“The Politics of Psychotherapy Research: Survival of the Measurable” Comments, Page 1

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12 Comments (4 Discussion Threads) on “The Politics of Psychotherapy Research: Survival of the Measurable”

  1. Couldn’t agree more. How do we know that people aren’t (primarily) rational – because the results of research aren’t implemented. Academics (and others) are still teaching psychotherapy as if it was school and technique that mattered. If they aren’t going to modify their behaviour based on (rigorously rational) research, then why hope that others will.

    Some of us (well, OK, me) are old enough to remember the 60’s. To us a critique of the medical model isn’t news. And it’s re-birth as ‘evidence based medicine’ is pretty tiresome. The problem being that advocates of wholism attempt to rationally show that the rational isn’t what is most powerful for people. It is not surprising that this isn’t effective.

    Social influence doesn’t have anything to do with effectiveness – just look at economics. Economists don’t predict the biggest depression for 70 years but then just a year later are still being asked for predictions – and government policy is sometimes based on these predictions!

    My guess is that psychotherapy needs to do some decent qualitative research (“quantitative is only bad qualitative” – as they don’t say). 100 therapists with 100 clients could pool a vast amount of data in only a few years. The design would have to be sorted out but it isn’t that hard. The associations could be doing this kind of thing (and yet aren’t – that would be a candidate for an interesting piece of research too!)

    It does appeal to my sense of humour that psychotherapists need to feel their fear, and break out of their current way of doing things (you know, the stuff they help their clients with every day). To do this will mean building a support base outside the existing system.

    Thanks for a stimulatingn post. I’ll be very interested to see what others think and I look forward to your coming post on psychotherapy’s effectiveness.

    1. Thanks Evan. I would add that there is *loads* of qualitative research done by psychotherapists. It just doesn’t get the same publicity or policy-making clout.

  2. Very informative and intriguing article, Sarah. As for the impetus for some of the bad science that so often promotes overly simplified conclusions about what works and what doesn’t, I think the old adage: “Follow the money” (i.e. all the various vested interests which ultimately have money as their bottom line concern) explains most of the “politics” of the issue. Can’t wait to read your follow-up piece!

    1. Thanks, George. Indeed, “follow the money” is simple, yet elegant and extraordinarily useful as a guide to understanding seemingly complex issues!

  3. In my experience, anger other than defining it as a physiological, biological response such as horripilation, adrenalin release, etc., seems more like a secondary affect. Hypothesis: anger is nearly always one response to pain, fear, or, if you will, fear of pain. ‘Pain’ in this case is defined as anything from physical sensation to emotional (territorial infringement, frustration, fear of rejection, envy, jealousy, ad infinitum), I’ve asked many colleagues to pose a counter-example. I would be delighted to find one. So far, no one has taken a firm disagreement to my observation. I welcome comment.

  4. Evan,
    Aside from a ‘brain’ problem or direct physiological dysfunction, (i.e. a tumor, stroke, etc.), I am looking for a counter-example (that is, an example that disproves my inductive hypothesis about anger) as described above.

  5. Repost: sorry about the grammatical typo and confusion.

    Evan,
    Aside from a ‘brain’ problem or direct physiological dysfunction, (i.e. a tumor, stroke, etc.), I am looking for a counter-example (that is, an example that disproves my inductive hypothesis) regarding anger as described above.

  6. Thanks for the clarification. I do think anger is an affect. I’m not sure that it is secondary (or maybe what you mean by this). If you mean later in time, perhaps I agree. Although sometimes my emotions kick in after recalling an incident, in which case the physiological seems to come second.

    I do think anger can be a useful way of setting aside fear (depending on how dangerous the situation is of course). My view of the cause is that something precious to us has been threatened or violated. In the case of threat fear may be involved but with the violation I don’t think fear need be.

    I was a sickly child and so often in mild pain (chest colds). This made me rather morose and miserable but not angry.

    I hope these comments are responding to your hypothesis.

  7. Dear Evan,
    Anger, along with disgust and several others, are generally assumed, in the ‘science’ of psychology, to be universally recognizable and primary. I am hypothesizing that, as an affect, anger is ONE response to fear, pain, and fear of pain or ‘uncomfortably-not-pleasant’. Other responses might be anxiety, sadness, depression compensation, over-compensation, and many of the ‘neurotic’ DSM-IV responses we give, mutatis mutandi. An useful therapeutic approach to so-called ‘anger management’ is indeed, I maintain, a cognitive, or even meta-cognitive, awareness of the underlying fear, hurt, slight, or ‘pain’ as I described above.

    All of this began with Sarah’s original remark (above), “At the conference, Paul Wachtel (an eminent psychoanalyst who integrates cognitive behavioural therapy into his work) mentioned a piece of research he and Schimek carried out (1970), which involved finding an operational definition of anger. It turned out to be impossible to quantify criteria rigorously enough for a definition to stand up, but it turned out that everyone involved in the experiment did in fact broadly agree on when anger was present, and there was a high degree of inter-rater reliability, which led to statistically significant correlations.”

    I am aware that the arguments can go quite deeper. I was simply offering a working hypothesis from clinical observation.

    Your point about the precedence (i.e. order) of thought and ‘brain’ i.e. physiological ’emotion’) is well observed. My belief is that ‘mind’ can stimulate ‘brain’ and vice versa. In Fact, in this age of ‘brain science’ (neuroscience) we seem to extrapolate all-too-often from fMRIs, PET scans, etc. far more than we can determine to be true. That is to say, I believe that often we confuse correlation with causality, largely because, in my opinion, complicated and complex feedback loops are difficult for humans to think about, in any science.

    By the way, I am sorry that your childhood was often morose and miserable. I don’t know that in your case whether ‘anger’ might have been useful and motivating to… I’m not sure what outcome. In any case, you are not alone in that experience, and most children (or reasoning adults) would hardly react to being ‘sickly’ with demonstrative and continuous anger. And I wonder if you were not a smidgen angry at times. Anyway, I empathise, in that I had a painful childhood, myself).

    Finally, I believe you instantiated yet another example of my oberved and posited hypothesis.

    Thank you, for your responding. I rarely have the opportunity (I am retired) to have a dialogue on these matters.

    Daniel

    1. I agree that anger is an affect. I would agree too that it is a response to pain or the perception of pain (more simply Hurts both physiological and psychological. I have found with clients that when we are doing anger management if we focus on the fear or the “hurt” that they then begin to process first causes and not simple rehash feelings of “anger”. Anger as a term other than as an affect needs to be left behind. The greater focus needs to be on how we manage “pain” and our fears. I have never seen an angry dog – a fearful dog who tries to scare me off by being angry – so this does not apply to the human animal as well? I think not.

      Also, I think the initial article was very good – we all too often follow the research ( i.e. the money) instead of doing what we teach our clients – to follow the truth you know in your heart. Shame on us for being hijacked.

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