Potentially Harmful Treatments.

I found the article of Lilienfeld(2007) very much informative and provocative. The article is comprehensively informative by 1) critically evaluating and updating earlier conclusions regarding deterioration effects in psychotherapy, 2) outlining methodological obstacles standing in the way of identifying potentially harmful therapies(PHTs), 3) providing a provisional list of PHTs(p.53). What I mean by “provocative” is that his argument of listing “PHTs” and calling for mental health professionals’ being aggressive in confronting the hazard posed by PHTs is compelling and legitimate with a possibility of inviting confrontation and complaints from those who have been and is using the treatments(i.e CISD, DARE, Boot-camp intervention, and so on). Even Lilienfeld was cautious by stating that the list of PHTs was tentative, I had a feeling that he must’ve had guts to put it forward in a public arena. Lilienfeld has my support on this move of heightening awareness of PHTs as he is indeed right that “knowing possible harms of therapies” is an obligation to therapists. Prior to reading the article, my knowledge and awareness on PHTs was very limited. I was surprised to know that 5 to 10% of clients(at maximum, p.54) could experience deterioration effects and the prevalence of PHTs was quite high(for example, about 25% of psychotherapists in the mid 1990s use two or more recovered-memory techniques, such as hypnosis and guided imagery…). I’m glad to have an opportunity to think about PHTs and issues related to them.

In the section of future research directions, Lilienfeld mentioned therapist variables and client variables. Specifically, clients can be at risk for deterioration when working with charismatic yet highly confrontational and intrusive encounter-group leaders. And client individual differences, such as high levels of borderline personality disorder traits, sometimes contribute to deterioration(p.64). As it is valuable to search for therapist variables and client variables in a respective manner, exploring a good match between them(so to speak “a goodness of fit”) will be intriguing and beneficial to therapy outcomes. This is rather off the topic, but I’ve seen many couples and parent-child relationships in conflict or trouble just because of the goodness of fit. One of my close friends who were very sensitive and anxious had hard time brining up her difficult daughter. Distressed by stress from the rearing, she came near to depression, and her girl had to go through play and speech therapies. Had my friend, I think, been easy going with the daughter, or had the daughter’s temperament been easy, things would not been exacerbated to the extent. Also, in my anecdotal experiences with many married couples around me, a couple gets to fight just because they are so different in personality wise. A husband is very much plan-driven, organized, and anxious while his wife being rather impulsive and enjoying spontaneity. The difference first appears to be not so significant, but accumulations and repetitive exposure to the difference results in a great deal of emotional conflicts. For a long time, I’ve been thinking a lot about compatibility among certain characteristics or personalities or traits, when involving in a relationship whether parent-child or marital ones. I do believe that the compatible or synergetic effects do exist in a working relationship as a therapist and a client, although no data or evidence is provided, and thus it does not sound scientific. My goal as a therapist if I becomes one someday is to know myself, letting along knowing harm. And by 1)actively and consciously searching for client variables compatible with my therapist style, 2) keeping myself exposed to ESTs and PHTs outcome literatures, I want to avoid potential harms at my best strength.

DBT : acceptance and change.

Lienhan(1993) presents the concept of Borderline Personality Disorder(BPD) with four approaches; 1) the single continuum approach , 2) biologically oriented approach, 3) eclectic-descriptive approach, 4) biosocial approach. The biosocial approach-emphasizing an interaction between an individual’s constitutional predisposition toward dysreguating emotions and an environment that invalidates the individual’s private experience(Hayes et al, 2004)-, is the theoretical foundation from which the author designed Dialectical Behavior Therapy(DBT) to treat individuals with BPD. According to the author, DBT is distinctive in several ways from CBT approaches to BPD, although most of DBT is application of CBT. DBT’s emphasis is on “dialectics”, which means the reconciliation of opposites in a continual process of synthesis(p.19). The synthesis in treatment occurs between acceptance and change. The therapist needs to accept the patient with a notion of unconditional positive regard, while coaching the patient to change. The therapist actively teaches the patient to accept him(her)self and to change to better regulation emotion, cultivate interpersonal skills, increase tolerance levels and so on. Over therapy period, more emphasis is placed on the process not the structure, while the therapist functions as a consultant to the person, which is core characteristic of the therapeutic relationship in DBT model.

The author introduces two studies showing the effectiveness of DBT with population of BPD. The first RCT investigated the treatment outcomes of DBT against individual psychotherapies. DBT participants reported a significantly less frequency of parasucidal behaviors, the low rate of treatment dropout, fewer days of hospitalization compared to TAU group. They were also rated higher on global adjustment by interviewers. However, interestingly, the participants did not report a success in accepting and tolerating both themselves and reality. But not surprisingly, accepting and tolerating seemingly problematic oneself or world is very tough task, even to an average people. The second RCT investigated the effectiveness of addition of group skills training to DBT as individual therapy is the usual therapy. It is found that the DBT group skills training is not efficacious.

According to Hayes et al(2004), there are more body of empirical evidence showing that DBT is effective in treating substance use eat-disorders as well as BPD. And growing consensus is made that DBT is the only empirically supported treatment for BPD. This can be attributed to Lienhan’s design of DBT with a focus on BPD, following her expertise dealing with parasuicidal individuals with BPD. The processes of how DBT was first designed and supported is one of exemplary ways to expand the list of ESTs. 1) Extracting remarkable resemblance of seeming different psychological behaviors and disorders through research work(e.g parasuicidal vs. BPD), 2) Integrating existing treatment approaches to best serve a specific population(e.g adopting “acceptance” form “Zen” and “change” from CBT), 3) Gaining evidence of the effectiveness of the treatment through RCTs and clinical trials.

Emotion Theory & Contemporary Learning Theory

Barlow(2000) and Mineka & Zinbarg(2006) both explore the nature and development of anxiety disorders. The authors agree that psychological vulnerability based on early experience is very important in understanding the etiology and maintenance of anxiety disorders. In addition, they share a strong emphasis of the effect of uncontrollability and unpredictability in the process of the disorders. Based on the research in animal studies, the authors contemplate the consequence of early experience with uncontrollability and conclude that a sense of control during development seem to inhibit the development of different anxiety disorders. This result is linked to studies in human regarding the concept of locus control. Evidences point that parenting style of encouraging the healthy sense of control over environments and experiences appear to equip children immunize against emotionally stressful events. Those studies taken together, Barlow(2000) strongly asserts that uncontrollability works as mediator between negative life events and the emergence of anxiety early in development. More specifically, Mineka & Zinbarg(2006) show how perception of uncontrollability is possible source of individual differences in vulnerability to the effects of social phobia, posttraumatic stress disorder, generalized anxiety disorder.

Barlow(2000) takes integrative accounts of cognitive science and neuroscience and learning theory in order to explain emotion related disorders such as anxiety and depression. He points out that different types of emotions are similar or distinctive in terms of phenomenological, behavioral expressive, psychometric and neurobiological leve(p.1249). For example, while the emotions of fear and anxiety seem to be fundamentally different emotions, anxiety and depression seem to be share common traits. Unlike Barlow(2000), Mineka & Zinbarg(2006) focus on the effectiveness of contemporary learning theory with a focus on anxiety disorders. Mineka & Zinbarg(2006) show how a contemporary learning theory contributes to capture the richness and complexity associated with development and course of anxiety disorder. Moreover, their argument-learning approaches are better grounded in research findings, and thus they provide a more explicit factors promoting and inhibiting the development of different anxiety disoders- is compelling with a wide variety of evidences. In addition, the authors suggest contemporary learning models can provide a good way of identifying populations at higher risk for anxiety disorder and preventive measures to be taken in parenting style.

Both emotion theory and contemporary learning approaches add comprehensive and cogent explanations on the etiology and development of anxiety disorders. They incorporate the role of genetic and temperamental variables into their models based on empirically supported research findings. Not only do the research finings and models make us understand the nature and processes of anxiety disorders in depth, but they also provide important implications on the treatment or prevention approaches to the disorders.

In reaction to an article, the etiology of depression.

I think exploring the etiology of illness bears significant importance in that causes of a disorder provide a great deal of information on treatment approaches. For instance, in treating a depression, a therapist can make an individualized approach to a patient, depending on the etiology. It makes more sense when the therapeutic approach to exogenous depression is differentiated from the one to endogenous depression. Admittedly, there are not many cases that causes are well identified in mental disorder. Furthermore, one primary risk factor does not necessarily account for outbreak of a disorder even though it is identified. In this regard, I do agree with the authors, Kendler, Kuhn & Prescott(2004), that exploring how distinct risk factors interact in the etiology illness is an essential topic to be addressed.

In order to test interaction among risk factors-the personality trait of neuroticism, sex, and adversity resulting from exposure to stressful life events(p.631)-, the authors tested out both additive and multiplicative models. And two types of interaction effects were found. The first is between neuroticism and adversity. Individuals with high neuroticism were more sensitive to the depressogenic effect of adversity. This finding is also empirically supported with previous research and can be explained by a stress-vulnerability model. The second is between adversity and sex. The effect of high adversity on onset of depression episodes was pronounced regardless of sex. However, the effect of low adversity on onset of depression episodes was pronounced only in women. This finding is not consistent with previous research.

I think the authors did not provide a good explanation of the interacting effect between sex and adversity. Initially, they tried to distinguish the research by pointing out that their work examined sex differences in reaction to the level of threat posed by stressful live events, instead of to the presence versus absence of them(p.631). In spite of the none-typical, but strong finding of interaction effect between sex and adversity, the authors only suggested that the origins of the sex effect in risk for major depression may lie in the considerably high risk in women for episodes that are unrelated to the experience of high-treat events(p.635). They should have explained more the link between the differentiated measurement by ‘posed threat' and the interaction effect. Also, they could have explored the possibility of a population-based sample resulting in the difference, so that the following replication study might clearly address this question.

Week9. SC, Routine and Predictability.

I found Bootzin & Epstein’ chapter, Stimulus Control, very interesting and helpful in that it clearly shows us how to set a sleeping routine by controlling stimulus around a sleep.
Focusing on internal cues, using bed for only for sleeping(except sex) even when you are awake during a night, waking up at the same time, do not taking a nap. Even though, those instructions are intended for PWI(a person with Insomnia)(p.167), they are very powerful and practical guidelines for lay people, too. As scientifically proven more and more like Voelker(2006), sleeping is one of essential components affecting human’s emotions and functioning at many aspects. If PWI is treated with SC of typical 4-week therapies, the benefit of establishing sleeping routines and getting a body accustomed to it will be tremendous without a doubt. On top of the effectiveness of the SC, it seems to be very much efficient in light of possibly easy dissemination of the treatment. Although the authors state that the implementation of the treatment is not as easy at it looks, mostly because of compliance issue, the procedures and techniques of SC does not seem complicated for a therapist to learn and practice.

In line with previous reading of ‘Behavioral Activation’, I think SC for PWI shares many components with ‘Routine Regulation’ in BA. As it is well illustrated a case with a depressed person, as a way to break free of depression, a client and a therapist worked together to establish a good sleep hygiene(p.264, Jacobson, Martell, & Dimidjian(2004)).
The importance of setting up a sound routine in those readings reminds me of a TV program called “my kids changed” in Korea. The program introduces a family having a trouble with problematic kids like being aggressive and out of control, and shows how the family changed with an assistance of an expert. The first thing the expert does after observing the life of the family for a couple of days is to set up “family routines”. This is almost the same regardless of types of problematic behaviors. The family routines include wake-up, bed times, meal times and play times, etc. In combination with other strategies for a family, restoring and sticking to routines works as a basis for the family functioning. And at the end of program, the intervention really works and the effect is sometimes reported to last for a follow-up check, depending on how well the family maintains routines.

I’m very much surprised to see the importance of routines every time I watch the program. And I wonder why the routine is so important to those kids in the program. My conjecture is that routines provides predictable environment especially for children. Children with less sense of time than adults are not in a good position to construct their own stuff on a regular basis. This means that they’re less capable of creating predictable environment on their own. Once routines are set and maintained in a consistent manner, children can predict what would come next and what their roles will be depending on a specific routine. This predictability leads children to have a reliable and stable feeling about their environment, getting their body ready for current and next routines.

It will be quite intriguing to see more explanation on the mechanism of how routines change people’s behaviors, thoughts and emotions.

Good to know about BA.

I was happy to be able to broaden my knowledge on a recent wave of Behavior therapies ; manly Behavioral Activation, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy, Functional Analytic Psychotherapy. I was also surprised to know there was indeed a wide range of new therapies rooted on behavioral tradition : Integrative Behavioral Couple Therapy, Mindfulness-Based Cognitive therapy on top of aforementioned ones. Looks like more integrated approaches taking variation forms are continuously created, assessed, and validated, which is good to know.

Among them I particularilly liked BA’s approach : BA is designed to help individuals approach access sources of “positive reinforcement” in their lives, which can serve a natural antidepressant function(p.255, Jacobson, Martell, & Dimidjian(2004). I do agree with the concept and approach the researchers proposed. My experiences tell me that the positive reinforcement is very powerful in keeping and creating a good momentum in many aspects and it indeed works as a natural antidepressant. There was a certain time that I was very stressed under pressures of fulfilling obligations as a student and employee. Those skills and knowledge required for a good performance in each area was quite different. I had to be very good at time and work management as well as code switching from a student to employee and the other way round. Initially I was kind of ambitious and optimistic that I can well manage both, but things didn’t turn out to be that way with times. I was first frustrated, then got depressed, in spite of not to the extent to a disorder. Sometimes I soaked in to a feeling of self-pity with a thinking of why a life is so hard on me. If I compare what happened to me with “ACTION”(p, 264) Choose: Instead of waiting for the mood to naturally pick up, I decided go to Yoga class about 4 times a week over lunch time. For a starting phase, there seems to be more cost than benefit associated the trial; all my muscles were sours, I had to sneak out for a quick lunch and gave up having fun eating and talking with co-workers over lunch time. Try : I was not discouraged by the cost, and kept practicing Yoga. Integrate : practicing Yoga became my favorite routines. Observe : I noticed that I felt way much better especially when I was down. Not only did Yoga help me in emotional change, it also helped me sleep well and gain body flexibility and strength. Yes, I was reinforced with the positive outcomes I experienced. Never give up : for about 2 years I kept attending Yoga classes. Yoga was a powerful tool for me to snap out of negative mood and keep my spirit up. This had a great impact on my performance at both work and study, and therefore I was able to go through though times with rather stable and happy emotions.

I was a bit lengthy about BA approach based on my experience. It is not analytic from scholastic perspective, but I was glad to do some analysis as guided by the researchers. It was quite intriguing for me to associate some concepts and approaches with my own stuff.

Meta analysis as an advancement in methodology.

I was surprised to know that the idea of gauging which therapy is effective, by seeing “what treatment by whom, is most effective for this individual, under what set of circumstances(Paul, 1967, cited in Ellis(1999)) had a such long history. Paul’s statement is in line with what exactly ESTs are aiming for with empirical evidences. Then, I am more surprised to see that still little has been known and achieved in term of the outcome research of psychotherapy, compared to the long history of the idea. Was it because of lack of knowledge in methodologies to address it? Or our professionals’ propensity to stick with “anecdotal impressions”? Probably combinations of many other reasons.

That’s why I was delighted by reading two articles, Engels, Garnefsk & Diekstra(1993) and Butler, Chapman, Forman & Beck(2006). At least it was obvious that scientific approach with a focus on rigorous methodology was one of desirable advancements made in the area of outcome research. Compared to Engels, Garnefsk & Diekstra(1993), Butler, Chapman, Forman & Beck(2006) employed more sophisticated ways of reviewing meta-analyses. For example, to resolve an issue of obscurity caused by the practice of aggregating the outcomes for all treatments across all disorders into one meta-analysis(p.18), Butler, Chapman, Forman & Beck(2006) breaks down the comparison of research outcomes into 13 disorders, starting with depression to chronic pain. This approach enables me to have a clearer and more extensive understating on the efficacy and effectiveness of CBT on specific disorders covered in this article. In addition, I also find the introduction of concept and interpretation of those concepts, categorization of effect sizes as “controlled” vs. “uncontrolled” and “U3”, very informative. I was aware of the ways of conducting meta-analysis, like by effect sizes, but did not have a concrete knowledge on how they were calculated and what would they mean. And therefore, it was amusing to get to know how to read figures in meta analysis and apply the knowledge to research I need to be familiar to or will carry out later on.

In spite of the strengths in methodologies in reviewing meta analyses and rigorous research efforts, it is still striking that not many of evidences do exist, telling us what therapies work for better on what disorders with what patients. Consider Butler, Chapman, Forman & Beck(2006) calls for comparing CBT with other forms of therapy in search for the answers to the question. And Engels, Garnefsk & Diekstra(1993) ends with a question “which particular type of client receives the greatest benefits from RET?” The research on this topic is challenging, but frustrating at the same time because I’m amazed with innovative methods of handling problems in research, but still they are considered not good enough in some ways.

A thought on research related “working alliance” vs. “ESTs”

In first reading the section of “the therapeutic relationship and EST” of Krischenbaum and Jourdan(2005), I was not sure about the relationship between ESTs and the therapeutic relationship. If I place a much of the emphasis on Rogers’ core conditions or common factors or the therapeutic/working alliance(p. 48), does this mean that I’m in support of psychotherapy equivalence because core conditions or common factors or the therapeutic/working alliance do not take specificity-driven approaches in the process and outcomes of psychotherapies? On the contrary, If I value ESTs with scientific approaches more than general elements in psychotherapies, does this mean that I underestimates the effectiveness and powerfulness of the relationship between therapists and clients during treatments(as a matter of fact I liked the summary “It is the relationship, stupid!”(Norcross, 2001, p.347)? Or do I not understand what ESTs or Working alliances enough to draw a good picture of those two research movements that are seemingly conflicting.

I kept trying to answer questions aforementioned in my mind, while reading this week’s articles. Here is a brief conclusion I came to. Research to address the present of therapeutic relationship were very much similar to ESTs in a sense that researchers made an scientific approach of measuring alliance(i.e.Working Alliance Inventory) and making it “nonspecific” variable(P.273. Castonguay et al.(2006)) And research to address the future of therapeutic relationship(i.e. how the alliance develop, especially at its very first step, different patterns of alliance development, alliance research with personality disorders or minority populations (Castonguay et al.(2006)) is in the same direction where research on ESTs are going to. It is because research directions are broken down to answer the impact of the specific conditions and specific patients on success of treatments like ESTs try to answer. Since the research on therapeutic relationships will be focusing on the mechanism of working relationship, not aiming for therapies itself, clinical significance will be amplified when research findings from both directions are integrated.

What is credential knowledge?

Meehl(1997) made a strong argument why discrediting knowledge claims based solely on anecdotal impressions in clinical psychotherapy is critical. And he also made it clear that it is through scientific approaches that we can discriminate a knowledge claim that brings good credentials from one that does not. But while reading the article, I could not grasp what constitutes a solid set of credentialed knowledge. If it is a collective set of credential knowledge, I think the five noble intellectual traditions (psychometrics, applied learning theory, behavior genetics, descriptive clinical psychiatry, and psychodynamics) could be good examples? But, on a second thought, Are they all made up of credentialed knowledge? Obviously, not all the component of each tradition do consist of credentialed knowledge. What will be a sound determinant to set up a good tradition against inherent none-credentialed components? How we deal with some variation and different forms of credentialed knowledge?

In addition, if a credentialed knowledge is powerful research findings with solid scientific methods, the time required for validation to be credentialed knowledge are the same? What is the degree of deal with spectrum of possibly credential, highly credential, and credentialed knowledge? For example, behavior genetics have found out etiologies of some disorders, such as schizophrenia and affect disorders, which cannot be refutable. A recent research, in the same area of behavior genetics, found out that gene seemed to play a different level of roles in infants’ IQ according to parents’ socio-economic status. With poverty conditions, the effect of gene on IQ seemed to be controlled, while higher SES group, the effect of gene on IQ appeared to be much more influential. To me, those two finding looks credential based on data, but the former one looks more clear-cut and more credential because there are less environmental variables involved. In this case, can I say the former study is more credential than the latter one?

I was very much confused with not just for this "credential kwnoledge" issue. The issue of integration also looks quite difficult for me. In order for psycotherapy to be integrated into practice of psychology, "making whole"(Sechrest & Smith, 2004), I think credentialed knowledge is one of the key paratemeters to be considered. Then, how can I draw the link between credential knowledge and the integration of psychotherapy into practive of psychology? I came accross with so many queries I could not think of answers with my limited knowledge. Hewwww.

In support of ESTs.

In general sense, I do admit that psychotherapeutic equivalence exist at a clinical settings. There are cases that people with problems show alleviated symptoms by just being wait-listed for psychotherapy. Furthermore, people with depression often bounce back without a treatment in real world. If treatments conducted on those cases, most types of interventions cannot but work at the end. On the other hand, complex symptoms such as severe
schizophrenia accompanying with personality disorders are hard to deal with by any kind of psychotherapy. And therefore there could be no differences in the effects, according to types of treatments. Even if the effects by different kinds of therapies do exist, the effect size caused by specific therapy techniques is only 0.2, according to meta analyses by Luborsky(2002). All of those lend a support that “dodo bird do exist”.

However, I agree with EST approaches that specific therapies are helpful to "specific people in specific situations with specific problems” with two reasons. First, the goal of evaluation research is to be applied to practice to better, if not the best at all times, serve people with problems as mental professionals. In light of practical utility of research, EST is in a stronger position to promote practices based on rather validated techniques. Second, accumulative evidences, such as Hunsley & Giulio(2002), shows that substantial differences among psychological treatments do exist. In practice, clinicians adopting EST report the effective results of treatments with a wide variety of problems, phobias, eating disorders, anxiety orders, etc. Why not implementing EST if I come to treat specificity-driven disorders or patients where evidences are provided. I think patients will benefit from this approach likewise it is safer to depend on clinically-tested drugs, even though there is no 100% guarantee that the treatment or drugs will also effective on themselves.

In addition, I also think it is more constructive, as Hunsley & Giulio(2002) suggested, that future directions of research should focus on expanding the list of ESTs that work for specific conditions and 2) improving upon the therapeutic impact of currently available ESTs, rather than being involved in a contention of “psychotherapy equivalence vs. specificity”. In line with this, research to explore the interplay between clients’ personal characteristics and treatment, as briefed mentioned in Chabless and hollon(1998), will be quite interesting in a sense that it could identify exceptional cases which are like an outlier in statistics. Because those outliers bear significant implications in clinical settings, it is also worthwhile making an endeavor to pursuit it.

History, present and future of DSMs

Reading three aricles one by one in a chronological order(Persons(1986), Allen(1998), Widiger & Clark(2000) was quite intiriquing in a way that I felt like walking through history of DSMs along with issues and concerns for and against them. I was able to grasp the footsteps of argument for including psychological processes based on research findings.From a psychological standpoints Persons(1986) argued for utilizing the advantages of the symptom approach in research, which was quite new ideas bacK then when DSM-III was used. Then Allen(1998) well illustrated current DSM-IV in a informative way with a rather neutral standpoints, from organization and contents of the DSM-IV to Challenges to validity and future directions. For Future directions, he just introduced advantages and disadvantages of three approches-Current Categorical, Prototype, and Dimensional ones. He does not voice out which one is best for more effective advancement for DSM-V. However, Widiger and Clark(2000) anticipated the future direction of DSM with integration model of “diemension” and “Categories”. (“The fundermental struture of future DSMs may consist of an ordered matrix of symptom-cluster dimensions, a diagnostic table of the elements that are used in combinations to describe the rich variety of human psychopathology, P954.) He cited a wide variety of research findings which lead him to this conclusion. For instance, the role of newroticisim in internalizing disorders and the role of personality dimension, particulary disinhibition in externalizing disorders. They are empirical evidences that dimension or latent factors for co-occurrence of certain types of disorders do exist, which provides a ground for calling for the inclusion of this aspect over the process of revision in DSMs.

P.S I’m kind of overwhelmed to see a huge and innovative progress in research methods in efforts for psychologists to be emprically strong with their studies. Extensive longitudinal studies, sophistcated statistical methods like SEM based on solid theoretical grounds, very structured designs to address specific research questions....

Thoughts on Dawes's writing.

I had a couple of thoughts on “Excerpts from Dawes”.

First of all, current trends of emphasis on empirically-validated therapies are good evidences that his strong voices that clinical psychologists should adopt scientists model seriously has been heard. Ever since he raised this issue in 1994, there have been accumulating researches examining the outcomes of specific therapies on specific disorders. For example, there are well-supported evidences that exposure therapies works well on PTSD or extreme fears, and CBT on eating disorders, panic attacks, OCD. Although limitations are still with the research -statistical significance can not be easily extended to clinical one, clinical psychologists, in general, have made a good progress in terms of endeavoring to apply sciences into practices.

Second, in accordance with his firm standning in support of a scientist, clinical psychologists should be aware of what they do know and do not know. With this awareness, they will better try to 1) be very discreet on words and actions affecting other people’s lives and 2) refer to research findings in search for answers to problems at various professional settings.