Ok, good intentions aside...a response to Marc's responses. Marc: But having an alternative interpretation of the data, and teaching students to be critical analysts of those data, is a far cry from cautioning them that psychology is an "inexact science" and so we should feel somewhat free to use -- or not -- those data.
Me: Egad, yes there's a difference, and I do make that difference clear (or try to). Generally, when I'm responding to the students' inability to cope with ambiguity, I can't in good conscience say that the data are exact and allow students to think there is no ambiguity in science. Marc: And I do not think that treatment decisions are exempt. Surely there are *some* data that bear on the status of a client; perhaps it is not an exact fit, and perhaps it won't work exactly as it worked in the literature. I assume that there are a lot of data out there on almost any sort of person (broadly interpreted) that one is likely to come across. Me: I don't think that treatment is exempt from using data, but I would maintain that the symptoms that most folks present with are, to quote Alan Esterson, "nebulous emotional/behavioral symptoms". I'm not sure that the data (or maybe the majority of therapists) are really up to the task to the degree that you're assuming. I'm sure one can find data on almost anything...but the validity and reliability of the data have to be critically considered, and therapists are dealing with "nebulous" (love that word) client symptoms. Marc: Otherwise I would wonder, what do we teach our students in those five long years of school? Me: Are you talking about a PhD? Of all the people out there who are licensed to practice psychotherapy, what is the proportion of PhD to Master's level therapists? Marc: As for the worried well: are there not data on anxiety? Don't we know what causes it, and cannot we learn from talking with the client what the source of some of that anxiety is? Can we not then make recommendations, based on our understanding of anxiety and how it works and what sorts of treatments have worked with anxiety (even if not exactly the mild form presenting)? We learn what we know about what makes people do what they do. They we try to apply that knowledge to individuals. Me: My reference to the worried well was really a reference to people who present with symptoms that are not clearly a diagnosable illness, the symptoms don't meet obvious or specific criteria. That doesn't't mean there are no data, only that there's probably a lot of data to be sifted and evaluated. I think that the constrictions of time, insurance company demands, charting and the like, all conspire to push people in the direction of 'clinical experience'. Which takes me back to the issue of how data are 'packaged'. I don't think that most clinicians willfully ignore data, they are overwhelmed by it...and yes, some are undereducated about it. Do I think that's ok? No, but it is understandable. We have an obligation to find ways around that. I don't train clinicians, but I was one and I was taught to use known, evidence-supported treatment practices and I did. Marc: If you mean that most clinicians stop reading the literature when they get out of school, I'm horrified. If I thought that my urologist had stopped reading the literature, I'd surely go to another. Me: I maintain close friends & colleagues who still practice, and many of them keep up with data that interest them, which is problematic. However, I can also see that the sheer volume of research is a tremendous thing to try to keep up with. Marc: In any health-related field, it seems to me that it is an absolute requirement that one stay current with the literature. To not do that -- and I hope I'm misunderstanding you here -- is reprehensible. The result can only be things like SRA and false memories. Me: I think a psychotherapist is less like a specialist (e.g. your urologist) than a general practitioner. I don't know what the data are on GP/Family docs, but I'll bet they sure aren't keeping up with the data on all of the stuff that they treat or encounter...but they diagnose and prescribe anyway. Again, not a good thing, but the discipline of psychology could really find ways to ensure that we aren't like GPs, getting data from drug company reps. I don't know how, except that licensure and CE credits are supposed to do the job but they don't. Are the criteria for CE's too loose? (You can get CE credits for learning about EMDR in some states!) Should we be retested to maintain a license? Should standards be national rather than state-by-state? And, Master's level clinicians have to be included in all of these standards. Marc: To whom are we condescending? We're the *PhDs* for cryin' out loud. We went to school; we learned the data; we understand how things work (inasmuch as anyone can). Do you mean we condescend to our students? How so? Our clients? Again, how? Do you feel your doctor condescends to you when he tells you that your labs suggest you have a bacterial infection, and that a particular antibiotic has been shown to be effective when it works on that sort of bacterium? But I'm not sure I understand what you intend, here. Me: I was speaking about the tone I hear in comments like this: "We're the PhD's" "Clinical practice is based on psychological science, or it's nothing at all different from going out and having a beer with a friend. (Except perhaps it's more expensive.)" I am not a PhD, but even so :-) I agree with your second statement. But geez, what a way to elicit defensiveness! I hear all kinds of finger-pointing and remarks about fakes, quacks and charlatans as divisive and presumptive of ill-intent on the part of what are really well-meaning but poorly guided professionals, many of whom came into the field before the data amounted to what they do now, and who were the people who trained the next generation. In short Marc, we agree on much but I think we are coming from very different parts of academia and perhaps experiences in the field, which inform our ideas about how to approach the problem we agree on. Also, Alan Esterson's response to "medical model", states ideas I share but much more clearly than I could. Oy, more time consumed not grading, but this is more fun. Ruth -----Original Message----- From: Marc Carter [mailto:[EMAIL PROTECTED] Sent: Friday, December 03, 2004 6:58 PM To: Teaching in the Psychological Sciences Subject: RE: Actuarial data (was APA President-elect) Ah, right. Grading.... But I gotta go one more round. Ruth writes: Let me clarify, I am not in any way, minimizing the importance of the data. Nor am I saying that practitioners are not vulnerable to illusion and bias. But as this listserve consistently demonstrates, there is often disagreement about how to interpret the data, whether the methodology stands up and so on. Excellent and necessary disagreements which ultimately enhance our pursuit and understanding of information. That said, I was speaking to the use of data more broadly than actuarial predictions, in fact I was thinking primarily of treatment decisions (which I believe have been less fully researched) not diagnosis. Me: Perhaps then, I misunderstood, and apologize. But having an alternative interpretation of the data, and teaching students to be critical analysts of those data, is a far cry from cautioning them that psychology is an "inexact science" and so we should feel somewhat free to use -- or not -- those data. And I do not think that treatment decisions are exempt. Surely there are *some* data that bear on the status of a client; perhaps it is not an exact fit, and perhaps it won't work exactly as it worked in the literature. But as long as there is a reasonable degree of overlap, it's sure better than flying by the seat of one's pants. I assume that there are a lot of data out there on almost any sort of person (broadly interpreted) that one is likely to come across. Otherwise I would wonder, what do we teach our students in those five long years of school? Ruth: But, FWIW, here are some thoughts on the actuarial data issue : Actuarial data are not necessarily available in forms useful to the average clinician (Swets, Dawes & Monahan (2000) Psychological Science Can Improve Diagnostic Decisions, Psychological Science in the Public Interest, 1:1 reflect on this and other pertinent issues). Actuarial data are not necessarily available for the clients many clinicians work with most frequently, e.g. the worried well (as opposed to violent offenders). Me: >From your earlier comment (again, this may be my bad), I took it to mean that you were taught and that you teach students that data are approximations and as such need to be tweaked (I'm paraphrasing; please correct if I misunderstood this) based on the particular needs of the client. This is fine, if you have some principled manner for making such decisions, other than "clinical experience." The point of the research I alluded to is that the data are better than data modified by clinical experience. And I still maintain that being faithful to an inexact fit of the data to a case is better than trying to (essentially) guess at some alternative. As for the worried well: are there not data on anxiety? Don't we know what causes it, and cannot we learn from talking with the client what the source of some of that anxiety is? Can we not then make recommendations, based on our understanding of anxiety and how it works and what sorts of treatments have worked with anxiety (even if not exactly the mild form presenting)? This is what I mean. We learn what we know about what makes people do what they do. They we try to apply that knowledge to individuals. Ruth: Stanovich says "the field, and society, would benefit if we developed habit of 'accepting error to reduce error.'" (How To Think Straight About Psychology, p. 169). But the problem is that when you are the victim of the error (the violent offender is not predicted to reoffend, but does or one breast cancer patient's cancer is missed until it is too late) or closely connected to the victim, it's pretty hard to be that pragmatic. Interestingly, in other areas, society seems very ready to accept errors in models which impinge on civil rights. Me: But the whole point here is that in the long run you're going to be more accurate (make better decisions) by reliance on the data than by modifying the data based on [insert here any other criterion currently available to us]. So although it is unquestionably true that mistakes are horrible, the point is that *you reduce the likelihood of making mistakes by reliance on the data.* So yes, being the "inexact" science it is, psychology doesn't give us perfect guidelines and we're going to make mistakes. But that sincere concern about mistakes, coupled with an understanding of the data and that the data are the sole best guide, leads ineluctibly to reliance on the data, not experience. I'll reiterate: the data are all we have to separate us from frauds and charlatans and people who just make things up. Clinical practice is based on psychological science, or it's nothing at all different from going out and having a beer with a friend. (Except perhaps it's more expensive.) Ruth: And on research findings generally: Academicians/researchers don't seem to be finding many ways to "sell" the research. Would that science sold itself but it doesn't. Education is the best route, and we get to do that with our students, but most clinicians working today have left academia behind...so the findings have to be made into products. Some folks, like David Myers and Martin Seligman, seem to have done this well and recently. Me: I'm not sure what this means here. If you mean that most clinicians stop reading the literature when they get out of school, I'm horrified. If I thought that my urologist had stopped reading the literature, I'd surely go to another. If I thought they *all* had, then I'd take up religion. In any health-related field, it seems to me that it is an absolute requirement that one stay current with the literature. To not do that -- and I hope I'm misunderstanding you here -- is reprehensible. The result can only be things like SRA and false memories. Academic psychology should not have to "sell" its research to practioners; they should be clamoring for it. We shouldn't have to sell it to our students, either; we should simply and carefully explain to them that what makes psychology different from speculation is data, and that if they can't handle that, they should perhaps consider some other vocation. Ruth: Our tone, as academics/researchers, often comes off as condescending (not unlike the liberals' recent approach to values and religion) which certainly doesn't beckon others to come close and learn. Me: To whom are we condescending? We're the *PhDs* for cryin' out loud. We went to school; we learned the data; we understand how things work (inasmuch as anyone can). Do you mean we condescend to our students? How so? Our clients? Again, how? Do you feel your doctor condescends to you when he tells you that your labs suggest you have a bacterial infection, and that a particular antibiotic has been shown to be effective when it works on that sort of bacterium? But I'm not sure I understand what you intend, here. And Ruth, with wisdom: That's it for me, I have papers to grade, tests to write... Me: Me too. But it's fun debating these things, neh? m -----Original Message----- From: Marc Carter [mailto:[EMAIL PROTECTED] Sent: Friday, December 03, 2004 12:38 PM To: Teaching in the Psychological Sciences Subject: RE: APA President-elect Yes, he did. And others have, in a variety of domains. Given the actuarial data and then asked to "individualize" the prediction (or diagnosis), the therapists or physicians make it worse. I do not intend to minimize the importance of experience, but neither should we forget that we are all human and are all subject to illusion and bias. Minimizing the importance of the data is the most serious disservice we can do to our students. After all, the data are what make us different from charlatans and hucksters. m -- Marc Carter Baker University Department of Psychology Assistant Professor, Itinerant Scientist, Inveterate Skeptic, Former Surfer. --- The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little. ----- Franklin Roosevelt -----Original Message----- From: Paul Brandon [mailto:[EMAIL PROTECTED] Sent: Friday, December 03, 2004 2:28 PM To: Teaching in the Psychological Sciences Subject: RE: APA President-elect >I'm going to quote from Stanovich (_How to Think Straight about >Psychology_, 7th ed., p 167): > >"In a variety of clinical domains, when a clinician is given >information about a client and asked to predict the client's behavior, >and when the same information is quantified and processed by a >statistical equation that has been developed based on actuarial >relationships that research has uncovered, invariably the equation wins." I believe that Paul Meehl further demonstrated that when clinicians tried to 'improve' the actuarial predictions they actually made them worse! >So, yes, a clinician can make clinical judgments about an individual >tailored to that individual, when he or she does this, over the long >haul the clinician is going to err more than be correct. Using the >aggregate data means that you must accept some error in particular >cases in order to reduce overall error. There is a *lot* of research on this. > >The problem with second-guessing the data is that we do not know *how* >we should deviate from the actuarial predictions. We might have a >clinical "sense," we might rely on our clinical "experience," but those >judgments are as fraught with bias as any human judgment. It's only by >(somewhat slavishly) adhering to the data that we can be even >reasonably sure we know what we're doing. > >Otherwise, it seems to me, we might as well forgo the expense and time >of going to school. > >m > >-- >Marc Carter -- "No one in this world, so far as I know, has ever lost money by underestimating the intelligence of the great masses of the plain people." -H. L. Mencken * PAUL K. BRANDON [EMAIL PROTECTED] * * Psychology Dept Minnesota State University * * 23 Armstrong Hall, Mankato, MN 56001 ph 507-389-6217 * * http://www.mnsu.edu/dept/psych/welcome.html * --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED] --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED] --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED] --- You are currently subscribed to tips as: [email protected] To unsubscribe send a blank email to [EMAIL PROTECTED]
