How scientific are the need-based theories?

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medpsych0

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I'm an upper level undergrad studying psychology (after doing a degree in math), having taken a few upper level courses on abnormal psychology and clinical psychology already. One of the issues that bothers me is all the focus on need-based views of human beings. It bothers me because a lot of them seem more "well-intentioned" than scientific. It seems to me that the humanistic view came out as reaction to dehumanizing view of people at the time in the larger culture and society, and also other psychological theories like behaviorism, but that it does not have the strong empirical support many other theories have. In reviewing the literature, I have come across several dozen so-called "needs" and I can not find any conclusive evidence for which is more important or fundamental or even what a need actually is. Is it more like a preference, a drive, a desire? Is a psychological need the same as physiological need, like need for food or oxygen? Obviously not. Should an unfulfilled need lead to death or is it enough to throw the body off emotional balance (happiness? peace?), like lead to distress or discomfort, for something to be labeled a need.

I wish the various things labeled as needs by various researchers or well-wishers could be operationalized in much easier way. I mean think of need for power. Or freedom or autonomy. They almost sound like the kind of thing a scholar in in a religious, political, or philosophical program would study. Like they are value judgments. Imagine a study showing that people don't have a need for freedom. Are we gonna go back to slavery?! This is just the kind of culture and society we live in, we believe in certain things, we want to empower people, help them become freer, more autonomous. But let's not call this science, not good science, not yet. If I am right, and that's a big "if", then all therapy is doing is prescribing the status quo as solution to personal distress.

Sorry if my post sounds harsh, I actually almost fell in love with need-based theories originally, and I so wish that Carl Rogers and Maslow and others actually had done major studies on their views, the kind of expensive studies we do on drugs, so that we had a much better understanding of what our psychological needs are, and how to meet them, and have conclusive evidence to back us up.

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Then you should go into academic research and "fix it."

The search for "truth", in the sense that you seen to want it, is much better suited to physics. The study of the human condition is always gong to be hypothesis driven in which controlled experimental investigation is going to be difficult and inevitably confounded.
 
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Last time I actually looked at any of the literature, the humanistic theories had some support, but not very strong support. I suspect it's more due to a combination of the difficulty of operationalizing some of the concepts and lack of interested researchers in comparison to other treatment approaches. I don't see the tide changing on that, with federal grant money for the behavioral sciences shrinking up and a focus on EBT/EST's, the money really isn't out there for this type of research.
 
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A caveat is that aspects of some of the more humanistic theories are part of just about every EBT available. MI (which has been fairly extensively researched) draws heavily on Carl Rogers and his work in establishing rapport and trusting in the patient/client as the primary agent of their own change, for example, and just about everything under the sun draws on aspects of displaying empathy and unconditional positive regard.
 
There is some very good research on attachment that shows we have social needs that are closely aligned with the other basic needs such as food or air. I also agree wih other posters that some of he constructs we study are very difficult to operationalize and research but that doesn't mean they don't exist. Also, psychologists like to change the names of constructs with each new theory so that makes it hard to accumulate evidence.
 
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It's true that whenever you talk about optimal development, you are making normative statements, but there's reasonable indirect evidence to infer psychosocial needs. Failure to thrive in infants (who are fed), for example, and maladaptive cognitive and physical development with other kinds of neglect. The clear improvement in linguistic abilities and theory of mind with certain kinds/amounts of communication and play in childhood. The observed overlap of neural networks in physical and psychological pain; mirror neurons. edit: also -- need to exert control, inferred by studies on monkeys who are stressed when they are put in situations where they don't (same for people)

I'm not huge on Freud but I don't think he was far off when he talked about function as being able to love, work, and sleep (or whatever it was, can't remember exactly); I don't think it's really controversial to say that most people are happi-er, or feel better, looking at it hedonically - when they have affirming social relationships and can orient themselves around some kind of goal-directed activity, and I'm pretty sure there's cross-cultural research that supports that idea (though forms of relationships, goals, and activities look different).
 
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The book "A General Theory of Love" did a nice job discussing the science (e.g. limbic activity/resonance, development of the brain, importance of group cohesion) associated with attachment-based and humanistic psychotherapy. It's not a peer-reviewed source, but it's authors are reputable and their literature reviews seem solid.
 
The book "A General Theory of Love" did a nice job discussing the science (e.g. limbic activity/resonance, development of the brain, importance of group cohesion) associated with attachment-based and humanistic psychotherapy. It's not a peer-reviewed source, but it's authors are reputable and their literature reviews seem solid.
Another book to look at that is extremely well-researched and sourced and discusses the neurobiology is Alan Schore's Affect Regulation and the Origin of Self
Reading this text is great exercise for your scientific brain. It's like heavy lifting for the cerebral cortex. :happy:
 
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Hello 2am Pre-Internship Insomnia...:hello:

love, work, and sleep (or whatever it was, can't remember exactly).

"Work and love, love and work - that's all there is." - Sigmund

However, we generally refer to it as love, work and play nowadays. ;) Because play is essential to the human condition, as also seen other living organisms.

medpsych0, in this great big world of ours, there are "hard sciences," and then there is the lack of hard science. We all fall somewhere in the middle...on a continuum. What sometimes becomes difficult is sitting with the ambivalence (or the not knowing). But as stated above, get into academic research and figure out what your particular theory of mind is, then produce some results for yourself and your peers. If you are always searching for a finite answer, you will be searching forever because humans (& the humanistic perspectives) are collectively boundless, and quite simply not as definitive as mathematics. We must impose limits on our ideas and work from that framework (which is what Rogers and Maslow begun...hoping the future would lead to more conclusive evidence from folks asking questions like yours). This is how science builds upon itself. I bet the creation of the wheel was once "need-based" and "well-intentioned" (to echo your sentiments), but we have no way to prove this, and philosophically, sociologically, ecologically, anthropologically, we now accept this as fact from our ancient history.

Many of these contemporary psychological theories do not get (or deserve) this credence, so it is up to us to establish the literature and the research that supports it. And we eventually circle back to the discussion about the scientific merits of the field of psychology. Continue to fall "in love with need-based theories," they will give you perspective from which to start your hypotheses about what motivates those drug-based studies you speak of...yes, formal hypotheses will be based on more tangible facts and literature, but you will afford yourself the creativity and originality by being less rigid in your thinking and not denying your initial interests only because they seem unsubstantiated. This is how we learn to substantiate fact. For example, Maslow and Urie Bronfenbrenner had to start somewhere so they created their need-based concepts. Bronfenbrenner's concept led to the creation of Head Start Programs, which supports millions of children...from which the data can now be amassed. Bronfenbrenner was the initial theorist, the visionary...heck, you could even say he was well-intentioned; however, he did not limit himself because of lack of previous hard data....he just built upon existing ideas with his novel ones. And voila! If my insomnia wasn't fading, I could probably provide some pretty impressive federal grant funding, psychological, social, and probably medical/biological statistics from those Head Start Programs, which now make it become the hard science data you were looking for from a need-based theory. The field just needs more bright visionaries to put it all together in a neat manuscript (from conceptualization to data) and submit it. Spread the good word. Turn those need-based theories into evidence-based theories rather than losing your love for this type of knowledge base, and throwing in the towel on humanistic perspectives. Just understand empirical support is hard to come by when a field becomes diluted with so many differing perspectives. IMO humanistic theories still remain worthy and deserving of future research, and are not snake oil science and placebo effects when conceptualizing and understanding the collective needs of individuals.
 
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+1 to the idea that many humanistic folks aren't as interested in EBT/hard empirical research. There's a big qualitative movement in these groups right now...phenomenology, philosophy, human science stuff. The current president of the APA division is a phenomenologist.

I'm starting at a humanistic MA program this month and I'm expecting to be trained in some quantitative research methods, but I don't expect to be doing much of it, and I don't think my peers will be either. My undergrad was an English/Psych double major and the critical theory and literary criticism I encountered in lit courses will probably be more useful than the experimental research stuff I learned in psych.

I understand the disdain for "soft" social science type work, but I think in many cases people underestimate the power of critical discourse and philosophical analysis. A lot of humanistic and existential-phenomenological leaning programs encourage their students to examine the implicit values and foundations of the entire field, which I doubt you'll find much of at a behavioral program, not that I really dislike behaviorism, just a matter of personality fit. Variety is good; I think neuroscience and cognitive science and other "harder" areas of psychology are fascinating, just not what I'm interested in pursuing. I do think that what I'm interested in pursuing has something to offer the field, like Cheetah touched on here. I see room for broad, over-arching attempts to understand psychology from a highly theoretical approach as WELL as room for closer to the ground empirical data collection. Both are good, both will help each other along in a dialectical manner as long as they keep an open mind toward each other.

tangentially related, I just started a book called "Consciousness Reconsidered" by the philosopher Owen Flanagan and he espouses a "triangulating" approach toward the subject--neuroscience, experimental psychology, and phenomenology. I really love the idea of integrating the three fields and trying to discover confluence between them, and that this area of confluence will help shine light on the nature of consciousness. I believe it's true for many subjects in psychology, not just consciousness. Did I mention that humanistic psych has a strong penchant for holism? :p
 
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+1 to the idea that many humanistic folks aren't as interested in EBT/hard empirical research. There's a big qualitative movement in these groups right now...phenomenology, philosophy, human science stuff. The current president of the APA division is a phenomenologist.

I'm starting at a humanistic MA program this month and I'm expecting to be trained in some quantitative research methods, but I don't expect to be doing much of it, and I don't think my peers will be either. My undergrad was an English/Psych double major and the critical theory and literary criticism I encountered in lit courses will probably be more useful than the experimental research stuff I learned in psych.

I understand the disdain for "soft" social science type work, but I think in many cases people underestimate the power of critical discourse and philosophical analysis. A lot of humanistic and existential-phenomenological leaning programs encourage their students to examine the implicit values and foundations of the entire field, which I doubt you'll find much of at a behavioral program, not that I really dislike behaviorism, just a matter of personality fit. Variety is good; I think neuroscience and cognitive science and other "harder" areas of psychology are fascinating, just not what I'm interested in pursuing. I do think that what I'm interested in pursuing has something to offer the field, like Cheetah touched on here. I see room for broad, over-arching attempts to understand psychology from a highly theoretical approach as WELL as room for closer to the ground empirical data collection. Both are good, both will help each other along in a dialectical manner as long as they keep an open mind toward each other.

tangentially related, I just started a book called "Consciousness Reconsidered" by the philosopher Owen Flanagan and he espouses a "triangulating" approach toward the subject--neuroscience, experimental psychology, and phenomenology. I really love the idea of integrating the three fields and trying to discover confluence between them, and that this area of confluence will help shine light on the nature of consciousness. I believe it's true for many subjects in psychology, not just consciousness. Did I mention that humanistic psych has a strong penchant for holism? :p

While thats fantastic in the academic world, bringing that mentality to clinical practice is less pragmatic. Here is an example of one of my recent conversations with a Humanistic psychotherapist:

"But doctor X, we (unnamed HMO) do not cover on going, long term, non directional, supportive psychotherapy with no end in site especially when there has not been any benefit from 30 visits of psychotherapy as evidenced by your charting which reflects a GAF score of 55 at visit one and a Gaf Score of 55 at visit 30...especially when X treatment has been show to be effective for this condition in 12-16 sessions."

I dont make the rules. Comments?
 
As erg said, we have to separate the ivory tower from real world clinical practice. Sure, these are interesting subjects, but unless you can empirically show that they can somehow be applied in a real world clinical setting, with an efficacy that is at least equivalent to the EBP's we have, they don't do much for those of us with skin in the game.
 
While thats fantastic in the academic world, bringing that mentality to clinical practice is less pragmatic. Here is an example of one of my recent conversations with a Humanistic psychotherapist:

"But doctor X, we (unnamed HMO) do not cover on going, long term, non directional, supportive psychotherapy with no end in site especially when there has not been any benefit from 30 visits of psychotherapy as evidenced by your charting which reflects a GAF score of 55 at visit one and a Gaf Score of 55 at visit 30...especially when X treatment has been show to be effective for this condition in 12-16 sessions."

I dont make the rules. Comments?
I am thinking that there is more of a problem here than just theoretical orientation going on. The therapeutic relationship alone should be of some benefit. Of course I also find that effective treatment also tends to improve the therapeutic relationship.
 
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This is why future directions call for more research. And humanistic therapeutic techniques (compared to psychodynamics) are useful in conceptualization of clinical pictures. I agree that application of EBTs are necessary, but don't throw the baby out with the bathwater and discount something that may be extremely useful, as in my Bronfennbrenner example. His ecological/need-based theory goes a long, long way and serves millions of children and families. We should/could all only hope for this type of impact.
 
Not to nit-pick, but has the evidence in support of Head Start programs improved of late? Last I remember hearing, I thought they'd actually found little to no true benefit.

And I agree--there are certainly topics that should be researched further, and these are great in academia. Conversely, when it comes to daily clinical practice, we're best served by sticking with treatments that have been demonstrated to work in the condition(s) of interest...at least as first-line interventions. If they don't work, then we can start getting a little more exploratory.
 
Is long-term, explorative therapy (of any type) neat, educational, and possibly improve overall health. Sure it could. It could also enable, result in dependency, result in no improvements, or be be counterproductive. Is it medically necessary? Absolutely not. Why on earth would BlueCross/Blueshield of (insert state name here) pay for 100 sessions of something when it is not medically necessary and the desired health outcome can be produced in 16 sessions?!
 
AA, if you googled 'head start efficacy' the first article is one that criticizes Head Start and the billions of dollars allocated to it. However, then we reach a political discussion b/c lobbyists want to spend that gov't money elsewhere. Also, they followed those children through the 3rd grade and I did not quickly read if there was a control group comparison. So I will not argue the efficacy of the program, only to say if those underprivileged kids/families did not have Head Start, then I fear their outcome otherwise (as I live in a variable SES society and experience these issues everyday through the NYC Dept o Education updates, and then treat children from Low SES). Head Start Programs are sought and recommended for stability and exposure to early academics. But, hey, this is more complex than our quick posts and my argument still stands with the long-term benefits of the program which may take another 50 years.
Not to nit-pick, but has the evidence in support of Head Start programs improved of late? Last I remember hearing, I thought they'd actually found little to no true benefit.

And I agree--there are certainly topics that should be researched further, and these are great in academia. Conversely, when it comes to daily clinical practice, we're best served by sticking with treatments that have been demonstrated to work in the condition(s) of interest...at least as first-line interventions. If they don't work, then we can start getting a little more exploratory.
 
If it takes 50 years to measure an effect, chances are it's not because of Head Start. I'm with AA here. Even liberal research firms have criticized the Head Start program. The available long-term studies we have on it suggest no demonstrable outcome differences, irrespective of political ideology. It was a good thought, it just hasn't panned out. Time to either make significant changes to the theory behind it, or go back to the drawing board completely.
 
C'mon erg923, I've been through enough schooling to know that a beaurcracy, such as an insurance company should not dictate clinical care, but unfortantely does and most problems take more than 16 sessions (4 months) to produce long-term results. It is one horrible limitation to clinical practice. Let's say 30 yrs of a person's life to ***** them up and 4 months to fix it!? That is cynically laughable.
Is long-term, explorative therapy (of any type) neat, educational, and possibly improve overall health. Sure it could. It could also enable, result in dependency, result in no improvements, or be be counterproductive. Is it medically necessary? Absolutely not. Why on earth would BlueCross/Blueshield of (insert state name here) pay for 100 sessions of something when it is not medically necessary and the desired health outcome can be produced in 16 sessions?!
 
C'mon erg923, I've been through enough schooling to know that a beaurcracy, such as an insurance company should not dictate clinical care, but unfortantely does and most problems take more than 16 sessions (4 months) to produce long-term results. It is one horrible limitation to clinical practice. Let's say 30 yrs of a person's life to ***** them up and 4 months to fix it!? That is cynically laughable.

Many diagnostic problems can see vast improvements in 4 months or less with the right treatment. Some problems do indeed need more time. But that doesn't change the fact that you still need to prove the efficacy of that longer term treatment.
 
It's called longitudinal research...I still support the idea b/c I am a clinician and a parent in NYC. So let's see what happens. But just as erg923 is mentioning the approval of funds from insurance companies, I could also argue that the government funding of Head Start should account for something, as I don't see billions of dollars spent on any other single educational program for pre-school aged kids.
If it takes 50 years to measure an effect, chances are it's not because of Head Start. I'm with AA here. Even liberal research firms have criticized the Head Start program. The available long-term studies we have on it suggest no demonstrable outcome differences, irrespective of political ideology. It was a good thought, it just hasn't panned out. Time to either make significant changes to the theory behind it, or go back to the drawing board completely.
 
C'mon erg923, I've been through enough schooling to know that a beaurcracy, such as an insurance company should not dictate clinical care, but unfortantely does and most problems take more than 16 sessions (4 months) to produce long-term results. It is one horrible limitation to clinical practice. Let's say 30 yrs of a person's life to ***** them up and 4 months to fix it!? That is cynically laughable.

You play the cards you are dealt. You are dealt HMOs that indeed DO dictate clinical care if you choose to particpate on their panels. You are making a choice, make no mistake about that.
 
Fair enough. Head Start is not a clinical treatment program...it is educational.
Many diagnostic problems can see vast improvements in 4 months or less with the right treatment. Some problems do indeed need more time. But that doesn't change the fact that you still need to prove the efficacy of that longer term treatment.
 
It's called longitudinal research...I still support the idea b/c I am a clinician and a parent in NYC. So let's see what happens. But just as erg923 is mentioning the approval of funds from insurance companies, I could also argue that the government funding of Head Start should account for something, as I don't see billions of dollars spent on any other single educational program for pre-school aged kids.

Yes, and the longitudinal research that we do have suggests no change. What theoretical basis do we have that would suggest that while we see no changes within say, a five year span, that they would magically show up at year 10, 15, or beyond? It's become a fishing expedition.
 
I was thinking along the lines of this study: http://www.cdc.gov/violenceprevention/acestudy/

Where long-term outcomes were followed into adulthood.

Personal note: I want to get back to this discussion but I have to run along right now. TTYL

Yes, and the longitudinal research that we do have suggests no change. What theoretical basis do we have that would suggest that while we see no changes within say, a five year span, that they would magically show up at year 10, 15, or beyond? It's become a fishing expedition.
 
I agree. It is a choice for both clinican and patient.

Indeed. So, dont like it? Dont play the game.

But when 3rd pary is picking up the tab, dont expect them to want to jump on the bandwagon for treatments that, from their pepspective might as well be optional cosmetics. That is, literature suggests that treatment A works for disorder B in 12-16 session. Treat B works for X problems/disorder in 50 sessions. You do the math.
 
True, but kind of apples and oranges. Reducing risk factors vs. delivering an educational program. We can show effects in the short, intermediate, and long-term for positive outcomes in reduction of violence. We only have very short-term gains for Head Start that disappear before the intermediate term. I don't dispute that some kind of Head Start program could be beneficial. It's just that it's likely Head Start isn't. How many more billions of dollars should we spend on it to find out it's probably useless for long-term outcomes as well? Why not use that money to fund programs with short, intermediate, and long term benefits?
 
Head Start is a great program to discuss research questions and how to ask them and interpret results. We used it during discussions in my research methods class in undergrad back in 1998 or so. My understanding is that at the time initial results were that there was a benefit for underprivileged kids in program that brought them to same level as middle class as measured by basic academic skill acquisition. Then it was discovered that this effect dissipated after about 3rd grade and the lower SES kids began to fall behind again. That is not the same as stating there is no effect. It is saying that it is not a lasting effect. In any event, I am purely speculating here, but I doubt if this question has been as fully answered to the extent that some might try to make it seem.
 
True, but kind of apples and oranges. Reducing risk factors vs. delivering an educational program. We can show effects in the short, intermediate, and long-term for positive outcomes in reduction of violence. We only have very short-term gains for Head Start that disappear before the intermediate term. I don't dispute that some kind of Head Start program could be beneficial. It's just that it's likely Head Start isn't. How many more billions of dollars should we spend on it to find out it's probably useless for long-term outcomes as well? Why not use that money to fund programs with short, intermediate, and long term benefits?
I think we are saying pretty much the same thing. The answer to your presumably rhetorical question is: politics trumping scientific decision making. That's how the entire education system is run in my experience. I spend a lot of time trying to clean up the mess they make.
 
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True...apples & oranges, but I should've clarified that I was referring to the ACE Study's methods of examining different timepoints throughout a lifespan.

I appreciate smalltownpsych's responses because he summarized best the points I was trying to make, and we also analyzed the Head Start model in my master's program, which was geared towards child/school psych, in 2002/2003. So perhaps things are changing (in terms of outcomes), but I still wonder about the effects into these children's adulthood, as their needs changed, but the short-term goals of the program were (hopefully) established.

I'm all about short-term efficacy and skills training. No doubt about that.

Okay, i'm signing off for real now. Until later...
True, but kind of apples and oranges. Reducing risk factors vs. delivering an educational program. We can show effects in the short, intermediate, and long-term for positive outcomes in reduction of violence. We only have very short-term gains for Head Start that disappear before the intermediate term. I don't dispute that some kind of Head Start program could be beneficial. It's just that it's likely Head Start isn't. How many more billions of dollars should we spend on it to find out it's probably useless for long-term outcomes as well? Why not use that money to fund programs with short, intermediate, and long term benefits?
 
I think we are saying pretty much the same thing. The answer to your presumably rhetorical question is: politics trumping scientific decision making. That's how the entire education system is run in my experience. I spend a lot of time trying to clean up the mess they make.

You can't separate the politics and practice in education. But, that is besides the point here. The effect dissipates, so, you either need the program to run indefinitely and look at outcomes then, or scrap it. If it needs to be a longer term program, then it seems that a change in curriculum in general is needed. The point is that HeadStart in it's current iteration and form of delivery is essentially useless and a huge money sink, politically and empirically.
 
Useless is a bit harsh...it really depends on who you are referencing and your sources of information. Scroll down on your google searches...and you'll find these.
 

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Those studies don't provide anything new to the argument. The first is contaminated by a ton of error, and even if you look past that, the effect sizes are very small. The second is more data about the immediate benefits, which may be contaminated by demand characteristics, and doesn't address the lack of long-term efficacy data. In terms of a cost-benefit analysis, I just don't think HeadStart has shown the benefit to outweigh the costs. The data are not there.
 
Sure. Good critical analyses.... you get an A for effort, but THERE IS hard data in support of Head Start that is presented before Congress and reappropriation committees to renew the benefits, year after year for the past 30 years. You naysayers are arguing just to argue, stating there's no hard data in support (most likely based on scanning articles as I am). Fact is that it is an implemented program based on a need-based theory that produces hard data. (period), which was the basis of my entire argument, that it is an example that this concept is possibe in reality. And I could go off on a tangent to say, live and breath in the environments that call for these types of programs (and have some kids), then come back and talk to me. Sure, you'll say "I don't need to have kids to understand the data", like "I don't need to be a heroin addict to understand heroin," but these parents/families/children may significantly benefit from 'side effects' of these programs (regularly, consistency, parenting skills, etc.), and when you see the alternatives (i.e., no HeadStart or early intervention program), the outcomes are devastating and we (clinicians) pick up the pieces.
Those studies don't provide anything new to the argument. The first is contaminated by a ton of error, and even if you look past that, the effect sizes are very small. The second is more data about the immediate benefits, which may be contaminated by demand characteristics, and doesn't address the lack of long-term efficacy data. In terms of a cost-benefit analysis, I just don't think HeadStart has shown the benefit to outweigh the costs. The data are not there.
 
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I've read articles on both sides of the issue, not merely scanned. Both in grad school and more recently. The is a greater quantity, and more methodologically sound data that shows no real effect of the program than the data supporting it. Congress supports it because it sounds good and because they use data on a cohort that is not generalizable to the actual population (i.e., a pilot sample that was EXTREMELY well-funded). I'm not arguing just to argue. I'm arguing because the data says that there is probably a better way to spend 7+ billion a year on education and actually get something out of it. Remove the emotions from it and look at it objectively. I'm not saying "do nothing" for the people using the programs, I'm saying "do something better." It's all good and dandy to want to do something, but I;d rather do something worth a damn. Even one of the founders of HeadStart says that it's not working.
 
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Ok. I'll follow it more closely and let's see what happens. Like I said before, so far the alternative programs have not been widespread yet. And, I admit, the emotions of being a parent and treating low SES populations have kept me firing back. I could not imagine (anecdotally) what the kids I've seen benefit from the program would be w/o it, but that may true for most primary prevention programs.
 
While thats fantastic in the academic world, bringing that mentality to clinical practice is less pragmatic. Here is an example of one of my recent conversations with a Humanistic psychotherapist:

"But doctor X, we (unnamed HMO) do not cover on going, long term, non directional, supportive psychotherapy with no end in site especially when there has not been any benefit from 30 visits of psychotherapy as evidenced by your charting which reflects a GAF score of 55 at visit one and a Gaf Score of 55 at visit 30...especially when X treatment has been show to be effective for this condition in 12-16 sessions."

I dont make the rules. Comments?

Well, I do hope there's more rigorous empirical research done on psychodynamic and particularly humanistic types of therapy, because I do believe they *can* provide something alternative to the symptom management of some other types. I think the symptom approach is perhaps misguided and limited in efficacy if it focuses on short-term cognitive behavioral changes rather than deeper aspects of the person, from which complex dynamics symptoms emerge imo. But sure, this is a lot of theory on my part and not as much evidence. As far as I'm concerned personally, I hope to continue on to a clinical PhD program and I'll definitely be very careful about choosing what type of therapy to do with clients. There's nothing wrong, despite my earlier statement, with helping someone's OCD or social anxiety or whatever via cognitive-behavioral techniques addressing the surface issues. Ultimately I hope therapy can aspire to more than that, to being more psychodynamically transformational, but I understand there's a need for balance and practicality when dealing with the ethics of a client sitting in front of you. (and I understand that CBT isn't somehow excluded from helping people on deeper levels, as well)
 
Well, I do hope there's more rigorous empirical research done on psychodynamic and particularly humanistic types of therapy, because I do believe they *can* provide something alternative to the symptom management of some other types. I think the symptom approach is perhaps misguided and limited in efficacy if it focuses on short-term cognitive behavioral changes rather than deeper aspects of the person, from which complex dynamics symptoms emerge imo. But sure, this is a lot of theory on my part and not as much evidence. As far as I'm concerned personally, I hope to continue on to a clinical PhD program and I'll definitely be very careful about choosing what type of therapy to do with clients. There's nothing wrong, despite my earlier statement, with helping someone's OCD or social anxiety or whatever via cognitive-behavioral techniques addressing the surface issues. Ultimately I hope therapy can aspire to more than that, to being more psychodynamically transformational, but I understand there's a need for balance and practicality when dealing with the ethics of a client sitting in front of you. (and I understand that CBT isn't somehow excluded from helping people on deeper levels, as well)

Why would chages based on cogntive behavioral interventions be "short-term"?
 
Why would chages based on cogntive behavioral interventions be "short-term"?

Yeah, there is very good long-term data on many CBT tx's. Specifically, some of the trauma treatments have very good long-term data (the outcome data I am most familiar with) and some recent things have come out for more general CBT paradigms as well.
 
Ugh! I hate these CBT vs Psychodynamic vs Humanistic debates. I use CBT techniques and principles, I would be stupid not to, but I also integrate a lot of other information in my conceptualizing and treatment. All of the other information has varying degrees of support and evidence. Obviously more reductionistic views are easier to empirically validate in the lab, but that does not mean that it is the only or even the best source of data. When you are arguing using two different paradigms, CBT being focused and with other theories being broader, then each ends up being more polarized and frustrated.
 
I don't look at it as a debate of "this vs. that." It's simply a matter of showing evidence for efficacy. It's what we deal with in clinical practice. We don't do things because they "feel right" or because it's the way they've always been done. Healthcare needs to embrace an evidence based practice model. If you can show that it is efficacious in a meaningful way, I'm all for it, whether it is CBT or dynamic, or whatever. But, we can't just make unsubstantiated claims with little evidence.
 
Why would chages based on cogntive behavioral interventions be "short-term"?

Sorry, I wasn't referring to outcomes, just "short-term" in reference to their focus on symptoms, which is a little confusing. I do acknowledge that their outcomes can be meaningful and lasting. But I do have some questions about the "depth" of their penetrating power and transformational ability. Questions, literally, not answers, as I haven't put the time in yet to really have answers. Starting my program this month!

My initial point was that I don't think it's strange that the group that values empirical research more is also the group that has the more supportive empirical research. Not that there's no empirical humanistic research, but it's definitely not as big a priority among humanistic scholars, and yes even clinicians. Rather than knock them for it, exactly, I'd like to get to know why and what they *do* base their views and clinical practices on. In my limited interactions I believe they feel they have ample justification for their views and practices outside of a strict adherence to evidence based treatments. This may come down to faith in a more inductive/qualitative/philosophical approach rather than an empirical approach. Although I hope they can be reconciled and more empirical research is performed, like I said.

"Feeling right" about it is a straw man, I'd argue, as far as a lot of this is concerned. Having a different epistemological base isn't the same as being wishy-washy or uncritical. E-P stuff is very critical, just in a different way than empiricism. Obviously that doesn't solve the issue of mainstream institutional acceptance and financial issues, though, which is definitely something that needs to be considered.

Are you guys familiar with George Atwood/Robert D. Stolorow of the intersubjective psychoanalytic school? I think their stuff is really interesting, they stress phenomenology as an alternative to the "medical model." But yes, they're very philosophically inclined as opposed to empirically inclined. I've seen Atwood go off on CBT a lot.
 
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Sorry, I wasn't referring to outcomes, just "short-term" in reference to their focus on symptoms, which is a little confusing. I do acknowledge that their outcomes can be meaningful and lasting. But I do have some questions about the "depth" of their penetrating power and transformational ability. Questions, literally, not answers, as I haven't put the time in yet to really have answers. Starting my program this month!
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I would argue that CBT doesn't actually just focus on symptoms. Actually, not only I would argue that, check out some of Beck's work, and check out Judith Beck's CBT manuals. You're examining the cognitions that lead to the symptoms, not merely putting a bandaid on symptoms in the first place. Also, there is some good fMRI and imaging data on funtional changes in activations of things such as fear conditioning in the intermediate term following CBT.
 
I would argue that CBT doesn't actually just focus on symptoms. Actually, not only I would argue that, check out some of Beck's work, and check out Judith Beck's CBT manuals. You're examining the cognitions that lead to the symptoms, not merely putting a bandaid on symptoms in the first place. Also, there is some good fMRI and imaging data on funtional changes in activations of things such as fear conditioning in the intermediate term following CBT.

Fair enough. I haven't studied it nearly enough at this point. I'm interested in looking into it, and I don't have a strong preliminary aversion even though I think Atwood is probably right about some things. I wonder about focusing solely on cognitions as well, as if they're divorced from all the other aspects of the person, emotional/behavioral/religious (or non-religious, basically implicit worldview type stuff)/familial environment/etc.

On a related note, this is from Brent Robbins, the current humanistic APA division president:

"Aaron T. Beck spoke at today's Global Summit on Diagnostic Alternatives, hosted by the Society for Humanistic Psychology at the Helix Hotel in Washington, DC. He said his ideas about schizophrenia are now "trending toward a more humanistic view." He continued: "We will only use delusion as a way to understand what is really a struggling individual. Underneath the camouflage, there are core values and aspirations. In order to get to the symptomatology, you will need to mobilize the person, get the person engaged. Ask into the core values and aspirations; find out what they want in life. Get them engaged, and the symptoms fade out."

He said he has two problems with the whole DSM diagnostic system. One, the "top-down structure" leads to "superficial observations. " He went on, "A huge body of psychological knowledge is being ignored in the DSM."

Second, he said "the whole notion of pathological models--the concept of a medical complex" is inferior to the "adaptational model." He supported the view that normality and harmful behavior are on a continuum in which "coping strategies" at the far end "are inadequate or excessive.""
 
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Well, yes, schizophrenia is not well treated by CBT, or any psychological treatment for that matter. No argument from me on that one. You can help with medication management and management of symptoms, but nothing "cures" it psychologically. And, the DSM stuff is another beast, it's technically atheoretical, so it's not really an a vs. b vs. c thing.
 
Fair enough. I haven't studied it nearly enough at this point. I'm interested in looking into it, and I don't have a strong preliminary aversion even though I think Atwood is probably right about some things. I wonder about focusing solely on cognitions as well, as if they're divorced from all the other aspects of the person, emotional/behavioral/religious ""

Well, it's called cognitive-BEHAVIORAL therapy for a reason, right?
 
What Beck seems to be saying looks to be pretty similar to, yes, some humanistic ideas, as well as to the whole Recovery Model-oriented approach that's been pushed by the VA for a few years now (and in particular in SMI populations). Many of the ideas are also prevalent in the "newer" paradigms like ACT and MI, both of which of course also draw on cognitive and behavioral techniques.

And I'd agree that the stereotype that CBT is particularly symptom-focused and/or surface level generally seems to be incorrect. By definition, you're addressing underlying cognitions (and the associated maladaptive behaviors), which generally then results in changing the way folks think about things, and thereby can lead to deep and lasting change.
 
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