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Saturday, May 26, 2012

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You will not like what I have to say. No matter---you can moderate it, if you wish---no one will ever know---or care---what is to follow. I am sorry. But there seems to be no definable good attending your science. As best I'm able to understand it, people seek help; are counseled and prescribed certain psychotropics to make them feel better. Perhaps my understanding is faulty? Ok, then. I am just a dumb carpenter.

Thanks.
Dave.

Dave,

I’ll respond at length because these are fairly commonplace perceptions and there is no point to just simply saying you're wrong.

First, some clarification: physicians/psychiatrists prescribe medication. People in my profession, clinical psychology, don't prescribe medication, except in two states (NM and LA) where prescription privilege programs and certifications exist. Even in those states, only a small percentage of psychologists pursue prescription privilege.

At the moment, I have just one patient on medication in addition to therapy with me. Through trial and error it became clear that this patient does better with medication. Over the long run, perhaps 15-20% of my patients have been on medication; most were prescribed by family physicians before they consulted with me, although I do, from time to time, refer someone to a psychiatrist. Not always, but more often than not, the benefit is very clear and definable.

The psychotherapy research indicates that we help people substantially, but I wouldn't call what we do a science. Scientific method is employed in psychological research, but for a variety of reasons, it isn't a science like chemistry or biology, number one reason being the problem of free will and determinism. But that does not mean there are no research methods that can tell us things about psychological life and behavior. If you actually investigate psychological research, which covers many areas of psychological functioning besides clinical work, you'll find that psychologists are quite good at making predictions in a number of areas. There is extensive quality research into memory, learning, cognition, perception, organizational behavior and the influences of situations on thoughts, feelings and behavior.

In the practitioner arena, research-supported aptitude assessment and employee selection is quite impressive, with nice predictive ability. Neuropsychology also has a strong research basis. In my twenties, I trained in neuropsychology both academically and for two years in hospitals. I did not continue with my studies in that area and would not present myself as a neuropsychologist today, but that knowledge has been invaluable in several cases. Most notably, in two cases, after consulting with me, patients were sent straight to hospitals where they received live-saving emergency surgeries. That's a definable benefit.

As for psychotherapy, extensive psychotherapy research with control groups shows definable positive benefits for short-term psychotherapy. There is also considerable research showing even more benefit from longer term therapies. Additionally, Consumer Reports (1995) ran a large scale survey that found substantial benefits based on patient-reported outcomes. Again, psychology isn't chemistry, but we do have research-based indications of clinical benefits. Here's http://horan.asu.edu/cpy702readings/seligman/seligman.html>Martin Seligman's critique of the C.U. study.

For something more recent (there has been a great deal of research since the CU survey), I highly recommend Roth and Fonagy's book: What Works for Whom: A Critical Review of Psychotherapy Research.

While it isn’t research, I’ve also seen the very clear benefits to patients in my office. Many people who arrived as desperate skeptics left with thoroughly changed opinions of psychotherapy.

Dave, there is a lot of research out there, but you would have to make the effort to investigate. If you don't, you really shouldn't be expressing either a negative or a positive opinion about psychotherapy. It isn't intellectually honest, it isn't fair to people who do what I do for a living and it isn't fair to people who need help. Lives are sometimes at stake. And quality of life is at stake for every person who walks through my door seeking psychotherapy because the difficulties in their lives have reached the point where their own efforts, as well as the efforts of family and friends, have gotten them absolutely nowhere.

I stand corrected, Doc. No hard feelings, I hope. Facts are always better than perceptions, hmmm? Thanks for putting up with my rants.I'll stick to more ephemeral comments about matters of philosophy. Carry on then,

Warmly,
The Carpenter.

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