The first myth about "evidence-based" therapy
Published on October 31, 2013 by Jonathan Shedler, PhD in Psychologically Minded
Media coverage of psychotherapy often advises people to seek "evidence-based therapy."
Few outside the mental health professions realize the term “evidence-based therapy” is a form of branding. It refers to therapies conducted by following instruction manuals, originally developed to create standardized treatments for research trials. These "manualized" therapies are typically brief, highly structured, and almost exclusively identified with cognitive behavioral therapy or CBT.
Academic researchers routinely extoll the “evidence-based” therapies studied in research laboratories and denigrate psychotherapy as it is actually practiced by most clinicians in the real world. Their comments range from the hysteric (“The disconnect between what clinicians do and what science has discovered is an unconscionable embarrassment.”–Professor Walter Mischel, quoted in Newsweek) to the seemingly cautious and sober (“Evidence-based therapies work a little faster, a little better, and for more problematic situations, more powerfully.”–Professor Steven Hollon, quoted in the Los Angeles Times).
The entire blog post is here.
Monday, November 25, 2013
Sunday, November 24, 2013
Are We Just a Bunch of Busybodies? (A Dialogue)
By Tamler Sommers
Flickers of Freedom Blog
Originally posted on November 9, 2013
Here is an excerpt:
Busybody [biz-ee-bod-ee] noun: a person who pries into or meddles in the affairs of others.
In the last two posts I described some cases that are hard for most existing theories of moral responsibility to handle. What I want to suggest in this post is that any attempt to develop a systematic condition-based theory of responsibility is both philosophically and morally problematic. Why morally? Because it turns philosophers into meddlesome busybodies who stick their noses in the private affairs of others and don't know when to mind their own business.
So here's the set-up: Sarah is at a party and has a few too many glasses of wine on a relatively empty stomach. She overhears her colleague Emma talking about her in another conversation. She’s drunk and she misinterprets the meaning of Emma’s remarks and gets angry. Without thinking, Sarah confronts Emma and lets off some biting insults about her performance at work. Emma is bewildered and humiliated in front of her friends and co-workers. Soon, the initial misunderstanding is cleared up and Sarah, mortified, realizes she was way out of line. She offers a bunch of drunken apologies, but the damage is done. Emma is furious and resentful and Sarah feels terrible overwhelming guilt what happened.
The entire blog post is here.
Note: This philosophical discussion of morality has direct implications for both individual and couples therapy.
Flickers of Freedom Blog
Originally posted on November 9, 2013
Here is an excerpt:
Busybody [biz-ee-bod-ee] noun: a person who pries into or meddles in the affairs of others.
In the last two posts I described some cases that are hard for most existing theories of moral responsibility to handle. What I want to suggest in this post is that any attempt to develop a systematic condition-based theory of responsibility is both philosophically and morally problematic. Why morally? Because it turns philosophers into meddlesome busybodies who stick their noses in the private affairs of others and don't know when to mind their own business.
So here's the set-up: Sarah is at a party and has a few too many glasses of wine on a relatively empty stomach. She overhears her colleague Emma talking about her in another conversation. She’s drunk and she misinterprets the meaning of Emma’s remarks and gets angry. Without thinking, Sarah confronts Emma and lets off some biting insults about her performance at work. Emma is bewildered and humiliated in front of her friends and co-workers. Soon, the initial misunderstanding is cleared up and Sarah, mortified, realizes she was way out of line. She offers a bunch of drunken apologies, but the damage is done. Emma is furious and resentful and Sarah feels terrible overwhelming guilt what happened.
The entire blog post is here.
Note: This philosophical discussion of morality has direct implications for both individual and couples therapy.
Vantage Points and The Trolley Problem
By Thomas Nadelhoffer
Leiter Reports: A Philosophy Blog
Originally posted November 10, 2013
Here is an excerpt:
The standard debates about scenarios like BAS (Bystander at the Switch) typically focus on what it is permissible for the bystander to do given the rights of the few who have to be sacrificed involuntarily in order to save the many. In a paper I have been working on in fits and starts for too damn long now, I try to shift the vantage point from which we view cases like BAS and I suggest doing so yields some interesting results. Rather than looking at BAS from the perspective of the bystanders—and what it is permissible (or impermissible) for them to do—I examine BAS instead from the point of view of the individuals whose lives hang in the balance. This change of vantage points highlights some possible tensions that may exist in our ever shifting intuitions.
For instance, let’s reexamine BAS from the point of view of the five people who will be killed if the bystander perhaps understandably cannot bring herself to hit the switch. Imagine that one of the five workmen has a gun and it becomes clear that the bystander is not going to be able to bring herself to divert the trolley. Would it be permissible for the workman with the gun to shoot and kill the bystander if doing so was the only way of getting her to fall onto the switch?
The entire blog post is here.
Leiter Reports: A Philosophy Blog
Originally posted November 10, 2013
Here is an excerpt:
The standard debates about scenarios like BAS (Bystander at the Switch) typically focus on what it is permissible for the bystander to do given the rights of the few who have to be sacrificed involuntarily in order to save the many. In a paper I have been working on in fits and starts for too damn long now, I try to shift the vantage point from which we view cases like BAS and I suggest doing so yields some interesting results. Rather than looking at BAS from the perspective of the bystanders—and what it is permissible (or impermissible) for them to do—I examine BAS instead from the point of view of the individuals whose lives hang in the balance. This change of vantage points highlights some possible tensions that may exist in our ever shifting intuitions.
For instance, let’s reexamine BAS from the point of view of the five people who will be killed if the bystander perhaps understandably cannot bring herself to hit the switch. Imagine that one of the five workmen has a gun and it becomes clear that the bystander is not going to be able to bring herself to divert the trolley. Would it be permissible for the workman with the gun to shoot and kill the bystander if doing so was the only way of getting her to fall onto the switch?
The entire blog post is here.
Saturday, November 23, 2013
The Moral Responsibility of Volunteer Soldiers
Should they say no to fighting in an unjust war?
Jeff McMahan
The Boston Review
Wednesday, November 6, 2013
Here is an excerpt:
Traditional Just War Theory
The idea that voluntary enlistment in the military can be morally problematic derives from a neglected tradition of just war thinking. This approach to the ethics of war informed the work of some of the classical just war theorists, such as the 16th century Spanish philosophers Francisco de Vitoria and Francisco Suárez. It was, however, gradually abandoned by thinkers whose views together constitute what I call “traditional just war theory.” The traditional theory has been ascendant since at least the 18th century, but the older approach has recently been resurrected by a group of “revisionists.” The best way to understand revisionist just war theory is to contrast it with the traditional theory, which has had a profound influence in shaping common sense thinking about the ethics of war, in part because it was developed in tandem with the international law of armed conflict.
According to traditional just war theory, a soldier does no wrong by fighting in an unjust war, provided that he or she obeys the rules regulating the conduct of war. This theoretical idea finds powerful expression in public sentiments. For centuries it has been regarded as not merely permissible but conspicuously noble and admirable for a soldier to go to war without any concern for whether the war’s cause was just.
The entire article is here.
Jeff McMahan
The Boston Review
Wednesday, November 6, 2013
Here is an excerpt:
Traditional Just War Theory
The idea that voluntary enlistment in the military can be morally problematic derives from a neglected tradition of just war thinking. This approach to the ethics of war informed the work of some of the classical just war theorists, such as the 16th century Spanish philosophers Francisco de Vitoria and Francisco Suárez. It was, however, gradually abandoned by thinkers whose views together constitute what I call “traditional just war theory.” The traditional theory has been ascendant since at least the 18th century, but the older approach has recently been resurrected by a group of “revisionists.” The best way to understand revisionist just war theory is to contrast it with the traditional theory, which has had a profound influence in shaping common sense thinking about the ethics of war, in part because it was developed in tandem with the international law of armed conflict.
According to traditional just war theory, a soldier does no wrong by fighting in an unjust war, provided that he or she obeys the rules regulating the conduct of war. This theoretical idea finds powerful expression in public sentiments. For centuries it has been regarded as not merely permissible but conspicuously noble and admirable for a soldier to go to war without any concern for whether the war’s cause was just.
The entire article is here.
Swastikas, Slurs and Torment in Town’s Schools
By Benjamin Weiser
The New York Times
Originally published November 7, 2013
Here is an excerpt:
“There are anti-Semitic incidents that have occurred that we need to address,” John Boyle, Crispell Middle School’s principal, said in a deposition in April.
In 2011, when one parent complained about continued harassment of her daughter and another Jewish girl, Pine Bush’s superintendent from 2008 to 2013, Philip G. Steinberg, wrote in an email, “I have said I will meet with your daughters and I will, but your expectations for changing inbred prejudice may be a bit unrealistic.”
Mr. Steinberg, who, along with two other administrators named as defendants, is Jewish, described the lawsuit in recent interviews as a “money grab.” He contended that the plaintiffs had “embellished” some allegations.
The entire story is here.
The New York Times
Originally published November 7, 2013
Here is an excerpt:
“There are anti-Semitic incidents that have occurred that we need to address,” John Boyle, Crispell Middle School’s principal, said in a deposition in April.
In 2011, when one parent complained about continued harassment of her daughter and another Jewish girl, Pine Bush’s superintendent from 2008 to 2013, Philip G. Steinberg, wrote in an email, “I have said I will meet with your daughters and I will, but your expectations for changing inbred prejudice may be a bit unrealistic.”
Mr. Steinberg, who, along with two other administrators named as defendants, is Jewish, described the lawsuit in recent interviews as a “money grab.” He contended that the plaintiffs had “embellished” some allegations.
The entire story is here.
Friday, November 22, 2013
The Morning Morality Effect: The Influence of Time of Day on Unethical Behavior.
By M. Kouchaki & I.H. Smith
Edmond J. Safra Center for Ethics, Harvard University
Psychol Sci. 2013 Oct 28
Abstract
Are people more moral in the morning than in the afternoon? We propose that the normal, unremarkable experiences associated with everyday living can deplete one's capacity to resist moral temptations. In a series of four experiments, both undergraduate students and a sample of U.S. adults engaged in less unethical behavior (e.g., less lying and cheating) on tasks performed in the morning than on the same tasks performed in the afternoon. This morning morality effect was mediated by decreases in moral awareness and self-control in the afternoon. Furthermore, the effect of time of day on unethical behavior was found to be stronger for people with a lower propensity to morally disengage. These findings highlight a simple yet pervasive factor (i.e., the time of day) that has important implications for moral behavior.
The entire story is here, hiding behind a paywall.
Edmond J. Safra Center for Ethics, Harvard University
Psychol Sci. 2013 Oct 28
Abstract
Are people more moral in the morning than in the afternoon? We propose that the normal, unremarkable experiences associated with everyday living can deplete one's capacity to resist moral temptations. In a series of four experiments, both undergraduate students and a sample of U.S. adults engaged in less unethical behavior (e.g., less lying and cheating) on tasks performed in the morning than on the same tasks performed in the afternoon. This morning morality effect was mediated by decreases in moral awareness and self-control in the afternoon. Furthermore, the effect of time of day on unethical behavior was found to be stronger for people with a lower propensity to morally disengage. These findings highlight a simple yet pervasive factor (i.e., the time of day) that has important implications for moral behavior.
The entire story is here, hiding behind a paywall.
‘Don’t Tell Coach’: Playing Through Concussions
By Jan Hoffman
The New York Times - Well
Originally published November 5, 2013
Here is an excerpt:
An extensive report about sports-related concussions in young people, released last week by the Institute of Medicine and the National Research Council, made recommendations that included bolstering research, collecting data, examining injury protocols and educating the public. But the report identified one particularly stubborn challenge: the “culture of resistance” among high school and college athletes, who may be inclined to shrug off the invisible injuries and return immediately to the field.
“There is still a culture among athletes,” the report said, “that resists both the self-reporting of concussions and compliance with appropriate concussion management plans.”
The entire story is here.
The New York Times - Well
Originally published November 5, 2013
Here is an excerpt:
An extensive report about sports-related concussions in young people, released last week by the Institute of Medicine and the National Research Council, made recommendations that included bolstering research, collecting data, examining injury protocols and educating the public. But the report identified one particularly stubborn challenge: the “culture of resistance” among high school and college athletes, who may be inclined to shrug off the invisible injuries and return immediately to the field.
“There is still a culture among athletes,” the report said, “that resists both the self-reporting of concussions and compliance with appropriate concussion management plans.”
The entire story is here.
Thursday, November 21, 2013
Morality in Psychotherapy
By John Gavazzi and Samuel Knapp
Submitted to The Pennsylvania Psychologist
Individuals rarely, if ever, enter psychotherapy with the explicit goals of understanding the origins of their morality, their moral reasoning skills, or matching their expressed moral ideals with their everyday behavior. Nonetheless, clients and psychologists always bring their moral values into the psychotherapy session. Although morality and moral values may not be an overt part of the therapeutic dialogue, many psychotherapy sessions are rife with moral issues, value-laden comments, ethical conflicts, and moral reasoning.
If morality is seldom overtly addressed in psychotherapy, what makes morality so important to the practicing psychologist?
The entire article is here.
Submitted to The Pennsylvania Psychologist
Individuals rarely, if ever, enter psychotherapy with the explicit goals of understanding the origins of their morality, their moral reasoning skills, or matching their expressed moral ideals with their everyday behavior. Nonetheless, clients and psychologists always bring their moral values into the psychotherapy session. Although morality and moral values may not be an overt part of the therapeutic dialogue, many psychotherapy sessions are rife with moral issues, value-laden comments, ethical conflicts, and moral reasoning.
If morality is seldom overtly addressed in psychotherapy, what makes morality so important to the practicing psychologist?
The entire article is here.
Talking with Patients about Other Clinicians' Errors
By Thomas H. Gallagher, Michelle M. Mello, and others
The New England Journal of Medicine
Originally published November 6, 2013
Here is an excerpt:
The rationales for disclosing harmful errors to patients are compelling and well described. Nonetheless, multiple barriers, including embarrassment, lack of confidence in one's disclosure skills, and mixed messages from institutions and malpractice insurers, make talking with patients about errors challenging. Several distinctive aspects of disclosing harmful errors involving colleagues intensify the difficulties.
One challenge is determining what happened when a clinician was not directly involved in the event in question. He or she may have little firsthand knowledge about the event, and relevant information in the medical record may be lacking. Beyond this, potential errors exist on a broad spectrum ranging from clinical decisions that are “not what I would have done” but are within the standard of care to blatant errors that might even suggest a problem of professional competence or proficiency.
The entire article is here.
Thanks to Gary Schoener for this information.
The New England Journal of Medicine
Originally published November 6, 2013
Here is an excerpt:
The rationales for disclosing harmful errors to patients are compelling and well described. Nonetheless, multiple barriers, including embarrassment, lack of confidence in one's disclosure skills, and mixed messages from institutions and malpractice insurers, make talking with patients about errors challenging. Several distinctive aspects of disclosing harmful errors involving colleagues intensify the difficulties.
One challenge is determining what happened when a clinician was not directly involved in the event in question. He or she may have little firsthand knowledge about the event, and relevant information in the medical record may be lacking. Beyond this, potential errors exist on a broad spectrum ranging from clinical decisions that are “not what I would have done” but are within the standard of care to blatant errors that might even suggest a problem of professional competence or proficiency.
The entire article is here.
Thanks to Gary Schoener for this information.
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