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Psychotherapy reader – summaryIntroduction and the importance of scientific research
Paper 1: Understanding why some clinicians use pseudoscientific methods
The value of clinical experience
Research contradicts the popular belief that experience ad clinical competence is positively
related with clinical competence.
Difficult for mental health workers to learn from experience
Experienced clinicians are no more accurate than less experienced clinicians given the same
set of information
Judgmental validity appears to be unrelated to experience regardless of the type of
information presented to the clinician.
Experienced vs. Less experienced clinicians
In one study number of years in clinical experience was negatively related to the validity of
the diagnosis: older psychiatrist made less reliable judgements which could be related to
the improvement of clinical psychiatry in recent years.
Experienced clinicians are no more accurate than less experienced clinicians given the same
set of information
When practitioners are required to search for information to decide what judgement should
be made (interview) experience may be related to validity for some judgement tasks.
Clinicians vs. Graduate students
Clinicians have rarely been more accurate than graduate students, regardless of the type of
information presented
Clinical psychologists were not better in predicting IQ from Rorschach test data than were
graduate students who where just beginning their training
Treatment-plans written by certified counsellors were more valid than those written by
graduate students in masters degree programs (had no education in this area at all)
In making diagnoses based on the Rorschach or MMPI, psychologists were not better than
beginning graduate students.
Graduate students followed over time
More accurate judgement of client profile following a specialized training but additional practicing
experience did not improve accuracy
,Clinicians and graduate students vs lay judges
Given non-psychometric data: clinicians and graduate students tend to be more accurate than lay
judges depending on characteristics of the lay judges and characteristics of the subjects.
Clinicians did outperform lay persons when making a diagnosis based on biographical and history.
The same was not true for the data of a normal subject. This may be seen as an indication that
clinicians overpathologize normals because they are not used working with them.
Students that were Trainerin MMPI protocols outperformed students that were not in the accuracy
of their judgement which speaks for the effect of training.
Clinicians differing in experience and specialized training
Mental health professionals who received special training are more accurate than other mental
health professionals.
Summary:
Pseudoscientific methods are invalid because it si difficult to learn from clinical experience.
The value of training in mental health care profession is supported
Mental health professionals who received special training are more accurate than other mental health
professionals
The value of experience is questionable
Judgements and decisions made by experienced or less experienced clinicians do not differ significantly
Experienced clinicians no more accurate than advanced graduate students
Longitudinal results show that graduate students become more accurate after didactical training but not
after training at a practicum site:
!Training is of value but it can be difficult to learn from clinical experience!
Why is it so difficult to learn from experience?
Professionals are succeptible to numerous cognitive and nvironmental influences that can result in poor
judgements and a failure to learn from experience
1. Heuristics
Can be efficient but the are faillable and can lead clinicians to fail to learn from experience
Availability heuristic
The clinicians judgements are influenced by the ease with which certain cases can be
recalled. For example they are more likely to remember a case where a test indicator and a
rymptom were present than when the occurrence was not congruent.
o An illusory correlation occurs
o The act of making a diagnosis can determine which client details/ symptoms are
being remembered and which are not
Illusory correlations
,2. Biases
Confirmatory bias
o Review patient information in such a way that they seek and attend to information that can
support but not counter their initial hypotheses.
o Also occurs in the diagnostic decision making process
Many diagnoses are made already after a few seconds and were not changed even after
receiving disconfirming information
o Can lead to overconfidence which in turn leads to a greater reliance on confirmation bias
o Both concepts can help to explain how hypotheses are initially formulated : initially the
clinician is subject to a number of biases that shapes his or her decision and later they
engage in confirmatory hypothesis testing and become overconfident which makes them
unable to overcome biases.
Hindsight bias
Mental processes that occur when individuals generate explanations for events that have occurred.
The nature of feedback in clinical practice
Typically no feedback of their judgement and decisions
When asking clients for feedback many errors can occur:
1. Client my be reluctant to dispute therapist
2. May be unaware of or unable to describe some of their own traits
3. Psychological tests often describe traits that are suitable for the majority of the population
o P.T. Barnum effect: „I try to give a little something to everyone“
4. Client may accept the validity of the test report on face value.
5. May also happen that they receive misleading feedback when they make incorrect interpretations
but convince clients that the are correct.
, Paper 2 – Psychotherapy and implicit mental processes
1. Mental problems involve undesired experiences
2. Psychological problems are seen as insolvable
3. Mental problems are very often perceived as absurd
Implicit mental processes
One dominant concept in the literature on psychotherapy: mental disorders are a cause when a
person becomes alienated from him/ herself
Assumption: psychopathology persists because of certain motives from a part of their personality/ego
to which the person does not have sufficient access.
Goal: understanding how to integrate the inaccessible parts into the personality (bring it into
consciousness)
The ego (I think in this context the ego is referred to as the part of our psyche which we are
conscious of and which we might intuitively call our “self”) does not organize or control
unconscious and automatic processes. It is rather one component of these processes.
Conscious learning: enables us to acquire skills is one means by which we are able to flexibly
attune our automatic processes to the environment which is necessary to take advantages of
changes in the environment.
Implicit learning: unconsciously our minds make connections between situational
characteristics and those characteristics and our own behavior. conditioning
- Can be quick and powerful in emotional, biological relevant situations
we don’t really have access as to the way how we think, interpret or use our memory
distinction between two forms of representations to describe our knowledge and our personal
view
propositional representations:
- by nature linguistic, symbolistic and factual
- easily expressed in language
- enable us to reason logically and to use deductions to arrive at a particular opinion
Schematic representations:
- Holistic by nature
- Integrate different sensory information that we acquired through the experience with a
particular object or situation
- Not easily expressed in words (still very precise)
- Contain emotional information about the situation or object at hand that cannot be
supplied by propositional representations
Link to psychotherapy:
- Clients often have a very schematic representation of their situation in a sense that they
have a very holistic view. They see situations as hopeless and probably made a negative
emotional link to certain stimuli that are now activate in their schematic representations
and thus make them suffer from the consequences.
- The therapist should not respond to those holistic views my means of assurance (logical
reasoning/ it will turn out good).
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