You’re here–great! This post would have been here yesterday, but I took an extra two shifts at work this week and am worn out for other reasons.
In the last post, we talked about the Clinical Method and the Actuarial method, and declared the Actuarial method more accurate. We are still under bullet point number 1: practitioners and their intuition/expertise, or what I’ve been calling Clinical Arrogance for years.
Now, why is there such a level of clinical arrogance out there? Well, it probably has something to do with the lack of push for randomized clinical trials in psychology and this idea that case studies are the best way to identify/predict other client’s behavior.
For example, Ronald Fox, a previous president of the APA is quoted with:
“Psychologists do not have to apologize for their treatments. Nor is there any actual need to prove their effectiveness.”Why Many People Perceive the Study of Human Behavior Unscientific
For those unaware, the APA is the American Psychological Association. They argue over the DSM and other irrelevant things.
There was a push for randomized clinical trials to become a staple for the understanding of the mind, for understanding better avenues of treatment for mental health adversities, but this would have sprung detailed instructions for treatments (backed by the research) and standardized treatments. Psychologists had a somewhat valid argument, that there needs to be some flexibility in treatment. Standardized tests are shit, and I believe there’s probably a huge chance standardized treatment could end in the same category. However, I’m not sure if the standardized tests given in school are backed by any research saying they are accurate predictors of a student’s knowledge. These standardized treatments would be developed based solely on the research.
But clinical psychologists disagreed for other really stupid reasons too, rest assured. They believed psychology is an art, not a science. It doesn’t need to measure variables. Intensive case study analysis gives better understanding and insight anyway.
They’re quoted with:
“Alternative ways of knowing [case study, intuition], for which the scientific method is irrelevant, should be valued and supported in the practice of clinical psychology.”Defining Psychology: is it worth the trouble?
Another APA president was found to say starting up randomized clinical trials would be “fundamentally insane” .
Why is this a thing? Well, I could think of many reasons. Some reasons revolve around the fact that psychologists are educated in psychology minus research. They take a couple courses maybe in their career, but there is no effort put into helping them really understand the value research has in their practice, and so we have many clinical psychologists who firmly believe psychotherapy techniques emerge from experience. Research says differently: there are certain techniques, like CBT, that work better for certain adversities, but because no one reads the research, no one implements the technique when it’s most appropriate.
This provides for a very naive group of professionals. And what does naivete strengthen?
Well, drug companies for one. They could have research that says a medication has zero efficacy and it will still be prescribed by practitioners.
For example, Abilify has no efficacy above 10mg. It’s in the physicians desk reference. I read it. Back when I was on medication, my psychiatrist kept pushing me to 20mg because it would “help my voices”.
She obviously doesn’t read, obviously doesn’t know much about Abilify, and obviously doesn’t understand anything about the spectrum of voices.
It’s a well known fact that insurance companies, drug companies, and the APA are all very connected. That can be another series I’ll push out when I’m less worn out. It’s a very tangled web.
The issue with ignoring research which says certain treatments are more likely to have an effect over others is that psychologists never learn from their mistakes–mostly because they don’t know they’re making any mistakes. If a treatment doesn’t work, it’s because the client isn’t focused. The client isn’t “putting in the work”. While that can be the case, it can also be the case that the psychologist hasn’t kept updated with the information in their field and therefore has some build up clinical arrogance.
There was a push in 1990 for evidence based practices to be the center of psychological practice. The APA’s response? Let’s lower what it means to have “evidence”; more things will be approved and more treatments will be made.
A group of scientists and researchers realized their efforts to drill logic and intelligence into the APA was vain. They then formed the APS, the Association for Psychological Science.
In the same way that Peer Respites and peer alternative programs were started out of the need for compassion in mental health care, the APS was started out of the need for competent practitioners and valid research in psychology. They sponsor science-based clinical psychology and there are many universities in the united states which hold their Psychological Clinical Science Accreditation. More are being accredited each year. UC Berkeley is one. I mention them only because I plan to attend that program for graduate school assuming I continue with psychological research.
So there are many elements of science within psychology. The issue isn’t with whether or not it’s a science. The issue is with whether or not the science is embraced and whether or not we are too limited in our human ability to learn anything worth while. Is human variation too much of an obstacle? Is that what pushes clinical psychologists to believe their intuition can outsmart a math formula? Math formulas, after all, can only describe what we observe and what we observe is inherently limited. We can generalize behavior from a sample size, we can generate neurological predictions when observing the behavior of neurotransmitters but none of it ever seems to be certain; even what we’ve studied, the effects we see, are simply based in probability.
Tomorrow we’ll talk about bullet point number 2: how this probability relates to other sciences and why I call psychology the quantum physics of human study.