Thursday, October 28, 2021

Comments by Gerard

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  • I would think that a paradigm shift should also include how psychology views distress as the dominant view taught at universities is still that something “in” us causes our distress such as faulty thinking, cognitive distortions, activated schemas, etc. David Smail’s quote probably sums this idiocy up best: “It is about as sensible to seek the reasons for distress inside the ‘self’ as it would be to see feeling cold as a matter of personal responsibility.”

  • From the “Draft Manifesto for a Social Materialist Psychology of Distress (published in the Journal of Critical Psychology, 2012)

    When therapy succeeds it seems to be primarily a matter of two kinds of influence: on the one hand relationality (ordinary human compassion and understanding); on the other, coincidence with social and material and circumstances and resources.

    In the therapy literature is it well established that the clients who do best are generally young, attractive, verbal, intelligent and successful – YAVIS. By contrast, the people whose needs are described as ‘complex’ and requiring long-term treatment are usually the poorest. Where people have (or can obtain) more resources then they will have more scope to act upon whatever insights they might have gained.

    It is also well-established in this literature that so-called ‘non-specific factors’ are a consistent predictor of good outcomes: in other words, that the therapist and client are able to establish a good relationship. Indeed, unlike professional therapists, service users frequently declare the most ordinary aspects of therapy the most helpful: listening, understanding, respectfulness.

    Despite this, therapy is mostly presented as a matter of technique. CBT, psychoanalysis, and almost all other schools of therapy appear as specialist technologies of subjectivity, skilled interpersonal practices founded on specific assumptions, locked in place by particular theories and evidence bases. In a thoroughly commodified society it is perhaps understandable that some practitioners will want to have branded, marketable products, just as in a professionalised culture some will want to identify themselves as bearers of highly specialised knowledge and skills. Like everyone else, therapists must earn a living, so it is only to be expected that interest should influence how they present themselves and their work. Nevertheless, doing so distracts attention from the actual causes of distress by bolstering the belief that it is a mysterious state amenable only to professional help; it disables friends and family, who may feel that they could not possibly understand; and it negates the contribution of community, solidarity and trust. The presentation of therapy as specialised technique cheapens and oversells psychology itself; leads to resources being wasted comparing the marginal differences between this brand and that; and deflects effort and attention from the very real opportunities for psychological research and insight that are supplied by the highly privileged situation of the therapeutic encounter.

  • The cultish enthusiasm has not waned in the last 20 years and this is due to psychology students still being taught that therapy is quite simple: you merely apply a technique/tool to a diagnosis. Armed with only a hammer, EMDR proponents have with blind enthusiasm and dodgy science been able to make every presenting problem a nail and thus affirming EMDR’s cure-all status.

  • Psychiatry has had a long battle with itself to find and justify its place alongside actual medical professions which were founded on and supported by scientific knowledge. When you, for example, claim that poor sleep and poor eating are both symptoms and causes of an “illness” (depression) then don’t be surprised why you have become the laughing stock of the medical and scientific community.

    The Royal Australian and New Zealand College of Psychiatrists – https://www.yourhealthinmind.org/mental-illnesses-disorders/depression

  • The biggest problem with this article (apart from championing how treatment is a mechanistic endeavour ala the medical model) is that the science behind EMDR is speculative at best, but is sold as solid and supported fact. Many forms of exposure to trauma can be helpful (given the conditions about what constitutes a therapeutic relationship are met) and the most accurate description of EMDR I came across was: “what is effective is not new and what is new is not effective”.

  • Conceptual depth and breadth as proposed by some pluralistic integrative approach will still only provide general and oversimplified answers to a specific and complex question: what will work/bring about change/relief for this particular person, in this co-constructed process with this psychologist, who both have particular histories, backgrounds, current circumstances and relationships, who both make sense of things in these ways and who both have these preferences and needs?

    The closest (but still remote) answer to this is a real relationship and it astounds me how little (if any) time and effort are spent selecting people for psychologist’s training programs who 1) are naturally kind and generous, 2) have a bit of wisdom and humility about them, 3) are comfortable enough with themselves and thus other people and 4) display some basic interpersonal facilitation skills that can be harnessed. Instead it would seem universities prefer to select the “academic” ones, arm them with a bag of tricks aka CBT techniques, well equipped to “provide treatment” to their passive, unthinking, disordered patients.

  • “To all therapists and psychologists, please be careful with the phrases you use and the diagnoses you hand out.”

    It would be a massive waste of money and time if after 6 plus years of study to become a therapist or psychologist, you don’t come away with a certain kind of knowledge that allows you to reduce the impact of childhood trauma and neglect into a diagnosis. When these diagnoses and its symptoms have scientific sounding names and contain Greek or Latin phrases you can convince yourself that you are really smart and forget for a moment that you are merely a psycho-mechanic applying some or other technique instead of trying to actually understand the person in front of you.

  • In the VICE article Awais Aftab is quoted as follows: “These critics have no skin in the game because they are not the ones responsible for caring for these individuals; they are not the ones who have to witness the profound impairment of the psychotic individuals and the profound suffering of their families.”

    I just wonder who he thinks cares for these individuals and their families and who has to witness their suffering once they have been profoundly impaired by psychiatric “medication”

  • Not only a psychology without a soul, but without a clear identity. I would have thought that if the profession wanted to retain any credibility they should move further away from psychiatry, but the opposite is happening. We need to accept that for an ever decreasing number of psychologists it is still a calling and they are primarily moved by a need to be of service to others, while an ever increasing number (aka mini-me psychiatrists) see it as an easy and simple way to make money (“teaching” people to breath, tense and relax muscles and other “skills”, “psychoeducate” on the reptile brain and the amygdala, encourage them to keep diaries and challenge all those wrong thoughts, go for a walk, buy a pet, etc.). More and more people are waking up to this farce and that psychologists are less and less able to meet their need for human connection, genuineness and true understanding in times of crisis.

  • “Interventions varied significantly in length, lasting between 6 weeks and five years.”

    If it lasted that long, how did they isolate the effects of the therapeutic relationship and positive changes in a person’s life on eventual outcome?

    It seems overly simplistic and misleading to solely attribute change or positive outcomes to the so-called treatment and ignore a myriad of other factors including the fact that people are not passive recipients of “interventions”, but resourceful, meaning-making, self-acting agents who can reflect on the treatment they “receive” and decide if and how that is incorporated in their lives.

    A more humble stance would be to say that there are many factors and circumstances that contribute to positive changes and we believe that particular psychological techniques may play some role. At best we can only make probalistic generalisations from those who met the strict inclusion criteria for the studies to any other individual out in the community.

  • “The effectiveness and efficacy of cognitive-behavioral therapies (CBT) have been widely researched in comparison to other psychotherapeutic modalities.”

    Not true. The vast majority of CBT studies compare it to waitlists, that is, no treatment at all or “treatment as usual” (for example, seeing your doctor or community mental health nurse). Also, effectiveness and efficacy in CBT world is short-term “symptom reduction” based on a statistical measure and have nothing to do with the quality of life, a sense of meaning and purpose, satisfying relationships, rewarding employment or fulfilled needs, the lack of which was the reason most people came to therapy in the first place.

    So-called evidence-based treatments have little to do with guiding and informing treatment decisions, but there to protect psychologists and manage their own anxieties dealing with the complex lives of their clients. That complexity is shoehorned into a specific diagnosis and when the client being given the-best-there-is-proven-to-work-on-others but without the desired outcome, then the problem must lie with the client. Terms like resistant, lacking insight, unmotivated and not psychologically minded will then be used and the psychologist can avoid self-reflection and scrutiny.

  • Only 29% of the participants (n=26) completed the study. In addition to ingesting a toxic substance by halve of the participants, I am guessing this high drop-out rate also had something to do with the warm, caring, non-patronising and empathic attitude when participants are seen as inert objects acted upon by the clinical psychologists who “provided CBT” from a manual.

    Of note also is that CBT is known to subtly teach people that they are expected to report improvement on outcome measures whether this is in a research or clinical setting. Not sure we should take any studies involving CBT all that seriously.

  • Linked to the last example and a favourite out of the Cognitive Behaviour “Therapy” camp is: it is not a situation in and of itself that determines what you feel, but rather the way in which you construe a situation. In other words, how you feel is determined by the way in which you interpret situations rather than by the situations per se. For example, feeling depressed, anxious or angry are due to excessively negative interpretations of say, losses we suffer or the abuse and trauma we are subjected to and have little to do with the actual life events and circumstances that merely act as “triggers”. When psychology apes psychiatry, the result is drivel like this.

  • Complicit in this stupidification endeavour is the whole CBT movement in psychology who treat people like morons by 1) providing them “psycho-education” on the obvious and things which you can read online, for example, expect to react after a horrible experience, there is a fight/flight response, how you make sense of things determine to a large extent how you will feel and act , 2) teaching them life changing “skills” like breathing deeply when feeling anxious and 3) making groundbreaking suggestions like taking a bath or talk to a friend when you are stressed. And when these magical solutions don’t work they blame their clients for being emotionally unintelligent, resistant, difficult/personality disordered (whatever that means) or just not that psychologically minded

  • “The research organization MAPS, the Multidisciplinary Association for Psychedelic Studies, is currently sponsoring an effort to win FDA approval for MDMA’s status as a prescription medication by 2021. Similarly, psychiatrist Scott Shannon has argued that MDMA’s legalized prescription status could represent a significant shift in the medical model’s focus on chronic symptom management, in favor of personal transformation, given MDMA’s ability to catalyze therapeutic change.”

    That is a long-winded way of saying it is all about selling drugs and making money and using phrases like “personal transformation” and “catalyse therapeutic change” is to deflect from that

  • “There’s no way of knowing; there are too many factors involved.”

    Translated: “I have no clue as a I don’t practice actual medicine. When faced with any form of complexity i.e. humans or asked to provide an explanation for behaviour or reactions, I throw out smart sounding lines to deflect from my lack of understanding and care. Recently the questions I have been asked have become more difficult to answer as the public have woken up to our lies and deception, but please continue to trust me as I have a lavish lifestyle to furnish.”

  • Don’t know about NZ, but in Australia psychologists are dictated to by the Medicare system to get paid. This requires an assessment and diagnosis of a GP first in order to be referred to a psychologist. Financial considerations will then get in the way of independent thinking by professionals

  • The value for me of the PTM framework is the emphasis on context. We cannot attempt to understand ourselves or explain our behaviour independent from our life context and that is a good starting point. I also like the focus on needs such as positive identity, connection to others, belonging, control/agency, meaning and purpose and safety that can be threatened and how we react and adjust to, overcome, avoid or tolerate this as possible explanations for our distress and behaviour. It can obviously never be an all-encompassing account of our diversity, individuality and complexity, but the PTM framework just made a lot of intuitive sense to me.

  • It would be interesting to hear what this compromise would look like. Is it where you tell clients that anti-depressants are not actual medication as there is no chemical imbalance to be corrected but to use it anyway as it will “take the edge off” so that they can be “stabilised” enough in order for them to be receptive to your magical techniques that can rewire their broken brains?

  • “By being theoretically well developed and informative about how to conceptualize and approach client problems, these alternative diagnostic systems ironically make themselves less broadly appealing.”

    Agree. These theoretically well develop psychologists tend to be rigid and locked into their approach, make little space for common sense and tend to be deaf to the lived experience of their clients

  • Good article, because it gives psychologists ways to manage within a system and deal with colleagues that suffer from context blindness. The “ordinary language” strategy should be used with colleagues too and they should be reminded that labels provide no explanation, cannot inform any “intervention/treatment” and are a lazy and simplistic way to refer to people and what they are going through

  • Instead of only focusing on how some new mothers feel, diagnosing and then drugging them, we may also ask: “What are the life circumstances of the mother at the time of birth, leading up to and anticipated to be still present some time afterwards that can contribute to her feeling overwhelmed, helpless, guilt-ridden, unsafe, disempowered, hopeless, incapable, unsupported, etc.?”

  • “Schizophrenia is associated with “insanity, hopelessness, desperation, violence, stigma and discrimination,” negatively impacting those individuals diagnosed, their family, and service providers”

    This not just true for “schizophrenia” but also the other made up conditions psychiatry have come up with and I am not sure that renaming it will change anything. Psychiatry must come out and say that they have been misleading the public and change can start there

  • If I understand all this correctly then the problem is not psychiatry, but a society who have always been fearful of troubled people and their troubling behaviour. Society has then given psychiatry the license to deal with this “problem” in any way they see fit and in the process scientific considerations have become irrelevant. Moreover, the casualties of psychiatry’s approach are largely tolerated by society in the same way collateral damage is accepted in war as it served a purpose and was aimed at meeting the broader need to feel safe.

  • Just wondering what this “evidence base” is that you are referring to. Is it the research trials during which people are selected based on fictitious disorders, these people considered to be a homogenous group that can be studied solely based on sharing a non-existent disorder, their individuality and the unique causes of their distress dismissed, a treatment applied according to a manual that has no bearing on how therapy is practised in real life, where all other variables that might impact on outcome are ignored and where researchers with vested interests delight at the statistical significance of pre and post treatment measures?

  • In a recent Australian survey, 62 per cent of doctors said the top reason for a patient’s visit was a psychological complaint. The response to this was either drugs or a referral for CBT and Australians are left wondering why aren’t people getting any better as prevalence and “diagnostic rates” have been increasing every year. As Lucy Johnstone once put it, if we don’t focus on the origin of people’s distress and suffering then we are merely mopping the floor with the faucet still running

  • I do not believe that the variance and individuality of people can be captured in any “system”. Best a psychotherapist try and establish what will work for this person, who makes sense of their experiences in these ways, with this history, with these current life circumstances, who are connected to these people, at this point in their lives and in relationship with me. But since very few can work comfortably with complexity and tolerate ambiguity, they opt for “systems” and the lazy, short-hand, reductionist references to people contained in them.

  • My problem with these drug studies and when claims are made that there is a “reduction in symptoms” (whatever that might mean) is how do they account for the myriad of factors that could have contributed to doing or feeling better in addition to ingesting the drug. It is as if we are seen as an inert recipients of “treatment” and that nothing else goes on for us or in our lives while we just wait for the drugs to do their magic

  • I just don’t get how anyone with any sense of responsibility can prescribe a drug to someone in crisis when that drug has a black box warning about deepening your crisis and making you more suicidal. But psychiatry has never failed to disappoint us with yet another “model of care” and firmly establishing themselves as nothing more than sales agents for drug companies

  • My thoughts exactly. Psychiatry has nothing else to offer than their magic pills and when I looked at the original article to find out what is meant by “intensive contact” the authors were quick to point out that is not for every psychiatrist (?), how stressful it is for psychiatrists to care for people in crisis and that many are traumatised by this kind of work. And they make the astonishing suggestion that psychiatrist and suicidal patient should have daily consultations. At $450 an hour in Australia who can afford that, but it is all about the patient, right?

  • I have always found it astounding that psychology can make claims about the effectiveness of this or that approach or technique when there are so many variables such as the nature of the relationship between “therapist” and “client” that remain unaccounted for in their research. In any event, I do not believe that there are many psychologists, except for the insecure, mini-me wannabe psychiatrists ones , that would try and help people with a cookbook approach.

  • “If a person is overwhelmed with stressors (apparent causes of stress) and challenges beyond their adaptive capacity to keep everything under some sort of control and to maintain an internal equilibrium, and if they are severely decompensated by their experience, their weakest point of physical or psychological susceptibility is what will break down under the pressure; they will likely succumb in the direction of their greatest weakness, whether that means an undesirable gene is switched on, mood becomes disturbed, anxiety sets in as an intolerable burden, or a compromised immune response leads to sickness.”

    John, I liked your article and look forward to future contributions, but I wondered how the above, if I understood it correctly, can be applied to children who are subjected to abuse and trauma. Surely we don’t think of children under these circumstances as having experiences beyond their adaptive capacities, weak points, succumbing, susceptible or decompensating, but merely as children who are abused or traumatised. Furthermore, are we blaming these kids for not being resilient enough to deal with these experiences and that they should develop a greater capacity for it?

  • “Parents and educators often feel helpless in the face of children’s aggressive outbursts.”

    Just imagine how helpless and frustrated a child must feel when they are mistreated by these very same parents and educators

    “Children who have this problem are often referred to pediatric or psychiatric services for evaluation and treatment.”

    Children don’t “have this problem” unless you want to take the simplistic route and think like a psychiatrist. Children merely react and adapt as best they can to their prevailing circumstances and also model what they see from those closest to them. Also none of the suggested “treatment approaches” seem to focus on what in the child’s life might cause, contribute or maintain their reactions as the focus is on what is wrong with the child and how they can overcome “their problem”. Just silly

  • I don’t know what definition of “effectiveness” was used in this study – I guess it was whether there was ANY response to the treatment and not whether people were still “symptomatic” as two thirds of people’s self-reported symptom scores indicated that they still may have PTSD after six months. You get this kind of nonsense when psychologists want to sound scientific and do research based on medical model thinking

  • We may be giving way too much credit to CBT as something that can cause adverse effects. It is those psycho technicians and psycho educators (I find it hard to call this lot therapists) that cause the damage. A small percentage of people sees a psychologist for “symptom relief” and unfortunately the majority of “CBT therapists” are not equipped to meet other needs clients might have.

  • Sounds wonderful, but by focusing on the burned out employee (as if it they are lacking the resilience or robustness to deal with workplace stress) it diverts attention away from the myriad of organisational factors that contribute if not cause people’s worries and distress at work. The organisation doesn’t need fixing, only the individual. Sounds familiar?

  • Shaun f, you said “most of us professional therapists don’t adhere to the medical model much”. When you think that people respond based on their “strong emotions”, then you have ignored the whole context of the discussion, blamed people for being irrational and you as the authority had nothing to do with their reactions – that is exactly what the medical model does

  • I don’t think anyone has denied that a fear of needles actually exists and that it can be very distressing. What is worth considering though is that a fear of needles may not be a fear of needles. For some people there may be a displacement of a fear of something more abstract but nevertheless still threatening into something more concrete (such as needles, or dogs, or heights, etc.) in order to manage (avoid and control) better with that. Unfortunately I can’t cite any scientific psychological research to support these wild claims that these peoples’ fears may be very unique to them and that they have absolutely nothing in common with people who are actually afraid of needles based on injections gone wrong in the past

  • Brett, how can you know that your needle phobic client was helped more by the technique you used than by your care and respect for and genuine interest in helping them, your confidence, their perception of your expertise or their trust placed in you? My point is no “evidence based research” can measure this and by ignoring these factors as contributors makes psychology appear “scientific”

  • Brett, I believe MIA comments on this not to promote any particular approach but to highlight that when psychology uses the term “evidence-based treatments” it is banging the drum of the medical model. This model is flawed on so many levels which I am sure I don’t need to elaborate on, but worth mentioning is the stigmatising and discouraging message of the problem “in” people, or put differently that they “have” some or other fictitious disorder as result of some or other inner failing yet to be proven. This cannot be supported in any shape of form and thus MIA should report on this

    On psychotherapy research I find the claims that this or that approach is more helpful/effective than others astonishing. There are so many factors, circumstances and variables that can impact on outcome and these studies do not and cannot account for that. Using the term evidence based is thus more a selling point than something based in fact – a money spinner for those in private practice while the simplicity of it all very alluring for prospective clients

  • We already know that physical activity/exercise has many benefits under various circumstances. The problem with studies like this is that there is the implied equation with actual conditions where exercise has proven to assist recovery and re-occurrence (for example, certain forms of cancer), and thereby trying to appear scientific and informative

  • Not sure why MIA would report on a study that views depression through a medical lense, that is, a condition with symptoms, treatment and preventative measures. Most importantly though, a lense that ignores context and the life circumstances which contribute to these feelings, provide explanations for it and should inform any efforts to assist us feeling better

  • The same type of problem? People tend to react and adjust to, make sense of and try and manage with what happens to them in seemingly similar ways because they are people. If you see these as their problems, then you and I are worlds apart in terms of how we think about people

    With regards to your last paragraph, I have come across people who described their CBT therapists as cold, technical and appearing to follow a script or recipe. Needless to say they didn’t experience these therapists as helpful, especially when their severe and chronic anxiety had an interpersonal origin (which, and this is where you and I might differ, is most often the case)

  • To say that a particular approach is specifically and uniquely effective for any kind of problem makes the people with that problem a homogenous group which they are not and it obscures context which you claim matters. I am sure you would agree that people aren’t their presenting problems and that therapy requires a creative mind to assist this person at this particular point in time of their lives under these circumstances. As Steve mentioned elsewhere you have to re-invent therapy for every client. The one size fits all approach seems too simplistic for all our complexities

  • Agree with Steve. Therapy is not a bag of tricks, but a relationship. Once people feel connected with someone else, safe, respected and validated a lot of things seem to fall into place for them anyway. Not saying this is all they need as that will depend on their unique situation. CBT however goes from the standpoint that all people need is symptom relief, that their techniques will work for any client, under any set of circumstances which is medical model thinking in its pure form

  • “practitioners should stay up to date on all treatment options and present them to patients in a transparent and balanced way.”

    I will have a go at this: “I need to tell you that there is no such thing as “generalised anxiety disorder”, the thing your GP referred you for. I am not sure how they researched treatment outcomes in trials for something that doesn’t exist and therefore I am unable to tell you what will work for this thing you supposedly have. What I can tell you is that you and I may be able to figure a way out to work together on what is going on for you. There is no one size fits all in psychotherapy and knowing what will work for you in your unique circumstances may take some time. I will not charge you until we know if and how we are going to proceed. How does that sound?”

  • Personally I like the link that has been made between needs and more specifically threats to those needs and how people react, adapt and attempt to change their circumstances as an explanation for their “symptoms”.

    This framework is long overdue and well done to the BPS for showing initiative in this regard. The American Psychological Association and the Australian Psychological Society should be ashamed of how they have continued to live in the shadow of big brother psychiatry and how they have endorsed the lies and misinformation from this pseudoscience.

  • “In this climate of profoundly disrupted relationships the child faces a formidable developmental task. She must find a way to form primary attachments to caretakers who are either dangerous or, from her perspective, negligent. She must find a way to develop a sense of basic trust and safety with caretakers who are untrustworthy and unsafe. She must develop a sense of self in relation to others who are helpless, uncaring, or cruel. She must develop a capacity for bodily self-regulation in an environment in which her body is at the disposal of others’ needs, as well as a capacity for self-soothing in an environment without solace. She must develop the capacity for initiative in an environment which demands that she bring her will into complete conformity with that of her abuser. And ultimately, she must develop a capacity for intimacy out of an environment where all intimate relationships are corrupt, and an identity out of an environment which defines her as a whore and a slave.” – Judith Herman in Trauma and Recovery

    I guess we would all be irritable under these circumstances

  • Hello Steffen
    Thank you for your reply. “Evidence-based CBT” has to assume that those “mental illnesses” it treats are actual disease entities (as opposed to reifications) and that is where it all falls flat for me. CBT is an extension of medical model (let’s locate the problem in the individual) thinking and therefore cannot be taken too seriously as an approach that accurately and thoroughly explains (and by implication effectively addresses) people’s distress

  • Whenever I see articles mentioning CBT, I think of what psychologist, Oliver James, said in an article in the Daily Mail: “However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of ‘positive polish’. Unfortunately, shiny services tend not to last. CBT fails to address the root cause of many people’s problems, which often stem from traumatic experiences during their childhood.”

  • “Global Impression-Improvement (ES = 0.46), with 47% of those on micronutrients identified as ‘much’ to ‘very much’ improved versus 28% on placebo”

    Subjective ratings on “much” to “very much” improvements and the fact that 28% on placebo improved really don’t give me confidence that this trial showed us anything

  • “What a a delight when we hear that the kids we have treated are making friends, experiencing positive interactions with their families, sleeping and eating well.”

    It may just be that these changes are a result of some interest showed by the parents and yourselves and not because of the changes in what they ingest