Return-Path: <zorrilla@cattell.psych.upenn.edu>
Posted-Date: Tue, 14 Apr 92 21:37:27 EDT
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Date:         Tue, 14 Apr 1992 21:37:27 EDT
              <PSYCGRAD@UOTTAWA.BITNET>
From:         Eric Zorrilla <zorrilla@CATTELL.PSYCH.UPENN.EDU>
Subject:      Re: curious re: exorcism
X-To:         PSYCGRAD%UOTTAWA.BITNET@uga.cc.uga.edu

> Science, when it typically sents out to evaluate a therapy, standardized
> the dependent variable.  I am not saying that science should not do this.
> The result is that articles are published on the efficacy of a therapy to
> change that standardized dependent variable.  THEN, the scientific\
> academic\practitioner\etc. community reads the articles and naively
> generalizes by saying "X therapy is not effective."  Effective to do what?
> Effective to change one set of standard dependent variables. (consc. sf)

This has nothing to do with the illegitimacy of examining the legitimacy
of particular therapy modalities vis-a-vis particular goals of those
modalities.  This only tells us that some people have trouble making
valid inferences from statistics.

> If we then set out to legislate psychotherapy methods, we then inflict on
> others the conclusion that X therapy is innefective in psychotherapy in
> general, and therefore is illegitimate, unethical, harmfull, and useless
> to practice.  Yet, it is forgotten that the studies showed that the
> therapy was only ineffective to do one set of very specific things.

You are assuming that the scientific community is dimwitted.  Some people
might leap to such invalid conclusions, but I suspect it would more likely
be the folks who work for USA Today and not the people who would be on
a review board examining the efficacies of particular therapies for particular
goals.  (though, of course, one would have to consider personal agendas in
appointing such a committee....this is a separate issue, however).

> If the consumer
> wants that thing done in psychotherapy, let him or her descide on that.

And if you belong to a religious organization that believes that there are
no such things as bacteria and you choose to deny your child appropriate
medical treatment, then _by all means_ let them decide.  I suppose there are
two points I'm making with this analogy:

	1)  The more general problem of who should decide when and what types
of therapy are appropriate for minors.

	2)  Many people enter a psychotherapeutic relationship under duress
of some sort.  It is unreasonable to assume that they will be making an
informed, rational and sound decision about what psychotherapy might be best
suited to their goals when they don't have the information they need to make
such a decision AND they probably aren't in a state where they SHOULD be
making that type of decision.  It is unreasonable to leave that type of power
within the hands of individual psychotherapists with highly personal agendas.
> then it wouldn't make much sense if we decide to evaluate the effectiveness
> of this therapy on depression.  Depression is not the dependent variable
> that this therapy claims to influence.  Therefore, if a bunch of researchers
> perform a bunch of studies and publish the results that this therapy is not
> effective in decreasing Beck Depression Inventory Scores, they are saying
> nothing.  The therapy never did claim to decrease BDI scores.

True.  Who ever said that someone was going to evaluate a therapy in it's
efficacy of changing something it didn't declare itself capable of changing?

> The sad thing
> is that people would read the articles and conclude that the therapy is
> ineffective and therefore should not be ethically practiced by liscenced
> clinical psychologists.

Who are these "people" you are referring to?  1st year undergraduates who
don't understand the scientific method and the meaning of failing to disprove
a null hypothesis?

> Scary?  You bet.  Committees take the ball & run
> without knowing the nature of the playing field all the time.

Odd.  Most APA Consensus meetings that I know of are consensus meetings on
the efficacy of therapies X, Y, and Z in treating/changing dependent
variable A.  I don't typically see committee meetings held that are making
global statements such as the ones that you attribute to them - at least
not with serious professional intention.


On the issue of it's OK to do a therapy as long as it doesn't "harm"....

Some people have rightly pointed out the issue of consumer fraud.
One or two others have argued that we should demand that therapies do more
than just "not harm" for extra-pecuniary reasons.  I think the point is rather
obvious and can be addressed with decision theory.  If we have therapies which
have been shown to be effective at helping people change particular dependent
variables (Interpersonal and Cognitive therapy for Depression, Cognitive
Therapy for Panic Disorder), then with-holding such treatment from patients
who want to change that dependent variable is morally wrong.  From a normative
sense, this omission is very real in the damage it inflicts on the person.
A person who has gone through 12 weeks of inefficacious therapy X at the
very best will be unchanged.  If however, he or she had spent those 12 weeks
undergoing 12 weeks of efficacious therapy Y, they will have had a XX% chance
of seeing a XX% improvement in the dependent variable in question.  In short,
we could sit down and calculate the expected values and utilities that bogus
therapies are costing clients and exact some moral premium from therapists
who continue to practice these methods without agreeing to test them in
a manner that is amenable to the academic community and to their orientation.

>
>       ___   ___
>      /   \ /   \
>      >---   ---<
>           /          This is fun!
>          (_
>      \\_______//
>       \       /
>        \_____/
>           (

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

This is odd. :)  (I hope people don't start using that big smiley face in
place of the ol' colon and closed parantheses)....

Eric Zorrilla
U. of Pennsylvania
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU