Cue the scene.
A person leaves the house one morning for their appointment at a mental health clinic. It is a regular day, like any other. This morning is an early one, though, too early for their liking, so they stop at a store for coffee along the way. Adorning the front of the store is a sign that says âWelcome.â The ownerâs eyes, however, say something else. As our traveler walks through the store, the ownerâs eyes suspiciously follow. The traveler, feeling that awful feeling of being monitored, soon makes their purchase and leaves the store. Upon exiting, their leg pain, dull and nagging, begins acting up again. They sit on the sidewalk for a breather. Before taking a few breaths, the security guard near the store suddenly approaches and asks, âAre you supposed to be here?â Rest time abruptly ends. âMove along please.â
Moving along, on their way to the appointment, the traveler accidentally takes a wrong turn and ends up in a neighborhood rather than the clinic site. A resident from one of the houses emerges on their way to their car, sees our traveler, and stops cold. Fumbling for words, the resident eventually asks: âAre you lost?â But our traveler knows from experience, from the countless times when nothing good came out of wrong turns, that the question is actually an imperative: Get lost; you donât belong here. It is a regular day, like any other. The traveler finally enters the mental health clinic. As they await their appointment, the waiting room TV is reporting news of a violent hate crimeâand the victim, who was victimized because of the way they look, looks just like our very traveler.
The appointment time finally arrives. During the session, the clinical psychologist empathically attempts to help the traveler with the social anxiety they have been inexplicably facing for the last several years, where they can suddenly feel unsafe in everyday situations. In order to tackle this anxiety, the provider asks them to focus on their faulty cognitions, their interpersonal relationships, or their family history, and makes referrals for medication. The session ends. As the traveler leaves their appointment, they suddenly need to go to the bathroom. As they walk down the hallway, empty except for fading carpet, they are asked by an approaching staff member some questions, all-too-familiar, but no-less-distressing: âAre you supposed to be here? Are you lost?â It is a regular day, like any otherâbut not for everyone or for every color. In that sense, it is not a regular day, and is unlike many others. The burdens faced by the traveler, due to color of their skin, weighs heavily on each and every day, but is often invisible to the clinical gaze.
The question that emerges for us as a field of clinical psychology dedicated to the amelioration of suffering is: where all are we supposed to be? How can we make our work better for those like this traveler, whose world is itself socially anxious about, and unwelcoming toward, them, and is much the source of the problem as any other? This book attempts to explore these questions.
The Problem of Clinical Psychology âs Insularity
There seems to be something within the very notion of a âclinicalâ psychology that tends to discourage disciplinary engagement with the wider world. Within a clinicâs walls and doors, after all, the world outsideâwhere culture, history, society, and economy are foundâcan appear out of view. Unfortunately, what may also recede from view are the ways in which that surrounding world is structured to produce the very distress that clinics are seeing, and that communities are facing. That is, these worldly problems, while often concealed from the clinical gaze, inevitably gaze back. They affect us. They effect us. They are us. Thus, clinical psychology âs insularity may actually be limiting the discipline from realizing its full potential for understanding and effective healing in and of the world. While good work can and does occur within the clinical space, what else might we be missing? What other possibilities are out there? The present work offers one possible suggestion for exploring these questionsâventure outside the clinic.
Travel and Movement
The themes of travel and movement form the core of this book. Travel and movement , I argue, are antidotes to insularity, narrowness, and near-sightedness. They open one up to the world and to the diversity of life as found in everyday, community contexts. Travel and movement , I also argue, are central components of good clinical psychological science and practice in general, taken here as participating in the movement of life forward. However, the kind of movement I am alluding to is that which moves life forward in all of its domainsânot just the psychological, but also those worldly terrains to which the psychological, whether it likes it or not, is intimately connected. This sense of movement thus involves personal and social movement . Overall, the goal of the present work is to make a stronger connection between the day-to-day science and practice of clinical psychology and the suffering world around us. Fostering these connections, however, may require some important shifts in the ways we typically do things in the realms of science, methods, theory, and practice. That is, movement may be called for in the field itself.
In a previous work, I argued for travel as a research method in psychology (Desai, 2014). The current work builds on this theme and focuses on the field of clinical psychology in particular. Here, travel and movement âas both experience and metaphorâwill be suggested as ways to allow clinical psychology to better understand peopleâs lives in their communities, to more deeply perceive social structures, to help challenge the fieldâs theoretical and cultural presuppositions, to better engage diverse viewpoints, voices, and practices that often get marginalized, and to more directly partner with those groups fighting for social change. Given the bookâs focus on worldly change and movement , it aims to position social justice as a central component of clinical psychology . I acknowledge that this present work is itself not done in isolation but in solidarity with a growing number of voices within the field that seek to broaden the horizons of clinical psychology , and the mental health fields in general, beyond their traditional boundaries. A movement is growing.
One major task of this introduction will be presenting the case for why and how the world matters to clinical psychology and then assessing the limitations of clinical psychological science and practice when this connection is not made. We will see how the world, far from being an extracurricular concern, already infiltrates everything we do. We actually do not need to venture far afield to see as much.
Whatâs the World Got to Do with a Psychology of the Clinic?
The words âclinical psychology â often bring to mind a clinic, a couch, or a therapistâs office. Perhaps it brings to mind an individual, two individuals, or a group of individuals in discussion. But what about the world we see on the newsâeconomic devastation, environmental catastrophe, racial conflict, and so forth. Clinical psychology has typically sought to help people in their personal lives with their personal problems or âdisorders,â with the disordered world often taking second stage. However, the world, and the way we structure it, may be more central to clinical psychology than once thought, and may be a far more integral component of the issues that typical...