What’s wrong with Clinical What’s wrong with Clinical PsychologyPsychology

““It’s Important to have an open mind, but It’s Important to have an open mind, but not so open your brains fall out.not so open your brains fall out.

Those who dance are thought mad by those Those who dance are thought mad by those who hear not the music.who hear not the music.

What’s wrong with Clinical What’s wrong with Clinical PsychologyPsychology

Kids today have it too easyKids today have it too easy

No one is preparing them to be adults.No one is preparing them to be adults.

What’s wrong with Clinical What’s wrong with Clinical PsychologyPsychology

Everyone needs to understand each Everyone needs to understand each other’s culture to do good therapyother’s culture to do good therapy

““You got to be one to know one.”You got to be one to know one.”

What’s wrong with Clinical What’s wrong with Clinical PsychologyPsychology

Everyone’s on medsEveryone’s on meds

Everyone gets the polio vaccine, could it Everyone gets the polio vaccine, could it be good that everyone is on meds?be good that everyone is on meds?

Pseudoscience

What it is Ad hoc hypotheses Confirmation Testimony/anecdotes Superficial science Gurus

What it’s missing Self-correction Peer review Refutation Scientific base Limitations Empirical support Burden of proof

Pseudoscience

So what? Opportunity cost Bad reputation Undermine science

PseudosciencePseudoscienceTable 10.1Table 10.1 Psychological Treatments to AvoidPsychological Treatments to Avoid

Intervention

Attachment Therapies

Critical Incident Stress Debriefing

Grief Therapy

Suggestive Techniques for Recovering Memories

DID – Oriented Therapy

Peer Group Interventions for Conduct Problems

Scared Straight & Boot Camp

Facilitated Communication

Potential Harm

Death

Heightened Risk of PTSD

Heightened Risk of Depression

Production of False Memories of Trauma

Iatrogenic Induction of “Alters”

Exacerbation of Conduct Problems

Exacerbation of Conduct Problems

False Accusations of Child Abuse

BRIDGING THE CANYONBRIDGING THE CANYONChapter 12 of Janet Jones’ “Chapter 12 of Janet Jones’ “The The

Psychotherapist’ s Guide to Psychotherapist’ s Guide to Human Memory”Human Memory”

Presented by Gordon BowerPresented by Gordon Bower

Go, You Go, You Longhorns!Longhorns!

INTRODUCTION: Why is so much misinformation out there?

• Partly due to unqualified authors of pop psych books and TV/Radio talk shows

• Considerable “balkanization” of psychology into mutually ignorant sub-disciplines

• The “canyon” between experimental and clinical studies of the mind only widens.

• The recovered memory battles were only the most recent symptom of the breach.

THE CHASM IS BORN

• Mental disorders were province of neurologists and psychiatrists in asylums and hospitals; “mental disease” medical model of disorder

• New “scientific psychology” distanced itself from “psychical research” with quantitative measures

• Lightner Witmer founded clinical psych-- mainly for learning and/or speech disorders, IQ tests.

• Psychoanalysis accepted by psychiatrists but vehemently rejected by academic psychologists like Watson, Titchener, Cattell, Woodworth.

Clinical Biggies

Experimental Biggies

CREATING MODERN CLINICAL PSYCHOLOGY

• 80%of WWII vets requested psychological counseling to re-assimilate to civilian life.

• Their needs motivated VA to fund clinical psych training programs -- needed psychotherapies quickly outpaced research validations.

• Conflict with psychiatry re admitting patients, insurance payments, certification, expert testimony; now it’s over prescription privileges.

• VA & APA convened Boulder conference 1949--adopted scientist/practitioner model. Rejected by many--- Ps.D. programs approved by APA- 1973.

The American Psychological Association (APA)

• Frequent splinter groups from APA of unhappy clinicians ever since its founding in 1892.

• Mid-1940s: divisions of APA arose & dropped requirement of publishing original research. “Professional” psychology goals adopted.

• By 1985, 75% of APA members were clinical practitioners. Far higher percentage now.

• Experimental psychologists (includes most academics) increasingly disenfranchised, formed splinter groups like Psychonomics (1959), SSPI, neuroscience. APS in 1987, now 16,000 members.

Growth Rates within APA

• Growth rates 1960-1980: psychology up 435%; clinical expanded at 8%/yr; counseling 13%/yr; school psych 18%/yr; ALL experimental, 1%/yr.

• By 1980, experimental psychologists comprise only 18% of all psychology PhDs. Includes devo, personality, cognitive, neuro, comparative, social, organizational, health & sports psych, ed psych, industrial, personnel psych -- almost all academics. Started forming specialized societies out of APA.

INCREASING SEGREGATION OF SUB-DISCIPLINES

• Arguments for integrated psych (nat’l org., univ. depts, annual reviews, etc.) became outdated.

• Difficult to keep up with other sub-fields with their specialized jargon and methodologies

• Bookstores overtaken by new age, self-help pop writings with little or no discrimination by sellers.

• Devaluing of “scientific” (lab) approach to understanding human behavior in humanistic, hermeneutic, or deconstructionist philosophies.

INCOMPATIBLE EPISTEMOLOGIES• Some clinicians/experimentalists hold conflicting

views on how knowledge of mind is acquired and validated. Can we generalize laws to single case?

• Utility of case studies can be improved by later controlled comparisons, e.g., compare to placebo.

• Lab research and clinical case studies each have their advantages and disadvantages.

• Disaffection between therapists and experimentalists have created increasing confrontations and distancing.

• Need to get past fights to form a “footbridge of communication” across the psychological canyon.

Three Main Perspectives

• 1. Experimentalus über Alles: field has its own intellectual justification; driven by its own questions; follows “hard science” model.

• 2. Clinicalus über Alles: therapy is mainly “compassionate art-form”; ideographic approach; advances come from within the field.

• 3. Let’s Exchange Information: both fields need each other, and should promote extensive interchanges of relevant information & collaborate in research projects.

JONES’ SUGGESTIONS FOR CHANGE

• Stop making villains of the other camp; drop false/simplifying dichotomies.

• Revise college curriculum to require spectrum of classes across exp’l/clinical. Make course content accentuate broader applications.

• Continuing education for “old”professionals.• Promote collaborative research in the

scientist/practitioner mode, e.g., NIDA• Teach all of us to evaluate research more

rigorously, e.g., shoddy research on EMDR.

Jones’ Suggestions (Cont’d)

• Licensure is big issue: none now required for therapists, compared to, say, plumbers, CPAs, dentists. Need stricter educational requirements on licensure.

• Educate public to distinctions between good vs. shoddy therapy, and to discount 1- min. therapies on talk shows, e.g., Dr Phil; Dr Laura.

DISCUSSION QUESTIONS

• What’s the medical model of behavioral disorders?

• Is psychiatry becoming a branch of psychopharmacology?

• What “APA politics” might impede acceptance of Jones’ suggestions for closing the gap between practitioners & academics?

We’re Friends for Life

• Farewell: good luck with your studies• May all your experiments yield significant F’s• Have a Merry Christmas