Clinical Readings

boulder model

psychologists should be trained in both clinical work and research to cross-fertilize clinicians and scientists and legitimize the field as a science

boulder model issues

most become clinicians, not researchers; there’s a big gap between the groups

scientist-practitioner gap

RCTs vs intuition; external validity issues lead clinicians to distrust research, but researchers believe evidence has enough flexibility; speak different languages

nomothetic

researchers prefer to look at the big picture, or what standardized treatment works for the most people

idiographic

clinitions prefer to look at their individual clients by tailoring treatments

empirically-supported treatment (EST)

highly specialized treatment for a specific disorder

evidence-based practice (EBP)

three-legged stool: evidence, then intuition/expertise, then client characteristics; clinicians believe their intuition is greater than the evidence

naive realism

intuitive belief that the external world is perceived as it exists

causes of spurious therapeutic effectiveness

bias that lead clinicians to believe that a client is improving from treatment when they are not

russian roulette fallacy

claiming gun cylinder odds don’t apply to a single player

dodo bird verdict

belief that all therapies are equally efficacious so long as the therapist has a good, empathetic bond with clients; empirically false

nonspecific factors

warm body effect, giving a rationale for behavior, and offering solutions; common among all psychotherapies and account for a portion of the efficacy

thought field therapy (TFT) > emotional freedom techniques (EFT)

tapping on pressure points can cure psychological problems; neurobabble; unfalsifiable

availability bias

remembering successes and ignoring failures

purple hat fallacy

wear a purple hat then go through talk therapy; conclude that the purple hat caused improvement

flexibility within fidelity

delivering the essential core components for efficacy while adapting the delivery to match individual characteristics

systematic dismantling

once a treatment is manualized, or written out step by step, it’s easier for research to determine which aspect is causing improvement

allostatic load

mental wear-and-tear people of color in stem experience from having to focus on their work and discrimination

efficacy research

internal validity is priority

effectiveness research

external validity is priority

dsm cultural formulation; steps to make diagnosis more fair

cultural identity, cultural explanations of illness, psychosocial stressors, cultural dynamics in clinical relationships, and cultural assessment for diagnosis/care

paquin et al

codes of ethics do not ensure non-discrimination; need re-framing to do no harm, helping everyone (not specific patients), and tools to remediate historical injustices

williams

sjt isn’t just about the past, it’s about fixing the here and now: power dynamics, access to care, and decision-making; balance of universalism with individual uniqueness

satel and mckay

sjt promotes binary distinctions, stereotyping, tribalism, and retribution; sjt forces therapists to be activists instead of prioritizing their individual clients; avatar framing where clients are avatars of their groups; fosters victimhood

checklist

extraordinary claims, marketing terms, little scientific basis, defensive, and psycho-babble

manuals to clinicians

rigid, loss of judgement, poor therapeutic alliance, reduction to technician, and perception that they’re there to cut costs for companies

misunderstandings of manuals

stifle innovation (except they encourage dismantling studies), no external validity (except they include complex cases), and rigidity (except good manuals require judgement)

cultural relevance of manuals

incorporate cultural metaphors, expectation, translations, address systemic factors, include psychoeducation, and remove barriers

transtheoretical prinples

promoting proper client expectation and motivation, establish a therapeutic alliance, psychoeducation of factors, encourage new behaviors, and encourage corrective experiences