riana coan?

Let me be clear (especially to Jim's boo). I do not want to be with Jim (and not in a yuck, Jim! way, rather, in a respect Jim way). Even if I did (which I don't), I wouldn't take his last name (not that there's anything wrong with that or with people who do, but if you know me, that's just not how I roll). The title simply puts us in the same family, but not of the nuclear fashion, instead, a research-based one. 

The moniker of my article for this week, had I written one and asked the group to read it, would have likely been named, Lost in the Mall of America: An Experience with Controversy. JAM JR. knows fairly well about my background, but the rest of America (who reads this blog faithfully, of that I'm sure - heck, I'm up to 7 followers!) may be unaware.  My undergraduate experience hinged greatly around diversity efforts at the University of Michigan, so it came as no surprise that my career goals were to effect change within the greater sphere of influence (even though while in college, you can't imagine your microcosm not being the entire world).  The shocker for most, however, was that I wanted to be a clinical psychologist.

One of my big brothers, Duane Smith, would attempt to cajole me, "Why Riana, you're one of the greatest political minds the 20th century has ever seen! Which law school have you applied to?"  "Duane, for the umpteenth time, I am not going to law school.  First I'm going to teach, then I'm going to graduate school!"  But it didn't stop with him.  Everyone who was in an organization with me or who saw me speak on issues of multiculturalism could not fathom why I was going into the field that I was. 

During my senior year (screw TJ, the term is SENIOR YEAR darn it!),  I had a "meeting of the minds" in my apartment.  The leaders of my class enjoyed salad, salmon, and punch, and discussed how each of our fields would contribute to the other as we slowly began to take over the world.  Optimistic, yes.   Idealistic, yes. Realistic, always.  (After all, reality is what happens, and anything is possible!) We knew that (to steal a childhood favorite line) with our powers combined, we would do just about anything.  The lawyers, engineers, social workers, and even wall street bankers knew that the training we got at Michigan - in passing signs with blackface (intentional or not, it was there: dark face, red lips), receiving calls about nooses being hung from doors, boycotting the newspaper, and being called nigger while going to class - was great preparation for the real world.  And I was thoroughly convinced that my role in breaking such mental entrapment was vital.

After teaching for two years in one of the most notorious neighborhoods in the U.S. (I'll spare the details on the blog, much more interesting in person anyway), I did research.  To long story short it, I worked on a faith-based intervention for African-Americans, and was assisting with our introduction by finding literature.  Or rather, not finding literature.  The dearth of information on interventions and mental health programs for African-Americans is astounding.

And then I get to UVa, where I learn that some reasons people don't publish their work is because it's not statistically significant.  Or even harmful! So let me get this straight.  Interventions are happening, but we don't hear about their ineffectiveness or failures because it's not publish worthy? Ah.  This is my calling.

Interventions are designed to work.  If they don't, we need to learn how to work from them.  It has been relatively proven that these programs are failing because of the environment that this community of people lives in.  Let's change the environment.  Let's go into the environment.  Let's be the environment.  One of change, optimism, and health-promoting behaviors.  It's not enough for me to wait until one of these children commits a crime and ends up as my client.  Or has diabetes and ends up in my office.  Or needs a new foster mother and gets added to my case load.  I'm going after the problem, at the root, whether it gets published or not.  Whether it was intentional or not.  Whether that's what everyone else sees me doing or not.  It's my passion, and it will be my purpose.

This class=eye-opener.  Many thanks for taking off the blinders.

[dream] chicken or the egg?

Grab a pencil and paper, read the vignettes, and answer the questions below:

A young man goes into a store and desires a pack of chips.  He looks carefully around him, puts the pack under his baggy shirt, and walks out of the store with the stolen goods.

A teen boy notices a man with a nice watch across the street.  He puts his hooded sweatshirt on, walks across the street, and puts a weapon to the back of the man and demands his watch. The man gives it up, the boy places it on and walks away.





Write down the following descriptions for each scenario:
-His race.
-His age.
-The city in which he lives.
-The reason he committed the robbery.

According to the Moffit text, there may be different reasons underlying the motive of each boy.  I initially wanted to delve into stereotypes that the reader may have had about who each of the males may have been, but I believe that discussion to be more effective in person.  In the meantime, evaluate your own answers, and see if they were validated by the evidence within the article.  It was of interest to me, morever, that Moffitt noted no differences between the race and class (among other factors) of offenders, and I would assume that many people do not believe, inherently, that this could be true, likely evidenced by the answers we would write to the above.

But, I'll move on.  The title asks an important question: which part of the cycle contributes to such antisocial behavior?  Is the neuropsychological nuances caused by the mother's malnutrition, poor neonatal care, and intoxicants ingested while pregnant?  Considering most studies do not take place within the inner-city, it would be difficult to measure the differences experienced between the proportion of low-income children with that of middle- and high-class children.  Considering the latter are the groups most often exposed to treatment, and therefore most-likely to be diagnosed with a pathology rather than a social stigma, it is difficult to see whether or not all groups are diagnosed with antisocial behavior in the same way, or even develop it in the same manner.

For example, would trauma be sufficient to affect the neurological component of a child born with relatively normal functioning?  Studying Traumatic Brain Injury (TBI) and Brain Tumor (BT) patients this summer, it is apparent that executive functioning abilities decrease after various treatments like chemotherapy or radiation.  Studies indicate that a majority of TBI and BT patients never quite function at the same level of their peers, but we do not see them develop antisocial behavior disorders, even those with the negative environments.  I therefore question if maladaptive parenting skills, which may be precipitated by pathology itself, may be a precursor to the neurological deficits that many of these antisocial children develop.  And if this is the case, is it truly accurate to say that discrimination is not found between various social groups?

Or do these deficits increase the problems parents face in raising such children?  The environmental factors that negatively impact these children is something that is found in many lax or overreactive parenting situations.  Such factors contribute negatively to the behavioral outcomes of children, particularly males.  When friends draw back, and parents, teachers, and other adults continue to penalize, a vicious cycle of negative socialization occurs.  I am reminded of my students who were not "good" enough to go out on field trips.  They were therefore chastised in class, not shown positive examples, and therefore more likely to commit such offenses again.  This same socialization occurs within juvenile systems as well as jails, where we continue to offer criminals new negative social networks, as well as more opportunities to act upon their impulses with their new found knowledge.  This environment, mixed with such neuropsychological deficits, leads to the taxonomical positions posed by Moffit in one of the most interesting articles we've read thus far!

I have soooo much to say about this article - I also can't wait to discuss how the differences between identity may shape the face of the pathology or diagnosis in class.

fight or fright? (halloween edition...)

My fears are extremely irrational.

Riana's fears (in order of severity):

• Bees
• Balloons
• Needles (I would love for the alliteration to continue through the series, but it's more than just blood drawing - it's ALL needles)

Bees - although more rational (I am highly allergic to them) - bring out the utter worst in me.  As if every bee on Earth is concerned with stinging ME, and therefore losing their life, I run zig-zagged across playgrounds, across streets, and scarily enough, out of a car when it's moving.  (The worst experience was when I was driving and the bee was in the car - I was headed towards the freeway entrance, approaching a major intersection, and I was ducking and dodging this bee to the point where I could no longer see over the dashboard.  Hmmm, my life or a bee sting?

Balloons? Fahgetaboutit.  The most irrational fear ever (next to clowns for me - I just don't get it! But then again, mine is grouped with this circus silliness.)  For whatever reason (and I HAVE tried to recall this "initial trauma" that, paired alongside my reaction, has conditioned me for eternity), I am pudding around these inflated latex contraptions meant for happiness.  Perhaps it was my grandmother popping them in front of my face, or the startling noise that reminds me of inner-city violence, but whatever it is, it leaves me, well, without air.

In reference to the needles, I am slowly getting over such apprehension.  Long ago were the days when it took 6 doctors and nurses to restrain me (I was 6 years old).  But I still feel the physiological responses - tension, increased sweat, quickened breathing, etc. I always tell my medical practitioner that I am afraid, and that act alone may very well trigger my fear, as discovered through the articles.

These articles really helped me to look at my own anxiety while exploring what the authors suggested were the etiologies of the spectrum of anxiety disorders.  I especially enjoyed Mineka and Zinbarg's piece, which very thoroughly broke down the general reasons for anxiety as well as each individual disorder.  The examples were especially helpful and salient, because I don't believe most people can really grasp what anxiety disorders are unless spelled out.  Further, differentiating between anxiety provoking situations and those that produce anxiety for extended periods of time was of great benefit.  Particularly, Emily and Marian's tales of dog trauma were continued throughout the text, and gave me the opportunity to postulate why one developed such pathology over the other, throughout each of their Learning Theories (biological, environmental, physiological, etc.).  This allowed me to introspect on my own fears to see where such conditioning occurred.

I also developed questions related to my own research from the article.  In particular, I posit, "Does anxiety have a color?"  Of course we can argue that certain environmental and cultural factors would affect coping, vulnerability, and exposure, but even taking those factors into account, are we finding similar percentages between ethnic populations?

Additionally, do we see the same traumatic experience resulting in internalization (anxiety) for one person and externalization (say, irresponsible sexual behaviors) in another?  This is most interesting to me, because if the previous question regarding a color of anxiety suggests that there are differences between ethnicities, then perhaps the explanation rests in how groups handle such trauma.  As described before in both class and previous blogs, I believe that PTSD, as expressed in inner-city youth, tends to get overlooked.  But if these children are more resilient to pathologies with respect to a given level of trauma than other groups, is it that we aren't adequately measuring the psychological effects of externalizing behaviors in school, gangs, and the community? ("Such research suggests that children reared with a stronger sense of mastery over their environments should be more invulnerable to developing phobias following traumatic experiences" pg. 13)  Sure, they may not flinch every time a gun is drawn, but this habituation resulted from trauma, so perhaps conjunctions need to be created between those who look at internal reactions and those who focus on external.  In that vein, since Jessica is our anxiety expert, I would love to hear feedback from her, and would further suggest that, as explored earlier, our research really can work in tandem to create positive results in communities everywhere.

when keeping it real goes wrong (remember that Dave Chapelle skit?)…

I don’t really know what the 3 articles were about.  Well, let me restate.  The Kendler et al. article is about the link between adversity, sex, and high neuroticism.  Coyne essentially spends 20 pages arguing why his initial graduate work is not the seminal work of depression, so we should get over it (by thinking interactionally). Finally, Cuellar et al. spend a tremendous amount of time exploring past literature to tease apart differences between unipolar and bipolar depression, to whit I am still unsure of whether they achieved their goal or not.  But after sitting on a toy toss-about plane where the couple sitting across from me continued their disgusting streak of PDA, I about had it with the Coyne article.  And then an airport employee was acting wildly inappropriate, though hilarious, throughout my ingestion of the Kendler article.  And poor Cuellar was subject to a ‘pause for the cause’ as I broke down the graduate school process to my WAIS volunteer (it was the least I could do for her, after subjecting her to a 3 hour test!).

Anywho, enough with my diatribe against all things airplain/airport/and graduate process related. 

The most interesting link I found between the articles was the exploration of trauma as it effects youth from the Coyne article.  Coyne explains that children tend not to develop severe depression from major traumatic events, and that if they do, it will appear as early on-set depression.  Rather, it is suggested that depression is a factor of various events that occur somewhat later in one’s life, coupled with the type of support that individual has.  This was also mirrored through the Cuellar et al. article, in that social support is extremely helpful in either uni or bipolar depressions.  In fact, without it, we see an increase in relapse, which ties in well with our readings from last week.

In essence, it’s all about support.  Kendler et al. brought about evidence that women are unfortunately lacking in this category.  Either unmarried, in a negative relationship, or suffering from a nasty divorce, women tend to be highly neurotic regarding the adverse events in their lives, and not only can relapse be improved by such data, depression in general can be minimized by it.  Female support groups, organizations, ministries, etc. can support the needs and welfare of women who have or may be prone to experiencing negative life events.  It’s not enough to be there a month after the divorce, but to have been there before and for years to come. 

Psychologists can definitely mediate such stressors by creating focus groups, or offering preventative, or ‘mind-grooming’ services, as I call it, to adult women.  It has been evidenced that women tend to need different emotions met than men, so, armed with this knowledge, we should certainly cater to these clients in a way that mediates preventable depression.

p.s. best benjabrunch/brunchamin EVER ladies (and ben, who is SURE to read this!! ;o) )

eyes wide shut

I want to immediately address two statistically significant findings in these articles:

1) The University of Michigan rocks.
2) Including super-huge portraits of each author in the article negates the fact that their writing is totally discombobulated and way too verbose.

Now, getting to the topic of stimulus control (SC) and stressors and abuses that lead to depression.

The techniques highlighted in the SC article as well as the sleep hygiene handout seemed to express the validity of using this therapy with sleep deprived clients.  I only questioned how the average person would be able to stick to such a regime, or participate it in the first place.  The therapeutic push, however, of suggesting that nothing else has worked so take a stab at this, was fairly convincing to me.  I wish I knew of it when I used to suffer from insomnia in college. But then I worked for Teach For America.  That would be the second most effective cure after SC, I'm sure.

I really enjoyed the Voelker article entitled Stress, Sleep Loss, and Substance Abuse Create Potent Recipe for College Depression not because it was published from Michigan (well, not solely because of that), rather it had a great mix of clinical and neuropsych, as well as social commentary.  In general, our executive functioning allocates specific areas and hormones to address stressors that can rewire the brain to handle stress, but this action takes away from its original function.  Meg commented in assessment yesterday that research appears to advocate less specific function related to one hemisphere only.  This is true, but from what I can recall this summer in neuropsych research, when trauma occurs in one hemisphere, the other hemisphere can compensate for this lack by performing the duties once associated with its other half.  This, understandably, burdens the lone hemisphere, so while there is certainly hemispherical interplay, there will be lessened functioning throughout the entire brain because one is inundated with double the tasks.

In reference to the depression model proposed by Voelker, this makes a world of sense.  People who compensate coping with their psychiatric disorders by overindulging in substances are placing an abundant request on their brains to sort everything out, which likely only further complicates their disorder.  This, coupled with social pressures and economic woes, leads to a lack of sleep, and in more recent cases, extreme violent behavior by those who are just unable to cope with the demands placed on their bodies and minds.

As stated, combing out the various kinks in our lives, i.e. monitoring the amount we eat, drink, sleep, and have time to address our maladaptive thoughts, will act as prevention for the large increase we're seeing in the obesity, substance abuse, insomnia, and depression in college campuses, which are sure to increase as a result of the flailing economy.

put me in [life] coach...i’m ready to play!

It’s 6:30 a.m. and you’re driving along a winding Atlanta road.  You can only envision the horrible day you had yesterday, and the day before, and the day before that.  You start to anticipate what a horrible day you’re likely going to have today.  Tears well up in your eyes, and you ponder, maybe, just maybe, if enough tears fill up in your eyes, you can claim that the reason you crashed your car was because you couldn’t see, not because you were actually attempting to kill yourself…

I encountered this scenario on a few dark mornings while driving to teach in a notorious neighborhood within Atlanta, Georgia.  I bring up this reality to respond directly to the claims made by psychologists who are proponents of Behavioral Activation Treatment for Depression.  There are two major flaws within the theory of activating behavior without addressing the cognition:

1)    Severely depressed patients may not have options to change their environments.

2)    If we engage in “coaching,” we have no jobs as psychologists.

In my situation above, I was so depressed that I did in fact follow the behavioral patterns of people within the reading by Jacobson et al.  The cyclical nature of depression is a beast, because surely the behaviors that we engage in cause further depression, and intensified depression only leads to further social withdrawal and personal negligence.  It took phone calls from my at-the-time-boyfriend to my roommate, in fact, to force me to eat and get out of my dark room where I would lay in bed from the time I got home from school to the time I woke up.  This routine antagonized my depression, but the reality was that only those few behaviors could be addressed.  The essence of my depression – the school environment that I encountered every day – was still there, waiting for me, mocking me.  I was able to address the fact that my behavior was exacerbating my depression, but I was not able to get to the root of it, as Jacobson’s title even suggests Behavioral Activation (BA) does.  It wasn’t until my cognitions about my work environment were addressed that I could truly wake up in the mornings ready for the challenge of a new day.

Additionally, if we engage in the coaching techniques described within the model of BA, even if through terminology, we are in essence diminishing our profession to someone who guides the actions of others.  In that realm, we could have forgone school and the 6 years of intensive training of empirically based techniques to partake in a counseling model that simply aims to shift individuals’ cognitions through behavioral modification.  Perhaps this is just being egregious, but I have the skills and will have the knowledge to affect substantial change within clients’ lives that goes beyond activity charts and forced social engagement.  I’m quite sure that some mindset changes will come as a result of those things, but I’m more confident that addressing the behavior as well as the cognitions surrounding it will provide the client with a more suitable way of coping with the impending stress involved with his/her environment.  Viva la CBT!

you down with CBT? yeah you know me!

(That's probably the corniest thing I've ever written to date!)

Our articles this week hinged around cognitive and behavioral therapies, both in the fashion of CBT (Cognitive Behavioral Therapy) and RE[B]T (Rational Emotive [Behavioral] Therapy). Of note, I found the Ellis article to be particularly amusing, in that the father of such a treatment seemed apologetic and provided a plethora of excuses or caveats throughout this entire article for why REBT is essentially CBT before CBT became what it is today!

In general, however, I was enthralled by the CBT articles, particularly that of the British Association for the Behavioural and Cognitive Psychotherapies' Mapping Psychotherapy - What is CBT? This guideline presented the perfect framework for the type of treatment I would like to practice in inner-city communities where mindsets are often the largest factor keeping those citizens enslaved. Bob Marley speaks to us through song about this concept, urging residents to "emancipate yourselves from mental slavery/none but ourselves can free our minds." (Redemption Song)

The map shown explicitly in Appendix 1 on page 6 highlights the necessary methods both clients and therapists must engage in to yield results. Through our exploration of EBP/ESTs, we acknowledge that assessment allows opportunities to establish rapport, as supported by Rogerian theory, as well as time to postulate which CBT assessment would best fit our client. Formulation closely follows this assessment in order to discover the presenting problem of our client while giving us a baseline with which to measure our client's success. Intervention stems from our hypothesis and involves a trusting relationship between client and therapist, so that outside homework can be achieved by each individual in order to benefit the client seeking behavioral modification through cognitive shifts - i.e. attempting exposure or addressing a fallacious belief. Finally, evaluation measures the impact both participants in the CBT have had on the outcome of the client, and long-term effects can be measured during this stage as well.

These four stepping stones to behavior changes, as well as cognition restructuring, are key to urban youth developing a more positive attitude about the impact that they can make in this world. As Butler et al's work displays, CBT is highly effective in treating adolescent depression and anxiety disorders. If children who live in these areas are constantly exposed to negative rhetoric about their existence, it is natural to assume that they would internalize these messages. CBT works for this age population, so it is worth the effort to administer this form of treatment on such groups. It will be interesting to note whether this treatment works across racial and class lines in such strong effect sizes.

The lab I work in for my research conducts a longitudinal study on the effectiveness of a prevention program targeting the parents of children with poor behavioral outcomes. Reading these articles really leads me to believe that as the children increase in age, offering CBT directly to some of the children will allow us to compare whether this type of intervention, mixed with preventative measures, will truly minimize the risk associated with growing up in inner-city neighborhoods. If this is the case, we may be able to revolutionize the way children within these environments perceive the world around them, thereby affecting both behavior and cognition - the basis of CBT!

...

what can one even say about the senseless killing of another? since we didn't have to write this week, i decided to dedicate this to something i enjoy - inner-city discussion.

but i really can't even speak after watching the video within this blog:

http://ow.ly/rDn6

speechless.

-R

it is the relationship, stupid!

The articles for the week, “The Current Status of Carl Rogers and the Person-Centered Approach” as well as “The Working Alliance: Where are we are and where should we go?” were both fairly straight forward. I felt like I was reading the same thing over and over in both articles, which brings me to point number one:

1) If things are so obvious (i.e. ridding ourselves of theory and forging stronger alliances with a client), why are they not being done?

To whit I am happy to answer! I will juxtapose my psychology life with that of my political and teaching (former!) lives respectively.

As the title of this blog indicates, Kirschenbaum & Jourdan take a stab at the Clinton-era rhetoric of “It is the economy, stupid!” This fact seemed very apparent to Clinton advisors advocating for change, but for those who appreciate the status quo, i.e. those in power or with authority, why would change be necessary? In many ways, that’s admitting to the failures you’ve already done in office as well as those you’re promulgating currently, so in essence, you’re giving several reasons why you’re incompetent. Face it, politics, after all, IS all about getting re-elected…

Well, so to is the real world, in which psychologists all over are having extremely difficult times admitting to their clinical errors in working with their patients in a very paternalistic way, placing demands, theories, and methods of therapy on a client that do not work as well as others. That would be an admission that for all of these years, the training, hard work, and most importantly, knowledge the clinician obtained and outputted would be less effective than another concept. This, by itself, is a large reason why many clinicians not trained on a model of alliance would rather default to their previous training than risk being the martyr or proponent of a new cause (which, as explored in previous topics, may not have been empirically proven while going through its beginning stages in the field – after all, it takes quite a few years to gain momentum, significance, and retraining).

And, in a dorky selfish sidenote for point number two:

2) How I truly appreciate the way in which this class is organized, for the information we are reading about continues to build upon each other!

As a (former) teacher, it is very important to me that knowledge be built linearly – if we are taught something, it should be in a logical sequence that would strengthen the former concepts. That is precisely what this coursework is offering! From the beginning of our class, we have continued to look at articles that help to explain both the former and latter weeks. These articles truly built upon the concepts of paternalism vs. liberalism, clinically-based vs. empirically-based, effect-size vs. significance, etc. When reweaving these themes throughout the fabric of this class, it not only strengthens our understanding, but makes us more competent to discuss these issues in ways that would not be attained had the articles had no relevance to each other.

This was clear for me when I read K & J’s citation of Elliott’s 2003 paper as he wrote, “Working effectively with clients requires adapting the therapist’s approach to the client’s general presenting problems, the within-session task, and the client’s immediate experience in the moment.” This immediately triggered sentiments of Consumer Reports, liberalism, and efficacy. I am not only getting stronger in my arguments, but I tend to understand many sides now, and can debate from either stance.

To bring it all together, the relationship between the client and the therapist is important. This we know. But what we may not know is why therapists may be hesitant to adopt such a model (I posit that it’s due to job security, as are all things in life). We are additionally fortunate to have a method of learning that advocates many sides in a systemic building block format, allowing us to gain knowledge of multiple subjects in objective manners over the course of the semester. I appreciate this method and look forward to addressing alliance more in class, since statistically speaking, I’ll likely be called (right probability proponents?).

I've got a theory...get over it!

First and foremost, shout out to the JAM JcRew for the most awesome birthday surprise EVER! :o) Totally caught me off guard, and as you can see from the pic, I was extremely happy! Go team!

Moving forth to the extremely dense readings this week...

Looking at Smith's article, "The end of theoretical orientations?", really makes me wonder whether or not I have entered into an archaic profession resistant to change. I think most people can reasonably agree that therapy, whether it be physical, psychological, or medical, truly benefits the patient if done correctly. In our field, however, we spend so much time worrying about who created the concept of our theory, or which trendy wave we entered into graduate school on, but are they necessary to complete the treatment of our patient, which is arguably the top priority.

In looking at other fields, do we really require them to highlight a certain technique with their treatment? Certainly, there are specialties within other fields - we need to know which portion of our body needs healing, so we go to an expert who can assist us with that. However, when we want our mind healed, there is a sudden shift to which way the professional is going to treat us. Now here's the conundrum: no two people have the same exact pathologies (as studied earlier with diagnostic categorization arguments), so should WE use one school of thought on THEM? Shouldn't the client dictate what type of practice we run?

The shift towards eclecticism accounts for this new way of thinking. I'll give the old geezers the benefit of the doubt - afterall, we are one of the newer sciences. But after a while, don't you think someone should have recognized that the round ball doesn't always fit inside of the square peg? One size does not fit all, so we should not think that one therapy would fit our increasingly more complex client need. (Tangentially, the concept of studying in graduate school under a certain school of thought [which would dictate where you wanted to study], coupled with the search for the perfect advisor relationship is just too much for an applicant to handle - we need to do away with such strain in the Ph.D. quest! Geesh!)

In essence, realizing that our main goal is to "create more smiles in the world" will guide us towards being better clinicians. Learning how to treat various symptoms as they are presented as well as being instructed in various methods of psychological theory will lend to more satisfied consumers and healthier minds.

One Flew Over the Cuckoo's Nest...

In reading the articles for this week, I was intrigued by the concepts discussed by Hunsley and DiGiulio in the Dodo Bird text, as well as through the extremely dense work of Chambless and Hollon in Defining EST. I would like to focus a bit more on the Hunsley work, especially because they were able to fit in three birds within their title.

The Dodo Bird theory was easily struck down throughout several meta-analytical studies presented in the work. What is most interesting to me is the initial theory of all psychological treatments having equivalent effects. I can only think to compare that to the educational system, in noting that regardless of the teacher, curriculum, and child within the classroom, all results are going to appear to be the same. I can assure you that that is hardly the case, as a former teacher, because so many variables affect the outcome of quality teaching and instruction. If this can be seen in areas of expertise ranging from the classroom to the emergency room, why would my clinic be any different? How could one even postulate that these various treatments would yield the same result?

If in fact equivalence was the end result of all clinician and treatment procedures, I find it highly unlikely that we (future clinicians) would be fighting so diligently for a spot to practice this art. Additionally, I believe that less trained professionals would be able to administer treatments to patients, considering our training would be irrelevant to their outcome. There has been a push in recent years over this (especially Masters level therapy in some states to reduce costs of mental health care), but a large pushback from professionals who can show through empirical evidence that the quality of the training of the clinician, paired with empirically relevant training models, yields better patient outcomes than the alternative.

I would agree hardily, therefore, that we must strive for results that benefit the patients and are replicable between and within treatments in order to solidify the effectiveness of highly-trained therapists and various treatments. Working towards this goal will keep our profession intact, and any potential clinicians from flying the coop…

Epic Fail!

Greetings all!

I'm UBER informal, and blogging surely doesn't help, so I will do my best to get back on the professional track starting...oh wait! here's the JAM _R (we love you Jess!) at din din Sunday! k...now!

I enjoyed both articles, but Persons resonated more with me. I've never heard of studying psychological phenomena rather than psychiatric diagnoses, but it certainly makes sense given one point that he states on 1253 (page 2). Persons very clearly outlines the case for schizophrenics who may not have thought disorder, and those without schizophrenia having thought disorder. This immediately triggered my memory for false negatives/positives. I thought, almost instinctively, that it must be worse to have the false negative, because you're walking around with a disease/pathology and not know it. But as I voiced my concerns aloud, my friend very wonderfully suggested that a false positive would be worse psychologically. Come to think of it, he's absolutely right, and summed up both articles very well.

Both Persons and Widiger & Clark suggest that a person is NOT going to miss out on the fact that s/he has symptoms indicative of pathology. For example, thought disorder or a low IQ can be symptomatic of schizophrenia and mental retardation, respectively, but do not necessarily imply either disorder. The inverse, however, is to give someone the label of schizophrenic or mentally retarded, which are stigmatized in any community, when in reality, s/he is void of such markers as thought disorder or may have genetic abnormalities such as Down's Syndrome. Although the person absent of diagnosis is still aware of his/her symptoms, the person with the misdiagnosis may be traumatized by such a label, and further not helped with his/her presenting problem, since a referral to another psychologist may result in treatment for the typical diagnostic problem of those patients.

We must remember, as clinicians, that our patients need care for his/her concerns, not for a cookie cutter solution to get him/her out of our office. Large bins that our clients go in may be a better tool for the average over-burdened employee, but what about the individual? Sure labels are easy to apply, but are they easy to get off?

-R.

As a reference, from our good pal Wikipedia...

*Type I (α) - false positive: reject the null hypothesis when the null hypothesis is true, and
*Type II (β) - false negative: fail to reject the null hypothesis when the null hypothesis is false

Check 2-1-2...

I'm about to read the articles - how exciting! This is a reminder to write the post either tonight or first thing tomorrow! ;)