Brand names in psychology

11 04 2014

‘The “brand names” tend to make difficult the analysis and comparison of these mechanisms or the exchange of knowledge between research groups. One can argue that it has caused and causes an enormous amount of duplication of effort. Physicists did not divide quantum mechanics into the Heisenberg Brand, the Schrodinger Brand,and the Dirac Brand, but analyzed in detail the relations among these and use one or the other according to their computational power in particular situations. When specific “brand name” choices have arisen (wave v. particle theories of light, Ampere’s v. Faraday”s theories of electromagnetism, phlogisten v. oxygen theories of production), they used experimental techniques to analyze both similarities and differences and to sort them out.’

Herbert Simon (spotted over here)





Power analysis for astronomers

7 03 2014

Stephen Senn (2002) explains the need for statistical power analysis.

“An astronomer does not know the magnitude of new stars until he has found them, but the magnitude of star he is looking for determines how much he has to spend on a telescope.”

Senn, S. J. (2002). Power is indeed irrelevant in interpreting completed studies. BMJ, 325, 1304–1304





Tea

14 01 2014

“… it is the simplest and most difficult thing in the world for one person, genuinely being his or her self, to give, in fact and not just in appearance, another person, realised in his or her own being by the giver, a cup of tea, really, and not in appearance.”
– From Self and Others by R. D. Laing





Book review: Power, interest and psychology by David Smail (2005)

11 01 2014

Power, interest and psychology argues that psychotherapists need to take seriously how the social forces of interest and power affect how we all – therapists and clients alike – think, feel, and behave. The main targets of the book are (what Smail believes to be) the over-ambition and limited reach of therapists’ actions; operating, as they usually do, through transference, warmth, empathy, and cognitive behavioural interventions. These influences, argues Smail, are dwarfed by the social environment outside the clinic. I read this book with interest as a (non-clinical, academic) lecturer who works with many kinds of psychotherapists and counsellors.

Smail rejects interventions which assume that insight leads to therapeutic change, that we have will power which therapy can encourage, that conscious thoughts accessible in therapy precede action. But what about clients who show improvement during the first few sessions of therapies which use these forms of intervention? He argues (pp. 24–25) that “such initial gains tend not to last… Rather like tender plants that thrive only in a greenhouse, it seems that people find that there is still a cold and hostile world waiting for them at the end of their therapy sessions…” The exceptions cited are clients who are young, attractive, verbal, intelligent, and successful. There is some research support for this clinical experience, for instance showing that cognitive ability positively correlates with outcomes (e.g., Mathiassen et al., 2012). A counterargument is evidence showing that “early responders” tend to sustain  better outcomes at long term follow up (Haas, Hill, Lambert, & Morrell, 2002; Lambert, 2005). However these correlational studies are open to attack: perhaps the early response just signals existing resources which were easily activated by therapy.

Therapy, Smail argues, tries to boost the perception of clients’ power to change, when in reality it is actual power that clients often need: power over material resources, money, employment, education; personal resources such as confidence and intellect; home and family life, a love life, and an active social life (Hagan & Smail, 1997). These are areas which often cannot be influenced by talk in the clinic. So why has individual therapy grown so popular? Smail argues – and emphasises that it’s nothing to be ashamed of – that therapists rely on income to put food on the table and pay the rent, just like their clients. He illustrates with the example of Sigmund Freud (p. 3) who wrote that “My mood also depends very strongly on my earnings… I have come to know the helplessness of poverty and continually fear it”. Freud, he argues, changed his theories so as not to offend those who paid the bills, e.g., clients’ parents. Smail argues that there is a great mysticism around therapy (p. 8): “rituals of therapeutic cure… bear a strong resemblance to the spells and incantations of sorcerers”, with practitioners rarely explaining to clients how their techniques (supposedly?) work. Together these interests help sustain psychotherapy.

Is it really true that therapists can only intervene in the room with the individual client? Couple therapy takes the first step beyond the individual by bringing a romantic partner into the room, and there is evidence it helps with relationship problems (Snyder, Castellani, & Whisman, 2006). Child and adolescent mental health services frequently intervene in the family (Carr, 2009). Multi-family therapy (Asen & Scholz, 2010) brings a chunk of the social network into one room and encourages families to help each other as the therapists gradually “decentralise” themselves. There is an awareness of the importance of the systems around people suffering distress. Another path outside the clinic is via homework, such as practicing social skills, which is (ideally) jointly agreed and set in a range of different types of therapies (Ronan & Kazantzis, 2006). Outcomes are better when therapies include homework than when no homework is included (Kazantzis, Whittington, & Dattilio, 2010). Smail, however, no doubt would argue that each of these interventions is limited when there are more material challenges at work such as poverty; what then would the homework consist of? Get a job? Make more money?

“The world is in a bloody mess,” concludes the book, “and even though I know, as do many others, what it would look like if it weren’t, I have no more viable idea than anyone else how to get there.” But there are constructive ideas in this text. Awareness that the causes of many of our actions is a mystery can be positive, for example in terms of accepting that social power flows through us and we shouldn’t blame ourselves for our situation or how we feel. A rich analysis is provided of the sources of this social power. The positive and convincing argument of the book is that the main hope of exercising power is through cooperation with others on all levels from friendship through to political activism. Indeed there is some evidence that activists who “advocate a social or political cause” tend to experience more positive emotions than non-activists (Klar & Kasser, 2009). To what extent these broader societal processes are within the scope of psychotherapy will no doubt continue to be debated. But whatever the scope, Smail suggests (p. 84) that the “appropriate role for therapeutic psychology is to record, celebrate and wonder at the extraordinary diversity of human character” – which sounds to me like a valuable starting point for therapeutic research and practice.

 

References

Asen, E., & Scholz, M. (2010). Multi-family therapy: concept and techniques. Hove: Routledge.

Carr, A. (2009). The effectiveness of family therapy and systemic interventions for child-focused problems. Journal of Family Therapy, 31, 3–45.

Haas, E., Hill, R. D., Lambert, M. J., & Morrell, B. (2002). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology, 58, 1157–72. doi:10.1002/jclp.10044

Hagan, T., & Smail, D. (1997). Power-Mapping I . Background and Basic Methodology. Journal of Community & Applied Social Psychology, 7, 257–267.

Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-Analysis of Homework Effects in Cognitive and Behavioral Therapy: A Replication and Extension. Clinical Psychology: Science and Practice, 17, 144–156. doi:10.1111/j.1468-2850.2010.01204.x

Klar, M., & Kasser, T. (2009). Some Benefits of Being an Activist: Measuring Activism and Its Role in Psychological Well-Being. Political Psychology, 30(5), 755–777. doi:10.1111/j.1467-9221.2009.00724.x

Lambert, M. J. (2005). Early response in psychotherapy: further evidence for the importance of common factors rather than “placebo effects”. Journal of Clinical Psychology, 61(7), 855–69. doi:10.1002/jclp.20130

Mathiassen, B., Brøndbo, P. H., Waterloo, K., Martinussen, M., Eriksen, M., Hanssen-Bauer, K., & Kvernmo, S. (2012). IQ as a moderator of outcome in severity of children’s mental health status after treatment in outpatient clinics. Child and Adolescent Psychiatry and Mental Health, 6(22), 1–7. doi:10.1186/1753-2000-6-22

Ronan, K. R., & Kazantzis, N. (2006). The use of between-session (homework) activities in psychotherapy: Conclusions from the Journal of Psychotherapy. Journal of Psychotherapy Integration, 16, 254–259. doi:10.1037/1053-0479.16.2.254

Smail, D. (2005). Power, interest and psychology: elements of a social materialist understanding of distress. Ross-on-Wye: PCCS Books.

Snyder, D. K., Castellani, A. M., & Whisman, M. a. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–44. doi:10.1146/annurev.psych.56.091103.070154





NATs

3 01 2014

From Power, M. (2010) [Emotion-Focused Cognitive Therapy, Wiley-Blackwell]:

“It is hard to know from the relevant literature how often cognitive therapists have patients [...] whose emotions and moods do not appear to be triggered by reportable [Negative Automatic Thoughts (NATs)]. [...] But whether the answer is that there are many or very few such NAT-free cases, the fact that a proportion of any cognitive therapist’s caseload must consist of such cases raises the question of what therapists do when this happens. Perhaps the comment about Freudian patients that they always came to have Freudian dreams and Jungian patients came to have Jungian dreams might be applicable; perhaps, clients may be suggestible enough to begin to have NATs if you persist long enough pursuing them as a therapist – if the clients can stand such therapy for that long. Of course, we know from the work on false memories that the therapeutic encounter is an extremely powerful one and that some clients may even falsely recollect memories of abuse, alien abduction or such, if that is the line being pushed by the therapist (Power, 2002). So having a few negative thoughts is small fry compared to alien abduction or imagined abuse…

“The point that we wish to make is that there are many strengths to the cognition focused approach, but there may be many limitations because of the failure to give emotion its rightful place…”

“We believe (Power & Dalgleish, 1997, 2008) that the problem is that the basic theory is wrong and that it is too simple. The cognitive therapies over-emphasize the role of thought in emotional disorders, and they lack an adequate theory of emotion:…”

 

 





An argument against payment-by-outcomes for mental health

17 12 2013

I have just seen a report on Payment by Results (PbR) for the adult Improving Access to Psychological Therapies (IAPT) programme and have concerns about the approach. The conclusion of the summary is that “the system appears feasible and the currency appears to be fit for purpose” which seems to suggest that the approach is going ahead.

This IAPT PbR proposal is outcomes based, so that the more improvement shown by service users, as partly determined by patient-reported outcome measures (PROMs), the more money service providers would receive. This is a worry as there is evidence that linking measures to targets has a tendency to cause the measures to stop measuring what it is hoped that they measure. For instance targets on ambulance response times have led to statistically unlikely spikes at exactly the target, suggesting times have been changed [1]. A national phonics screen has a statistically unlikely spike just at the cutoff score, suggesting that teachers have rounded marks up where they fell just below [2]. The effect has been around for such a long time that it has a name, Goodhart’s law: “Any observed statistical regularity will tend to collapse once pressure is placed upon it for control purposes” [3]. Faced with funding cuts, how many NHS managers will be forced to “game” performance-based payment systems to ensure their service survives?

PROMs have been criticised by therapists for leading to an “administratively created reality” [5] and being clinically unhelpful, perhaps even damaging. However evidence is building that feeding back results from PROMs to clinicians is helpful for improving care [4]. It would be very sad indeed if this useful tool were destroyed by payment systems, just as many mental health practitioners — and more importantly, service users — are seeing the benefits. Linking outcomes algorithmically to finances at all seems to be a bad idea in general – it’s especially bad when PROMs are just beginning to be trusted in routine practice.

References

[1] G. Bevan and C. Hood, “What’s measured is what matters: targets and gaming in the English public health care system,” Public Adm., vol. 84, no. 3, pp. 517–538, 2006.

[2] L. Townley and D. Gotts, “Topic Note: 2012 Phonics Screening Check Research report,” 2013.

[3] C. A. E. Goodhart, “Monetary relationships: A view from Threadneedle Street.” 1975.

[4] C. Knaup, M. Koesters, D. Schoefer, T. Becker, and B. Puschner, “Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis.,” Br. J. Psychiatry, vol. 195, no. 1, pp. 15–22, Jul. 2009.

[5] J. McLeod, “An administratively created reality: Some problems with the use of self-report questionnaire measures of adjustment in counselling/psychotherapy outcome research,” Couns. Psychother. Res., vol. 1, no. 3, pp. 215–226, Dec. 2001.





Five quotations to help thinking about quantitative thinking

16 12 2013
  1. “Quantification was a wImageay of claiming status… even the social anthropologists counted coconuts” (McCloskey, who’s not suggesting this is a good thing!)
  2. “Measurements presuppose theories” (Popper)
  3. “Facts alone are not enough…. Theory is sacred and we need it more than ever” (Žižek)
  4. Whatever information we use to interpret data, it’s “certainly not just from the new observations alone” (Freud)
  5. Quantification is not something “that can effectively be sought by measuring” (Kuhn)







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