I think
Nancy is on target with her points. Cognitive neuroscientists have made a
lot of contributions to our understanding of human behavior and I often find
that students in my Abnormal Psychology classes have a poor understanding of
brain-behavior relationships. This thread is
particularly interesting to me as I've lately been thinking about other ways to
teach my Theories of Counseling course. Most of the undergraduate-level
texts in this area focus on theories that have very little to no empirical
support. The typical text in this area usually covers:
Freudian therapy
Neo-Freudian
(Jung to Horney to Kohut) therapy
Adlerian
therapy
Existential
therapy
Person-centered therapy
Gestalt
therapy
Transactional analysis
Reality
therapy
Behavior
therapy
Cognitive-behavior therapy
Family
systems therapy
Feminist
therapy
Of these
theories, some have received a bunch of empirical support (behavioral and
cognitive-behavioral, in particular) whereas others have very little (for
instance, existential and gestalt therapies). Moreover, the layout of
these texts seems to be different than the current empirical trends in clinical
psychology that are focusing on common therapeutic factors (therapeutic
alliance, client expectations, etc.) and the development of specific treatment
approaches for specific disorders (exposure and response prevention for OCD, CBT
or IPT for depression, etc.).
Does it make
sense to teach our students theories that have a place in the history of
psychology, but that are being replaced by more contemporary approaches?
Personally, I am very fond of existential and Adlerian therapies and
consistently find them to be helpful when working with clients.
However, when I am working with a client experiencing panic
attacks, an ethical approach is to use a treatment that has been
shown to be efficacious through empirical research. On the other
hand, there is an art as well as a science to therapy and, like most
of life, our clients usually don't fit into nice little diagnostic
categories. Having knowledge and skills in approaches that may
not be empirically-supported is often extremely useful in therapy.
As Irvin Yalom (2002) notes in his most
recent text:
"...non-validated therapies are not invalidated
therapies. Research, if it is to be funded, must have a clean design
comparable to research testing drug efficacy. Design demands include
"clean" patients (that is, patients with a single disorder without symptoms of
any other diagnostic groups--a type of patient uncommonly seen in clinical
practice), a brief therapy intervention, and a replicable,
preferably manualized (that is, capable of being reduced to a
step-by-step written manual) treatment mode. Such a design heavily
favors CBT and excludes most traditional therapies that rely on intimate
(unscripted) therapist-patient relationship forged in genuineness and focusing
on the here-and-now as it spontaneously evolves...Analysis of results of
empirically-validated therapy (see Weston and Morrison) indicates far less
impressive outcomes than has generally been thought. There is little
follow-up at the end of one year and almost none at two years. The early
positive response of empirically-validated therapies (which is found in any
therapeutic intervention) has led to a distorted picture of
efficacy. The gains are not maintained and the percentage of patients
who remain improved is surprisingly low. There is no evidence that
therapist adherence to manuals positively correlates to improvement--in fact,
there is evidence to the contrary. In general, the implication of the
empirically-validated therapy research has been extended far beyond the
scientific evidence." (pp. 223-224)
Despite
these controversies, I've been thinking about alternative ways of teaching a
Theories of Counseling course. The ideal format would be a two-course
sequence. The first course could teach the traditional theoretical
approaches and techniques. The second course could focus on
empirically-validated therapies (although these types of approaches are
given some attention in Abnormal Psychology courses). In the
meantime, it would be great if we had a text that gave more attention to
empirically-validated treatments.
How do
others on the list teach theories of counseling?
Rod
Reference:
Yalom, I. D.
(2002). The gift of therapy: An open letter to a new generation of
therapists and their patients. New York:
HarperCollins.
______________________________________________
Roderick D. Hetzel,
Ph.D.
Department of
Psychology
LeTourneau
University
Post Office Box
7001
2100 South Mobberly
Avenue
Longview, Texas
75607-7001
Office: Education Center 218
Phone: 903-233-3893
Fax: 903-233-3851
Email:
[EMAIL PROTECTED]
Homepage: http://www.letu.edu/people/rodhetzel
--------Original Message-----It was written:
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, November 26, 2002 6:10 AM
To: Teaching in the Psychological Sciences
Subject: Kohlberg et al
"I wonder if there are differences of opinions on this issue among listserve members along the lines of professional training. At the risk of forcing a dichotomy that doesn't exist (some of us, myself included, are trained as scientist-practitioners), are there differences on this issue between the the "experimental" TIPSters and the "clinical" TIPSters?"
For the record, I started off as a clinical psychologist. Although I understand that some of Freud forms a basis for useful theory, I am far more impressed by the contributions of cogntive neuroscientists than those of object-relations theorists. Impressed in that these provide me with useful ways to understand human behavior and experience in a way that very little of the old school, pre-scientific psychology does. If Freud made great contributions to Western culture but relatively small ones to psychology (at least the future of psychology) maybe his work should be taught in other disciplines.
I also know plenty of instructors who don't teach the brain because it is somewhat more difficult to learn and communicate while Freud remains "sexy" and conceptually simple. I am not saying that this is why some are defending him here on the list; I am mentioning it because I am deeply disturbed that I need to teach brain basics in more advanced psychology classes to students who passed psychology 1. These students also have much greater knowledge of Freud than the brain. They are not being adequately prepared for upper division work, IMO.
Nancy Melucci
LBCC
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