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