What is Rationalization?
Rationalization, as defined by sociologist George Ritzer, is the process by which society and business enterprises are streamlined to become as quick and as well-ordered as possible. Ritzer’s ideology of rationalization is broken into four key pillars: efficiency, predictability, calculability, and control. Efficiency is the process of determining and implementing the quickest and most effective means by which to do a task. Predictability is the idea that the recipient of the goods or services provided can expect them to be the same, irrespective of time or location. Calculability focuses on the quantitative aspects of both the product and the customers, and introducing mathematical statistics and reasoning to business decisions. Finally, control centers on the ability of the service providers to work as accurately and with as few errors as possible via the combination of human skill and non-human artificial technologies (Ritzer 2020).
Rationalization is the process of streamlining the provision of a service.
In his book, The McDonaldization of Society, Ritzer describes how the effects of rationalization are demonstrated and near-perfected in McDonald’s restaurants, the most popular fast food chain worldwide. He describes the means by which each of the four aforementioned pillars of rationalization are enacted in each McDonald’s location, from simplified menus, the concept of the drive-thru, and even the purposefully uncomfortable seats contribute to the streamlining of the experience.
Origins of Counseling Psychology
Beginning in the 1890s, famed psychologist Sigmund Freud was in the midst of major discourse regarding the direction in which psychological research should go. Debates between structuralist and functionalist psychologists were beginning to spawn new ideas and ideologies that began to lay the groundwork for the many fields of psychology that are known today. Freud was one of the more controversial voices in such discourse, with several colorful theories regarding the true desires of man. Perhaps most famous, however, was his theory and school of thought known as psychoanalysis. The focus of his psychoanalytic theory was on the unconscious brain. He alleged that man’s true desires, thoughts, memories, and needs could all be found in the unconscious of the human mind, and to uncover them was to reveal the true identity of a person. Because of this theory’s allegations of true identity lying in the unconscious, Freud then determined that his psychoanalytic theory could explain personality, motivations, and, perhaps most importantly to this piece, mental disorders.
Freud's theories gave a basis to the profession of counseling psychology.
Development of the Profession
From the early 1900s, counseling psychology and psychology as a whole began its periods of growth and development. During its early stages, counseling psychology began to grow as a combination of several existing ideas and theories, all based on the idea of helping the mentally afflicted. A significant catalyst during its development were the First and Second World Wars, as many soldiers required mental healthcare for PTSD following intense tours of duty. The American Psychological Association (APA) was also founded during this period, along with counseling psychology's specialized division in the organization. These steps gave legitimacy to the profession, and served as an additional basis upon which the profession could grow.
Counseling psychology continued to develop through the 1970s, as certain therapeutic strategies and schools of thought were developed and fine-tuned. Unfortunately, during this period, many stigmas around mental healthcare and those who receive it were reaffirmed. During the culturally charged era of the 1960s and '70s, negative stereotypes about receiving mental healthcare were solidified, inhibiting the growth of mental healthcare as an option in the public eye.
Managed Care: The First Steps Towards Rationalization
Beginning in the 1980s, managed care companies became a large part of the provision of mental healthcare. As healthcare overall became more consolidated and commodified with the rise of big insurance companies and medical groups, the mental health field followed suit. The concept of managed care is essentially Ritzer’s ideas of efficiency, predictability, and control applied specifically to personal healthcare. It is focused around the ideas of cost reduction, expedited service provision, and overall increased accessibility to necessary mental healthcare. The idea is that a service would be delivered with the greatest efficiency possible, with few changes in the regimen, and largely by the same people and facilities for quality assurance (Scheid 2003). These efforts touch several of the bases outlined by Ritzer’s ideas of rationalization (Ritzer 2020). Managed care has become a means of centralizing and corporatizing mental health services, and avoiding the fee-for-service ideas of previous healthcare plans which had boosted costs so drastically. It is a complex system that, rather than charging fees for specific services and rewarding practitioners for expensive and often unnecessary tests and procedures, is a series of plans that takes into account efficiency and the patient’s financial capabilities.
Managed care is a movement towards increased efficiency, predictability, and control in the mental health sector.
Digital Therapy
Although the idea of receiving mental health counseling via video chat may appear to be something that only recently became necessary in the Covid age, the idea of Internet therapy is far from new. Even in the early days of the Internet, there was an establishment of digital counselors, or counselors who operate either via email or some other form of instant messaging. Dr. Judith Schwambach was just such a counselor, a self-described “email counselor” who operated off of a blog through which patients seeking counsel could reach out and establish a connection with her (Richtel). These ideas of digital counseling have grown and changed along with the Internet. As the Internet has come to attain the levels of operating capacity that it has in the last 20+ years, so too have means of electronic communication, and thus have improved the capacity for online therapy. Services like BetterHelp.com and Talkspace.com provide services for clients seeking mental health by pairing them with a licensed mental health therapist, with whom they might begin to work out some of their personal struggles, or potentially be referred to a medical professional if the mental health issue is more serious. These efforts increase the predictability and efficiency of mental healthcare, as a client can come to expect a certain quality of care provided, and in a more efficient way than if they were to go to a therapist's office.
Artificial Intelligence
While it seems unlikely at first, AI plays a legitimate role in the rationalization of mental healthcare. Even though artificial intelligences may not be able to completely replace a licensed mental health professional, they still play an important role in the provision and predictability of mental health services, if not specifically to counseling psychologists. One major way is in the collection of research and information on mental health issues, remedies, treatment plans, and in the general consolidation of information discovered. AIs can improve things like empirical analysis of research, data-driven model development, and personalization of treatment. Moreover, AIs would be able to assist in the collection of research by increasing psychologists’ capacity to obtain the data necessary for increased understanding of potential ailments or problems (Horn & Weisz 2020). Because of this increased capacity for acquiring data and information, new standards can be set for the field, leading to the increased predictability of the research aspect of the profession.
The Trouble With Rationalization
Ritzer defines rationalized systems as irrational in themselves. That is, they are unreasonable in that they eliminate the human element in the provision of a service. Rationalized systems are able to function very well in uniform, low-variation situations involving purely objective calculations. However, in systems requiring the deftness of a human touch, rational systems struggle in their efficacy. Such rationalized systems do not function well when they are applied to systems more complex than a McDonald’s restaurant. This leads to the assessment that rationalized systems are designed to be as machine-like and autonomous as possible, which is contradictory to the process of providing a mental health service. When looking at mental health care as an industry, this issue of irrational rationality is exceptionally profound. In a field like healthcare that requires a deft professional hand, it is paramount to the treatment of the patient or client that the balance between rationalization and the best interest of the client is properly maintained.
Rationalization can be irrational in itself.
The Need for a Human Touch
One of these irrationalities is the need for a metaphorical human touch when providing psychological assistance. When working with a mental health patient, part of the healing and recovery process lies in the establishment of an interpersonal connection between the patient and the counselor or caregiver. This necessitates a deliberate, humanized effort, the antithesis to rationalization practices and managed care. This is particularly evident in mental health counseling situations such as talk therapy, which is one of the forms of therapy in which a good relationship is crucial.
Additionally, the standards enacted by managed care companies also have had negative consequences on the way that psychotherapeutic practices have come to be delivered. Managed care providers’ efforts to increase control over the system have been proven to have a direct effect on the patients who require mental healthcare, as the new standards of managed care have limited the amount of insight-oriented therapy that can be provided decreasing the efficacy of the service.
Another of these irrationalities manifests in a different way: the additional stress put onto the caregivers themselves. In the managed care movement, there are multiple instances of additional stress and controlled malpractice, for want of a better description. For one, there are instances of mental health practitioners going against the course of treatment suggested by the managed care establishment, and providing the sort of care that they deem to be in the best interest of the patient. There are also records of instances in which the therapist might lie to the managed care authority representative in order to achieve authorization for the course of action that he or she thinks is correct in their professional opinion (Donald 2001). This creates additional tension between the care providers and the corporations. Moreover, there are mental health concerns for the caregivers themselves, in that there is an emotional toll that comes from being unable to provide the care that they deem legitimate for the patient, forced to sacrifice the patient for the cost of the service. The forces of rationalization are creating feelings of helplessness and lethargy in healthcare providers, as it is not a suggestion but an insistence from the managed care companies to enact their healthcare plan.
The Managed Care Conundrum
All of these issues with the rationalization of counseling psychology are indicative of the overall dilemma that surrounds the relationship between the medical practitioners of counseling psychology and the medically-untrained officials of the managed care groups. Because it is a healthcare service, the interests of rationalization can and have clashed with the interests of the medical professionals. The accrual of capital and the idea of rationalization is largely antithetical to the slow, deliberate, methodical procedures that are required for the diagnosis and treatment of mental health problems. Moreover, the issues that come with the discrepancy between the opinions of the professional versus the managed care organization are unique to mental healthcare work; it is far easier for a managed care organization to assert that a patient being treated for depression has made enough progress as to warrant the elimination of subsidies for medical care given the innate subjectivity of “progress” in one’s mental health issues. This is where the lack of calculability comes in, as calculability necessitates quantifiable results; in the mental healthcare sector, such results are not easily obtained (Scheid 2003). A broken bone, for instance, is an objective healing process with a start and end, whereas treating someone for mental illness is far less cut and dry as it pertains to a patient’s progression towards recuperation.
Conclusion
Overall, the pillars of rationalization have each played their part in the transformation and rationalization of counseling psychology and mental healthcare. As mentioned before, control may not manifest itself in the elimination of humans for automated technologies, but rather in the culling of resources and information that would then prove beneficial to those involved in the study and treatment of mental disorders and illnesses. Efficiency is the primary goal of managed care corporations, as the idea is to deliver the most cost-effective care in the most expeditious and effective manner as possible. Managed care corporations have run into the issue of a lack of calculable results, given the ambiguity of mental illness. However, while difficult to specifically quantify mental health progress in the vein of calculability, quantity as a measure of quality is another defining factor of managed care, as the ability to take in and treat as many patients as possible is certainly a measure of success for the managed care company (even though this can and often does come at the expense of both the mental health professional and the client). Predictability is difficult to achieve, as the patient’s feelings and state of mind often vary between and during counseling and treatment. However, managed care provides a certain amount of predictability in that it provides a relatively limited amount of variability in the service plans provided (the operative word being “relatively”).
Rationalization efforts have no doubt had a positive impact on the effectiveness of mental healthcare practices. Rationalization has brought upon the concept of Internet therapy, an idea that might bring counseling psychology services to those who may not have had access to such services before. It also has been able to provide mental health counseling in a more clandestine manner, as people who seek counseling might be fearful of stigma or ridicule from their peers or family; such a fear can be eschewed in a more controlled situation such as an online relationship between therapist and patient. Managed care practices have made mental health services more attainable to people who may not have been able to access them. That said, rationalization has also provided some serious downsides to the world of counseling psychology. Before the advent of rationalization practices in the field, the medical professional’s opinion was valued and sought after for both its quality and exclusivity. However, with the introduction of managed care, there is a balance that must be struck between the often-conflicting interests of the practitioner and the managed care provider. The effort to reduce costs for patients is a valiant one, and that must be taken into account before disparaging corporations. The responsibility of making sure cost reduction is done ethically and equitably, however, is paramount to a properly functioning mental health service.
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Created with images by ElisaRiva - "head brain thoughts" • janeb13 - "sigmund freud portrait 1926 founder of psychoanalysis" • jarmoluk - "the war the military defense" • Sozavisimost - "doctor patient consultation" • Vitamin - "web cam internet video" • geralt - "artificial intelligence brain think" • tiyowprasetyo - "counseling stress angry"