2007년 9월 24일 월요일

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.

2007년 9월 18일 화요일

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.

2007년 9월 10일 월요일

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.

2007년 9월 5일 수요일

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....