Do not make therapy or medication suggestions based on your experience

People think because they were diagnosed with a disorder at one time, or their friends, or family members were that they have some basis for suggesting mental health remedies in the lives of others. It can be actually dangerous, a waste of time and money, and actually detrimental for a lay person with mere “experience” to make such a suggestion. Please keep in mind, if you suspect a friend or family member to have some mental issue, always encourage professional help specifically a therapist, psychologist or even social worker, NOT your family practice physician! This example illustrates why…

I once dealt with a clinical situation as follows. Joe had an uncle who was 62 and went on medication for depression. Joe had known the uncle had been widowed, but was dealing with that quite well. This is all that Joe knew of his uncle. The medication worked quite well for the uncle, depression was effectively gone!

Joe’s niece was Jenny (well still is) and 20, who also indicated she was depressed. Jenny’s mom and dad were very religious and expected her to go into accounting while in college. As, a result of Joe learning of the depression, and critically, not knowing of the religious part and school expectations he suggested that Jenny go on the same medication as his uncle.

Here is where the problem occurs. When I met Jenny, I found out she was depressed specifically that she was now a confirmed lesbian in her mind and wanted to go into english vs accounting. Her family was expecting her to help with the family business, and was very conservative and religious. Hence, she was depressed because she was not able to be educated the way she wanted in english vs accounting. Also, was not being able to “be herself” a lesbian around her family of which she did love.

I ended up finding out (long story) that the uncle who was depressed, actually had long standing depression for decades in which he attempted multiple modes of therapy. In his case it was actually according to research appropriate to go on medications.

You make think you know someone, yet you don’t know the personal struggles that they are dealing with in life. Specifically, their private life they don’t want friends, family, co-workers, and even including you to know about. Also, simply because two people are labeled with Depression, PTSD, Anxiety, etc. the genesis or underlying cause, may be radically different. Furthermore, different therapeutic interventions will work better for different conditions, and personality types. This is why you must have a professional do the analysis, not you as a friend, loved, one etc.

In this case, therapy was appropriate for Jenny, and it worked out well. Yes, the family was not as close in the end, yet when checking with her years later, she was happy, with no need for medication.

Many may be thinking that trying the medications could have helped or worth a try, with very little side effects except wasting time! I would agree! However, when you consider other more intensive forms of intervention in Jenny’s case such as hospitalization, treatment centers, and even relocation. These can actually be detrimental to the person, when professional help is not involved. You may for example think pulling them from college for a year will help, Jenny divulged the family was thinking of it. When in actuality the person, Jenny being in college (in this case of depression) may be the only place they feel they can express themselves. In fact, she may have committed suicide if brought back “home” where she feels isolated and not around other gays and lesbians. In Jenny’s case she opened up to talking about depression because she actually felt free finally, around people she can relate to in the college setting. The point is you want a professional involved and not giving “arm chair” psychological advice simply because something worked for you or someone you know!

Again, note how this post dovetails nicely with the previous post on personal experience.

AA & 12 steps are not good

I have had academic and research issues with AA for years. Here are my five main reasons I think AA is terrible. However, I have chosen to restrict my criticism. A close friend Sue, brought up some quotes out of the “big book” of which just plain irritated me. She tends to remind me of good points I even try ignore. In all honesty, I had forgotten about them. I tend to attempt to not clutter my mind with non-sense that is not scientific and useless.

Here is the reality…. I see people who adhere to the dogma of AA just like religious people. They ignore the research and science that completely debunks, refutes and shows its just plain wrong. Instead, AA, people like religious people back track, and try to salvage what they can as the science undermines their beliefs, showing its just not true! They say things like, “take what is useful,” “it’s a metaphor,” “you don’t have to believe it all,” “don’t take it literally,” blah blah blah….As stated in point 1 (see below) decades of research and no adaptation! That is an Anti-Science position period, end of statement. So, in light of Sue’s astute points privately made, I will not waste my time, rereading the “big book” (which I already did academically) and then deconstructing and tearing apart with research citations the dogmatic, blind adherence to ideas presented. Simply a waste of mental rent, here the the top five!

1. The 12 step model published in 1939, has not been adapted in now officially… 78 years. This is completely inappropriate in science. Models or theories of which are representations of the naturally occurring world, are best approximations. They are not perfect and should be adapted as research comes in! Come on! We have had over seven decades of research, and are applying the same model, this is ridiculous. Then on top of it the 12 steps treat “hard” drugs, the same as alcohol, sex, and video games. All are under the same concept as “addiction” of which is not properly operationally defined. Not operationally defining it leaves it vague and allows for “wiggle” room and reinterpretation depending on the debate. Addiction is being applied basically to any maladaptive use of anything, those last four words before the comma, actually start to approximate an operational definition.

By the way an Operational Definition is how the concept is measured, and defined precisely. If we can’t measure something then we cannot study it scientifically, that is how science works. Philosophy of science issue there. A simple example will suffice.. If you measure depression on a 1 to 5 scale for study and I measure it on a 1 to 10 scale, these results will be difficult to compare in two different studies. Clearly a 5 on each scale represents something completely different! So, when comparing studies, you need to make sure both groups operationally defined the variable the same/similar way.

2. Same twelve steps apply to all types of people, and addictions. As we know, not all medications work for each person in medicine, one works for me while another one works for you. In therapy, yes we start with a theory, and hypothesis deductively drawn from said theory, but then adapt to every patient. The AA 12 steps don’t do this….It’s the same twelve steps for every person. Yes, I know the frequent cop out is to take from it what is useful…. come on, it’s like people with the bible saying these stories are metaphors when shown via science they could not be true. It’s trying to salvage what you can, grasping at straws. We could also, go to a psychic, church where they speak in tongues, palm readers, astrology, etc and find something useful!

3. It’s a one sided, or as I say half of therapy. You  go in vent, listen to stories, but there is not an expert to “correct” thinking as we do in therapy and see underlying patterns. People vent, yes I admit if you give them measures regarding how they feel after a meeting damn right they feel better! Who doesn’t after venting. The issue is there is not the same substantive change like you find with therapy. People usually go to a therapist after friends and family can’t and have not helped them, people who know them very well unlike randoms in a meeting. Therapists are trained to point out these common errors unique to the individual patient as to how they are screwing things up! So a professional, who is trained to not just listen to a venting session, they instead, actually tell you what you are doing wrong.

4. Unethical
People as stated in the previous 3 points, do all of this and waste for some hundreds of hours of time! They keep going too as they say after treatment “90 in 90” so 90 meetings in 90 days! Oh my god!!!!! If I see a patient therapeutically for that many hours (actually many less with current, research on outcomes) or even just 30 hours lets say. I have to be able to stand before an ethics board and justify why treatment is taking so long! When I was trained cognitive behavior therapy was 15 to 20 sessions, now I have heard outcomes stating 10 to 12 sessions should be expected. What I am saying is it would be better for a patient to work extra hours at their job each week, or an extra shift to be able to cover actual therapy. Instead, I have heard of and met people who have been going to AA meetings for literally 20 years continuously.

5th point just since its irritating to hear…
People say its a support network. Yeah, again it was intended to be more therapeutic, especially historically since back then there were few treatments available and the term was ill defined. Again, its a back tracking method like the bible to hold on to precepts that are frankly just not useful now. If ideas that seem as if they come from AA they are parsed into finer detail. So in reality many times they were not even culled from the 12 Step model to begin with! It’s like freud saying the brain, is ultimately responsible for the mind. Yippee so vague absolutely any neuroscience finding falls under that “prediction.”

All of  these above points are valid and have been written about by other psychologists. So, any professional reading please realize I am not stealing the ideas. I am not taking credit that these five criticisms are of my own invention, but combinations, adaptations, and adjusting what I have learned. Again, attempting to respond with some sob story or personal experience of you or some friend, does not validate the 12 step model. It’s merely an anecdotal observation at best.

A final statement, on that note regarding the statement “it works for me.” Yes, something may work for you. Look at it this way, some intervention may increase your productivity, by 20% lets say, or decrease negative effects by 20%. However, another intervention may help/ameliorate by 70%, or 80% vs your pittyful 20% intervention. I look at this comparative clinical effectiveness of interventions, I get it… AA is free, people may perceive some benefit. I still think it preaches too many dogmatic, anti-scientific ways of thinking that ultimately undermines mental health treatment of drug an alcohol issues. Not even to mention this silly 12 step model is used in more far reaching areas when originally only meant for drinking.

So in summary, AA is dogmatic, like religion, it ignores science. Decades of research have information to give to people. I have never recommended it to individuals, instead I always suggest therapy, and guess what we have group therapy as well, for those who love the group format!

Questions and/or Comments please!

I would like people to send in any and all questions you may have specifically regarding psychology. I am quite familiar with the philosophy of science as well, as well as issues related to sexuality, so they are welcomed as well. It should be made clear that you can ask any question. If you want a name associated with your question, I will indicate the name you indicate. If you would like it as an anonymous question no problem either. Feel free to simply send a comment to my email I will respond to the question or comment. For those, of you who know me personally, and know I could comment on something or have an idea for a post, please definitely dro me an quick email.

Personal Experience = Invalid, Useless

Ok I admit that title is a bit hyperbolic. I get very tired of people invoking their personal experience on most topics, but especially when it is related to science, and of course psychology. Here are my two main issues, this post will relate to many others in the future, so please read, and take it to heart! There will be a part two as well to this…

Point 1… Standstill, stalemate.

One of the things I have always loved about philosophy are thought experiments. This is where you simply ask someone to think of some case or situation of which usually you can’t actually engage in. This one you actually can… Yet since you are reading this please do in fact think of it. Imagine you are in a room, with another person, me lets say me, arguing about discrimination against black people. Remember the ONLY information we have available is our experience. We can’t cite news, research, hearsay, tv, reading we have done or anything else… Purely and only our personal experience counts.

You tell me that you throughout all of grade school, middle school and high school witnessed discrimination against black people. You give examples, and tell stories and such. Now, here is the crux of the issue, that is your personal experience that you witnessed, were exposed to etc. Now enter me. I then come back with the fact which is a true statement in actual real life, that I have never throughout my grade school, middle school, and high school ever witnessed discrimination against black people. Now, this is the essence of the problem with personal experience. You had yours, I had mine, and they are opposites. Now the standstill, or stalemate happens.

Again we are not allowed to bring in any outside information into this room. Well, we by definition are now at a standstill. Since, we can’t bring in outside information, your experience can’t outweigh mine or mine outweigh yours, they are equal! For you reading this type of description, you probably want to know where we both grew up, socioeconomic status, and variety of other pieces of information. You want this information to determine which person is more representative of the population. In other words, whose experience should in the discussion outweigh the other persons. Obviously, the easy answer is well I saw … on the news, and  you start to think of various research projects that have been done on discrimination. Again, all of that is null and void when we use personal experience in this room, and give such psychological weight to personal experience.

See this is where the power of research and information from sources other than our own experience absolutely should override your personal experience. Yes, personal stories are great at touching people, however, when we get down and dirty, we need outside information. It sounds silly but how do I know kangaroos exist. I have never seen one in person, even at a zoo. Yet, I have seen them on tv and learned about them in school. A well educated and literate person should necessarily go beyond their experience to gain information. Personal experience, will by definition result in a standstill discussion eventually with someone that you meet.

You can always find someone who counters you. Yes, then it becomes a debate as to which experience should carry more weight in the discussion. However in the end in almost every discussion I have witnessed or been a part of, both parties bring in information outside their personal experience to ultimately support their point of view.

Point 2… It’s emotionally manipulative.

The second reason why I dislike personal experience points of view is how usually they take on an emotionally manipulative stance in a discussion. Forget, about being in a room closed off from everything. Now imagine you and I are at a dinner party at someones house, say a group of ten of us.

Now in this situation, we are arguing guns in the U.S. In this discussion, a woman cites the fact that her teenage son was shot by a person, during a drug deal of which he was not even a part of, innocent bystander. She goes into a lengthy explanation describing it, how tragic it was that someone innocent was shot. She is crying during it yet maintaining a description of the story accurately and passionately.  Now, if I (which is not my stance on guns) started to point out how statistically this is such an anomaly and rarely ever happens. I quote stats and blah blah… Imagine to yourself, how big of an insensitive jerk I would appear to the other dinner guests. I would be considered to be the root of all evil in that situation, regardless of the statistical accuracy, and research based results that I’m spewing forth during my “rebuttal.”

The point here is that people like to give passionate stories to try to persuade people regarding a certain point of view. They utilize the social situation, which is very specifically that IF a person denounces their personal experience/story, they appear as the rude insensitive person in the discussion/social interaction. This is the second reason, which I have such an issue with these experiences/stories. All, I have to do is start to tell you how badly something went for me or a friend of mine, and bam, you can’t touch it otherwise you look like a jerk!

How many of you watch TED talks? Ever noticed how they have people speak who literally only, have personal stories? Sure they are well told and interesting and even tug at your heart strings, may even make you cry. Yet, after, that’s all they have, a story, not some extensive background in that area, but simply their personal experience, in an attempt to persuade you with emotions to do something or donate or support their cause! I find it as a cheap unfair social psychological ploy that people use all the time. Personally, and I will toot my own horn, have been in arguments/debates where I have had extensive personal experience with something. Yet, I’ll maintain a stance of research, and academic thought on the topic, and not use the cheap ploy of experience.

In conclusion to both of these two main points I believe that people should base opinions and decisions on research, education, and/or sound philosophical principles. I am the first to admit we don’t have research for all the different types of information available. Then yes, start from some well thought out philosophical position! At worst, yes use personal experience. However, be ready to immediately change your stance when you become educated, research is done, or someone deconstructs your position, and shows flaws. Furthermore, some issues transcend research, after all it is a lot of the time descriptive, not prescriptive. Just because something happened in the past research does not mean it should or ought to be that way. This is where adhering to a basic philosophy comes in. I for example believe in gay marriage. This is not at all because I have had friends who are gay and in love (personal experience), actually, never had close friends who are/were. Yet, my basic philosophical stance is that if two people are in love they should be able to get married! That’s it, not based on research, some religious text or otherwise. It’s a basic premise that is part of how I think and who I am. It has nothing to do with personal experience.

“Relationship” most important factor in therapy…. Really?

One of the most annoying things I hear therapists and professionals talk about regarding therapy and what helps is the “relationship.” Here is the problem, take a step back if you are a professional reading this or a normal person. What do they mean? I have many relationships. I have relationships with co workers, friends, parents, siblings, teachers. Now compare those to a gf/bf, of which is intimate and sexual. We would all say that each of these are of different kinds of “relationships.” My position is that therapists and even academicians throw the concept out there to try and try hard to say many different forms of therapy are of equal value. This means from freud’s psychoanalysis, to Roger’s rogerian therapy, to Cognitive Behavioral therapy, and behavior modification! The problem is that simply is not true that all forms of therapy work equally well, but that is for another entry.

So, in grad school I kept hearing the therapeutic relationship blah blah blah, is the most important factor for successful therapy. Actually, sometimes the profs would not even use therapeutic, but just the relationship… Well, words are important, the English language has quite a few, that delineate ideas at a fine level of analysis. Hangry was recently added to the dictionary, love the word. Because in one word if I say John is hangry, it communicates to you that he’s in a pissy mood because he is hungry. So one word vs literally saying the sentence, “John is in an irritable/angry mood because he is hungry,” efficient!

I then looked up the research on where my profs were getting this information on relationship and passing it onto us. It turns out, it is technically the “therapeutic alliance,” of which is measured by the “therapeutic alliance scale.” Now we are getting somewhere I thought. Now, this scale is broken down into 3 component parts (get to those in a few). I’ll give an analogy here to help you understand. When you think of someone as extraverted. You may think of 3 component parts of the concept, extraversion. First, lets just say verbal, they talk a lot, and to many people. Fair, simple. Second, time spent. They love to spend time around a lot of people, not being alone, prefer parties, clubs, bars, anything with people. Then the third component, activity. They tend to be very active individuals, out and about a lot, and again around a lot of people.

So, three component parts for extraversion, Verbal, Time Spent, Activity. The point is you can say these are three distinct aspects that can describe extraverts. Now, when I looked up the component parts of the “therapeutic alliance.” Again, this concept being sold to grad school students as the “therapeutic relationship” or just “relationship” we find something interesting. That scale breaks down the alliance into three parts Goal, Task, and Bond. So, to simplify… you walk into my office we start talking and identify the goal, lets say to lessen your anxiety, we both agree. Goal aspect of the scale is accomplished, you will give it high score on the scale. Now, we say how will we lessen your anxiety, and both agree on talk therapy, cognitive therapy, yippee two out of the three down. You will now score that as high on the scale regarding questions related to the task. Finally, then there are the questions related to how you feel towards me as in bonding. Liking me in general, my demeanor, attitude, patience etc.

The point I am making here is you can have an inflated score because we both have agreed therapist and client, on two aspects Goal, and Task that technically are very impersonal. You can hate me and think I’m a terrible person, yet we both agree that you want to lessen your anxiety (Goal)! The same goes for how it will be done (Task), talk therapy, both agree. Then yes, your idea of how well you mesh, get along with, like in general (Bond). Bond is only a component part of the scale that taps our lay conceptualization of the general concept of relationship.

When I taught this to the undergrad counseling psychology course I pointed out this scale could be used in the classroom… I said, you came in the first day, got the syllabus. We both agreed the GOAL was to learn counseling psychology principles.. The way we would accomplish this TASK was through lecture, with power-point presentations accompanying me throughout the course, with students asking questions. Then finally, the BOND was simply if they liked me as an instructor, my demeanor, sarcasm, amazing wit, and so forth! Well, I guess I just invented a “teacher student alliance rating scale.” Just kidding a 30 second google search shows something to that effect exists. Hey, I’m not an educational psychologist!

What I am saying is that profs are bastardizing the concept of the therapeutic alliance down to merely…. relationship…. in this context and is way oversimplifying it.

I think it is done for political motivations. In particular, I think many professors point to the relationship to attempt to get away, with doing poor forms of therapy. Stay tuned for entries on how many crappy therapies there are out there! freud is dead. His therapy is terrible and should be completely removed from curriculum except for its historical importance, and using it as an example of non-science….more to come.

Keep personal experience separate

You will be reading this for many reasons. Personal insights, morbid curiosity, because Eli is awesome, professional development/criticism, whatever. One thing I encourage, is to try to separate your personal experience on some of these topics from what I am writing. I say this because any time someone invokes personal experience it can muddy the waters. You damn well can be the outlier on a given thing, literally the .01%. Plus one personal story, is not going to outweigh systematic peer reviewed studies that have been replicated in some cases literally for decades.

You may try to play devils advocate, I know some people who bring up the exception all the time.. Annoying! Many things/interventions/therapies may “seem” logical in psychology, and you have experienced it and it was “right for you” however again according to research is not right for everyone else. I come across this all the time! So, when reading try to look at what I’m writing as what has been shown in the research and does apply to the masses even if not to you! Or you have some idiosyncratic example that may seem related yet upon further investigation actually is not related or not quite useful. A key here is many times you may have a lay conceptualization of an idea, yet in psychology/philosophy we may parse it into great detail. You think of the concept of extraversion, yet we have sophisticated measures in psychology to show different percentile ranks of where people stand on this factor of personality. Keep this in mind.

My Background

I did my undergraduate major in psychology at the U of MN. Then I went on to my M.A. degree in counseling and guidance at NMSU in Las Cruces NM. Finally, I did doctoral work at TN state University in Nashville, TN. Towards the end of my M.A. degree I became interested in the philosophy of science. This is the area of philosophy that deals with how and why science functions the way it does. Also, at this same time I became interested in diagnostic reasoning. This is the understanding of how clinicians actually go through the cognitive process of making a diagnosis of the patient. However, it includes the errors made, cognitive and social biases that influence the process, and what is the “optimal” process. I also was trained in psychological testing and assessing individuals.