The Professionalization of the Clinical Psychologists in Taiwan: A Comparative Method

Abstract

The objective of this research is to analyze the professionalization of the clinical psychologists in Taiwan. Four research methods were used: secondary data collection; in-depth interviews of ten clinical psychologists who played important roles in the professionalization of the clinical psychologists in Taiwan; participant observation of the professional activities and meetings of clinical psychologists; and a cross-national comparative method. The professionalization of the clinical psychologists in Taiwan was analyzed and compared with that of those in the u.s. From four aspects: clinical psychologists` workplace, work content, educational training, and professional jurisdiction.This research showed that clinical psychologists in Taiwan are profesionalized under the shadow of psychiatry. They have close relationships with psychiatrists throughout the process of their professionalization. The majority of them work as part of the psychiatric team whose leader is a psychiatrist. Their major clients are patients with psychiatric disorders. In a great contrast, the clients of clinical psychologists in the u.s. Were the students with learning disability at the very beginning of the development of the clinical psychology as a profession. Throughout the history of the professionalization of clinical psychologists in the U.S., the profession`s jurisdiction has been expanding, covering the behavior problems of adolescents, psychological testing, the psychological problems of soldiers, the psychiatric disorders, psychological consultation in industries, community mental health, and health psychology.The clinical psychologists in the U.S. own a much wider jurisdiction than those in Taiwan. They are almost equals to psychiatrists in their levels of status and power. In a great contrast, most clinical psychologists in Taiwan work in the arena of psychiatry. The first founder of clinical psychologists is a psychiatrist and from then on, the core of professional development of clinical psychologists in Taiwan has been embedded in the field of psychiatry. Furthermore, the government and health insurance policy-makers in Taiwan consider the clinical psychologist as merely a member of the psychiatric team without his/her own professional identity. Conversely, the profession of clinical psychology in the U.S. is based on a well-developed foundation of psychological knowledge. The general public recognizes the importance of clinical psychology. The government provided great support to the profession and the health insurance plan offers coverage of the services provided by clinical psychologists.The research of the professionalization of clinical psychologists is important because the issue of professionalization is an important aspect of social science, and the clinical psychologist is an important member in the provision of mental health services. Based on the theory of professionalization and using qualitative research methods, this research analyzed the unique professionalization of clinical psychologists in Taiwan and compared to that of those in the u.s. On the basis of the major findings of this research, some suggestions for policy-making and further research were made.

專業化理論是社會學研究當中一個很重要的課題，但在臺灣，有關醫療專業的專業化研究很少，且多缺乏理論基礎，其中，臨床心理師在臺灣專業化發展的歷史也尚無完整分析。故本研究在建構臺灣臨床心理師專業發展過程，並嘗試結合專業化理論來進行分析。主要的研究方法有四：(一)文獻以及二手資料蒐集及分析的方法，(二)深入訪談的方法，訪問專業化過程中較具影響力及具代表性的臨床心理師，(三)參與觀察的方法，研究者加入代表臺灣臨床心理師的專業團體—中國心理學會臨床心理學組—並參與各項會議，觀察臺灣臨床心理專業內部的發展情況；及(四)比較分析的方法，透過以上四種研究方法，建構出臺灣臨床心理師的工作場所、工作內容、教育訓練與專業力量的演變情形，及臨床心理師本身對臺灣臨床心理師專業發展過程的看法，並將臺灣臨床心理師專業發展過程和美國臨床心理師專業發展過程做一比較分析，同時以理論分析專業發展過程中，臨床心理師和精神科醫師間的互動情形。故本研究以質性的研究方法為主，描述性的量性資料為輔。研究結果顯示，從工作場所、工作內容、教育訓練、專業力量等來看，臺灣臨床心理師的專業化發展和精神科醫學之間有密切相關，且一直侷限於精神醫學範疇之內，即臺灣臨床心理師的主要服務對象為有精神疾病的病人，並在以精神科醫師為領導的團隊內工作；而美國臨床心理師的專業化發展，由早期青少年兒童的學習障礙與行為問題，到心理測驗的實施，戰爭相關的心理困擾和精神疾病的治療，而至晚近的工商諮詢、社區心理衛生、健康心理學等，發展出多樣化的內容，服務對象除有精神疾病者(這些病人即是精神醫學psychiatry的服務對象)外，也包括大量無精神疾病但有心理困擾者。整體而言，臺灣的臨床心理師受到精神醫療的影響十分深遠，而臨床心理師的專業地位較精神科醫師的專業地位來得低，但美國臨床心理師相對於精神科醫師來說，是一個地位平等，工作與經濟獨立的專業。造成這個現象的原因除了在於臺灣臨床心理師最初的工作是由精神科醫師所創設出來的之外，臺灣臨床心理師長久以來將其專業定位在精神醫學範疇之內也是重要原因之一，此外，政府與健康保險體系等外部力量也將臺灣臨床心理師視為精神醫療的一份子，而且心理學並未能被臺灣大眾所廣為接受。相對於此，美國臨床心理師在專業發展過程中則有深厚且不斷創新的心理學基礎知識做為支持，而且社會大眾對於心理學也有高度的認同，政府提供穩定的助力，健康保險體系則提穩定且獨立的經濟支持，這些都使得美國臨床心理師的專業力量十分強大而有助專業的持續開展。身為在現代社會中日漸重要的心理衛生工作的一員，臺灣臨床心理師未來的專業發展將對國民心理健康有重要的影響，而本研究以專業化理論與及比較分析的方法來說明臺灣臨床心理師獨特的專業化經驗，希望對臺灣臨床心理師未來專業化的方向提出一些參考與建議。