay area, offers training in Lacanian psychoanalysis.
The San Francisco Society for Lacanian Studies provides lectures and information about Lacanian psychoanalysis.

St. John of the Cross:
JUAN DE LA CRUZ
The Collected Works of St. John of the Cross

Miscellaneous:
Agnosticism, Atheism, Humanism, & Secularism
Chastity – In San Francisco? — psychological healing and spiritual direction in the Roman Catholic mystic tradition.
Institute for the Psychological Sciences — offers graduate training in clinical psychology that is grounded in spiritual values.
Miscellaneous Theology and Spirituality Topical Index Page — includes topics on Angels and Demons (e.g., Angels, Demons, and Evil); Anthropology (e.g., Soul, and Sin); Eschatology (e.g., Heaven, and Hell)
Moral Theology — includes topics on Morality, Absolutes, and Relativism; Ethical Issues; and The Good and Virtuous Life.
The Psychology of Atheism — offers some interesting psychology (but leads to no real answers).


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