Overall, psychotherapy sprang from the idea that thoughts give rise to feelings which can, at times, propel action. If any one of these pieces of the triangle are changed (i.e. in exposure therapy the person changes their behavior by directly confronting the feared object. This, in turn, changes the way they think and feel about the object, which, alternatively, reinforces future interacts with the object…etc).

Doctors, nurses, physical therapist, and others in the medical/health field have the same issues with effecting change. This is where we get the term non-compliance or non-adherence. It is always phrased in documentation that the patient was “non-adherent to their medication regimen,” behavioral or treatment goals, etc… That is why motivational interviewing is so important. I really love the theory. I believe more of a gradual approach to change is more effective, personally – one that is not as threatening or pushy, but rather uses constant of assessment of willingness to change and motivation toward the goals as a gauge for the potential that the therapy and treatment will work. If motivation is low, obstacles must be outlined and assessment of the client’s current standing in Prochaska and DiClimente’s Stages of Change Model is helpful.

Unfortunately, insurance and managed care dictate how many clinicians treat their clients. I, believe, this has taken a lot of the creativity out of the field. Authorizing time is a difficult thing to do and managed care will not alway do so without first approving the techniques and approach. The time that is authorized is usually minimal and change is expected to occur within a short period of time. Psychotherapists get 8 – 12 therapy sessions at most before the client is expected to drop down to a lesser or the least restrictive level of care. In a lot of ways, these things are good to ensure that the therapy isn’t stagnate; but, mostly, it is there to control costs. Sadly, a lot of patients return and are recirculated back into the system. Case Managers and Psychotherapists also get handed huge case loads – up to about 20 people, sometimes – and are expected to give effective treatment and attention to all. Not to mention, the pay is minimal and, without a license it is difficult to find work that is not Per Diem or Fee for Service. I have seen psych drugs be very effective and I have seen horror stories. Luckily, personality usually stays intact, even when their is severe impairment in functioning. There really is no such thing as long-term psychoanalytic therapy anymore unless you have the money and can pay out of pocket pretty easily for it. As beets says, above, I don’t really like the emphasis on the medical model and “diagnosing” every person who comes in. It is like putting a person in a box. Insurance requires this and the stigma that follows the label is, almost, everlasting. As such, when a person comes in they, usually, have the diagnosis and history that follows them. The documentation is taken and all this objective data cannot, always, offset the bias, stereotyping, and countertransferences that typify DSM-IV diagnoses.

Have to say, I’m really not happy with the field because it can do more. On the whole, I think it’s a problem of bureaucracy and the system, rather than of theory and the inherently good intentions of practice.

This is my perspective. Would love to hear your thoughts.

Jessica
M.S. Clinical/Counseling Psychology

Maybe it’s just time we cut the crap and had a big conference among the medi-psycho types and the talkie-psycho types….where an agreement can be arrived at….to consider the body and mind as ONE, and then determine to find ways to help people in all their areas of distress by a truly caring national health system (maybe macked by a national banking system that doesn’t disappear real money on people just cause some debt is paid off….some reward I must say!!!)
Drugs are always a cheap and cynical substitute for the true power of healing….the human touch, either physical or mental.
But in this society the motive has been stolen.
We really don’t wanna HELP each other any more.
We’d rather just exploit them.

They are not useful at all.

I believe drugs can help, but therapy? Come on… 20 years of theraphy is like paying 200 bucks for every session every week for 20 years to listen to a woman/man saying:
“So… what do you think?”
Hey… we were there because we need YOU to tell US!!!

I totally agree with you. Hard science is better.

The clinical psychologists I’ve met seem to be all about the cognitive-behavioural therapy. Applying it, testing it, often both. And it’s funny how some research clinical psychologists in particular aren’t all fuzzy and humanistic – they treat people a bit like computers e.g. depressed person + CBT = cognitive error modification = less depressed person.

I did my research project on a CBT-type thing, and I expressed skepticism to my supervisor about the effectiveness of CBT, saying I just didn’t see how it could possibly work. Being an expert on the subject, she referred me to the hundreds of articles showing it does (obviously the hundreds of never-published-but-binned articles are on rubbish heaps somewhere as well!), and researchers are doing experiments alongside the therapy effectiveness experiments to try and elicit WHY it works. I don’t think they have much of an idea yet, but if it helps some people without recourse to drugs (which, from sort-of personal experience, doctors are very willing to throw out), so much the better.

If you’re interested in my research project, or the research group that does this kind of testing, feel free to email me and I’ll throw you some links!

1)I am not sure if and how it helps. This is a matter which I will not discuss here, because it touches many other issues. I have commented on a few things on some previous posts, and I will express more of my opinions in the future.

2)It is an applied science. Even the research that clinical psychologists perform happens in the whole context of therapy. I am a great fan of cognitive sciences, because they have taken back psychology to what was in the 19th century: the study of consciousness and behavior, without any further implications.

Concerning the subjects you mention in your last paragraph, these are the subject that I find most fascinating about psychology in this century. And I find even more fascinating the fact that we finally study them. Right now I have only one article http://encefalus.com/neurology-biology/split-brains-consciousness-michael-gazzaniga/ , but more will come.

Concerning the conversation with the clinical psychologist, why don’t you contribute to Encefalus? If you wish to become a guest blogger just send me an email. I planned to invite professionals to write, but I believed that my blog needed some more time to draw the necessary attention. If you agree just contact me.

You also say that “most other psychologists are occupied with being guests in b-rated tv shows,” but, of course, this is *far* from true. And, by the way, your example, Dr. Phil McGraw, does not appear in the April, 2008, list of clinical psychologists licensed by the State of Texas, where he’s based (http://www.tsbep.state.tx.us/roster_2008.html). While he does appear to hold a Ph.D. in clinical psychology, he can’t call himself a clinical psychologist until he has had the appropriate post-doctoral training and earned a license. You’d also be hard-pressed to find in that list of licensees even one name you would recognize as a media psychologist.

There are *many* clinical psychologists who do *only* assessments and no therapy or research, and there are many others who do only psychological research and neither assessments nor therapy. Most of the clinical psychologists on university faculties, for example, do research either primarily or exclusively. It’s the researchers who provide the clinicians with the scientific basis for their therapeutic work, including the humanists, as well as the behaviorists, psychoanalysts, and all the other varieties you cite. There are lots of other psychological specialties besides clinical psychology, all investigating some aspect of consciousness or behavior or whatnot, but clinical psychologists also make enormous contributions to the science. Research clinical psychologists are the ones who develop and validate psychological tests. Every clinical psychologist must earn a Ph.D., and to get a Ph.D. they have to do a doctoral dissertation, which requires research, not therapy (although therapy may be involved). So every single clinical psychologist is not only an informed consumer of basic scientific research, they are also contributors to that research.

So you believe that a grand unified theory of human psychology is within our grasp? I very much hope you are correct, but I don’t see how. There isn’t even any agreement on how the concept of “free will” works, or consciousness itself, for that matter. That’s still in the realm of the philosophers (e.g. Daniel Dennett). There’s no agreement on how many factors are involved in “personality” (though, curiously, all the most popular guesses are odd numbers: 3, 5, 9). How about this: Why don’t you invite some local clinical psychologist, or, better yet, a local professor of clinical psychology from a university, to lunch, and have a conversation with him or her about this stuff? I think you’d find it enlightening and fascinating.

Warm regards,

Dan Henderson
MA, Clinical Psychology 1992
Sunnyvale, CA