What Does It Take To Become A Celebrity Psychologist?

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I think questioning someone who regularly responds negatively and cynically to many people is extremely productive.

Except that you haven't actually asked any questions, right-Only provided relatively nasty personal insults?

I don’t know who you are or where you came from with all this vitriol towards me, but I am not going to debate this with you. This will be the last post on the matter and if it does not stop, you will be reported.

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Oh erg, with all the threats I'm shocked you haven't reported me yet. Again, you're wrong I've not given anything close to nasty personal insults and a quick history search shows it. I've given relevant information to questions asked. I've seen you pull your stunts for years to many simply asking questions and looking for help and you've "flipped your wig" and see vitriol because someone calls you out on it. Understand?

Wisneuro - you should get into it if your way would be more effective and cost effective. This seemed to work for her and her employers. It seems likely that you just wanted to say that the Rorschach was garbage. I personally don't like it, but specific interpretation methods of it are valid. I know these skills are highly sought after at prestigious forensic sites.
 
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Nah, I enjoy my job quite a bit, no need to jump into entertainment. As for teh validity question, I think there is some ok validity for like 3 of the scales, of which there are more time efficient measures to answer the same thing.
 
When people assert that Rorschach can mean zilch to one clinician whereas it can mean something very insightful to another is actually a great argument for the invalidity of the tool...at least if we stuck to the same definition of psychological test (vs interesting parlor game).
 
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Any type of consulting job is going to have ethical considerations and assessments for a third party can be difficult. To me this would be somewhat analogous to law enforcement assessments used to screen for hiring purposes. I don't know much about it but as a psychologist I am going to question the validity of an assessment all day long. I even did that as part of my job as a clinical director. I am not sure why you get so upset when someone asks those questions? Just because of the sarcasm or cynicism?
 
I'm assuming that the producers were/are more interested in colorful personalities, what kind of people would draw ratings and that would be the emphasis of the referral question and that ruling out potential violence would be CYA. Our conversation was more about personality assessment.
Yep. This is generally what I've heard in regards to reality TV casting--they want dramatic personalities and conflict that stop short of physical violence. About 10 (?) years ago, there was a contestant on the Amazing Race who slapped/hit/smacked (it's unclear) his wife on camera, which created a lot of conversation about domestic violence but was considered to be one of the times where the screening process failed in not being sensitive enough.
 
It's the scoring systems that are validated, Exner comes to mind. Like I said, I don't care for it, but it's a perfectly acceptable and useful for the field for those who use it. I'm certainly not a forensic guy, but there's a need for it and the skills are highly desirable. The theme of something that doesn't fit your particular value being garbage and others need to stay away really permeates these threads. You know trying do debase others' POV doesn't make your own any more valid, right?
 
Last time I checked, many of the big name forensic experts agree that it does not meet the Daubert criteria. How does that meet the definition of highly desirable in a forensic sense? I'm not debasing a point of view, I'm debasing the junk science behind a measure that shouldn't be used in the field anymore.
 
That's interesting. I'd like to see that, where did you check? My knowledge comes from successfully matched intern applicants who applied at the highly competitive forensic sites. They were asked about their experience and sometimes given data to interpret during their interviews. Some of those past students said they used it frequently and I know of 1 student who was hired at a desirable forensic hospital and she believes her knowledge of the Rorschach gave her a huge advantage. It's certainly not my area of expertise. What is the junk science that was used?
 
It's the scoring systems that are validated, Exner comes to mind. Like I said, I don't care for it, but it's a perfectly acceptable and useful for the field for those who use it.

1. The Exner system is garbage. 3 scales out of all them meet traditionally accepted notions of psychometric rigor that makes something a "psychological test." The Rorschach has none of the psychometric requirements for a "test" of personality; what is “normal" is in doubt; we don’t know what it measures, whatever it is “valid” for is unknown, because there is no theory, just data bootstrapped onto interpretation. Interrater reliability is poor for most scores. Its sample of behavior, but not a "test." So, please. No. Please not in forensics. Ok. Its embarrassing to scientific psychology. There is no "need" for the Rorschach, and especially not on the witness stand.

2. The Exner system aside, proponents never seem to stay there, rather opting to waxing philosophically about the "deep insight" that they gleam from using this "test." Well, thats all very exciting, really, but I do not see any evidence that this translates into tangible treatment recommendations that justify the time to admin/score AND the cost to whoever is paying for it. Cost-benefit analysis. Get used to it folks. Managed care has a point there, I must say.

Despite the fact that nice people love the Rorschach, this is not just an “if you don’t like it don’t use it” issue. What if half our fellow clinicians used Astrological charts to predict their patients psychopathology? Would you say that all is fine and everyone can use what they want?
 
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Hello there...including you fellow/former VA clinicians...

Exner's Rorschach coding system is widely used to assess Veterans in our VAMCs in New York, having used them myself to ask clinical questions, such as "why isn't this person getting better....he/she's been enmeshed in our inpatient/outpatient system for quite too long now?"

And you know what?! These Rorshachs (combined with other valid, reliable tests) were very helpful to both the Veteran patients, treating clinicians, and us, trainees.

Generally, I've found if you do not have expertise in it‎, you poo-poo it as valid test. If you know it and support, it is a useful tool (in a battery of other instruments). There as much evidence disputing it as supporting it...just depends where you look (i.e., peer-reviewed empirical literature).

IMO‎ but this conversation is digressing...this is not about the ROR...it is about the relevance of testing folks to be on reality TV.‎ Correct? And working with celebrities, right?‎
 
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Show me the efficacy data. Show me where it improves treatment outcomes. I always ask for this data and no one can produce anything. I don't want opinion, I want empirical data.
WisNeuro, IF I were to present these data right now, you would quickly pubmed search studies to dispute it. It is a Projective Test...they are not 'rainbow and puppy-dog' (i.e., Lisa Frank) tests but definitely a league of their own.

And efficacious...‎yeah, well...it does take longer than usual (on VA salaries) to administer, interpret, score and integrate into a report...but in some cases...it's more efficacious to do it rather than try more EBTs with clients who are mismatched with their therapists and just not getting better. ‎

 
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And efficacious...‎yeah, well...it does take longer than usual (on VA salaries) to administer, interpret, score and integrate into a report...but in some cases...it's more efficacious to do it rather than try more EBTs with clients who are mismatched with their therapists and just not getting better. ‎


I have seen it used as 'grist for the mill' for patients who have stalled w. other interventions. I'm not sure if that is heresy or not for the pro-ROR people (as I am not one of them), but I guess it is better than trying to hit the same nail with the same hammer.

In regard to forensics, I'm clearly in the "lacks sufficient support for Daubert" camp, though I've always been curious to see who has been successful in getting it accepted.
 

WisNeuro, IF I were to present these data right now, you would quickly pubmed search studies to dispute it. It is a Projective Test...they are not 'rainbow and puppy-dog' (i.e., Lisa Frank) tests but definitely a league of their own.

And efficacious...‎yeah, well...it does take longer than usual (on VA salaries) to administer, interpret, score and integrate into a report...but in some cases...it's more efficacious to do it rather than try more EBTs with clients who are mismatched with their therapists and just not getting better. ‎

This doesn't mean anything without data. Joseph Mercola makes these kinds of statements with no data. Should we take him at face value too?
 

having used them myself to ask clinical questions, such as "why isn't this person getting better....he/she's been enmeshed in our inpatient/outpatient system for quite too long now?

You need a ror for that?!! I am not being flippant or sarcastic. If its not one of the obvious, of which I'm sure you know what I'm referring to, this is really something that cant be discovered via clinical discussion/interview?! By the way, this the question that is on every managed care precert/preauth form for psychological testing ever made.
 
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You need a ror for that?!! I am not being flippant or sarcastic. If it not one of the obvious, of which I'm sure you know I'm referring to, this is really something that cant be discovered via clinical discussion/interview?! By the way, this the question that is on every managed care precer/preauth form for psychological testing ever. .
No...it could not be discovered by seasoned psychiatrists and clinical psychologists...IMO b/c the wrong therapeutic approaches were addressing acute distress and it was simply more...dynamic. Testing feedback was enormously helpful.
 
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No...it could not be discovered by seasoned psychiatrists and clinical psychologists...IMO b/c the wrong therapeutic approaches were addressing acute distress and it was simply more...dynamic. Testing feedback was enormously helpful...

"Dynamic," huh...

So again we have another "beyond the Exner system" proponent. It means whatever you think it means? So long as that's clear.
 
I've read that study. It kind of supports the whole psychosis thing, using it's own internal data, which is a whole other bag of worms. But, I ask again, where is the data that it can be used in helping to guide treatment outcomes?
 
"Dynamic," huh...

So again we have another "beyond the Exner system" proponent. It means whatever you think it means? So long as that's clear. ..
I'm not saying anything about going "beyond Exner." I'll take him right where he is ~ ideally with updated norms that account for more nuanced perceptions of this millennium (i.e., "What might this be?" "Uh, my husband texting his mistress in between two dancing bears..."). Yes, let's be clear: it means whatever you think it means if and only if you know what you are talking about. :poke:

I've read that study. It kind of supports the whole psychosis thing, using it's own internal data, which is a whole other bag of worms. But, I ask again, where is the data that it can be used in helping to guide treatment outcomes?
I might want to start working on that ...want to write a grant together? You could critique all my points until it's ready for submission, and boy, will it be ready then!

Seriously, I haven't researched the treatment outcomes lately, but my hypothesis would be that treatment outcomes from the clinical batteries (that include the ROR) would be confounded by the other batteries administered, and would be based on clinical decisions made by the treating clinician (of course, not the blind tester - duh). Maybe you could elevate gains after feedback, but like I said too many confounding variables and too convoluted. (Unlike the actual ROR if you actually know how to administer/interpret it.) And it's okay to say that you do not know this test intimately, and this 'unknown' is the basis of your fears. I am scared too for all the half-a** interpretations that invalidate this instrument. I agree there is a lot more variability in administration versus WAIS or MMPI. And that part of the ROR involvement is scarier than it needs to be.

...But remember: Recommendations for treatment are based on clinical interviews, chart review plus the interpreted data...so again, you are asking a very good question, if you consider the efficacy.

Dissertation/Meta-analysis, anyone? :wtf:
 
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I'll take him right where he is ~ ideally with updated norms that account for more nuanced perceptions of this millennium (i.e., "What might this be?" "Uh, my husband texting his mistress in between two dancing bears..."). Yes, let's be clear: it means whatever you think it means if and only if you know what you are talking about. :poke:
..

CheetahGirl, this is exactly what im talking about. A harkening to the mystic Rorschach Guru- the well trained rorschacher who can decipher what is hidden to all others. "Dynamic" interperetations are alive and well within rorchahery. And thats what I mean by "beyond exner."

Roschach proponets inevitably revert back to examples such as the following: "Yea but, if someone says they see two bunnies high-fiving each other, that's going to say something different about you than if you say you see the face of Satan come to eat your soul."

Is that so? And. . . what would that be? That one person watches kiddie shows with their kids and the other just saw ajn Omen-Spawn double feature? Medical students see a lot of anatomy responses. One might suspect that if you have a pet bunny, you might see bunny responses. Satanists presumably see satanic responses, but so may fire and brimstone Baptists. How on does this earth does that inform treatment?! Is there any support at all in the research saying that Rorschach-directed treatment is better? Is it more effiacious?
 
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Is there any evidence that any testing improves treatment outcomes? If so, then shouldn't we be doing more testing? Of course, you have to weigh in cost benefit analysis which is less of an issue with the VA. I am actually not too keen on the utility of personality assessment in general. I much prefer cognitive testing as I feel more confident in the validity, reliability, and especially the utility.
 
Is there any evidence that any testing improves treatment outcomes? If so, then shouldn't we be doing more testing? Of course, you have to weigh in cost benefit analysis which is less of an issue with the VA. I am actually not too keen on the utility of personality assessment in general. I much prefer cognitive testing as I feel more confident in the validity, reliability, and especially the utility.

I think the answer depends on who you believe. Clinical psychology training programs and professors, or McKesson Interqual. Each have an agenda they are pushing and a stake (ie., money) in the game, right?
 
Is there any evidence that any testing improves treatment outcomes? If so, then shouldn't we be doing more testing? Of course, you have to weigh in cost benefit analysis which is less of an issue with the VA. I am actually not too keen on the utility of personality assessment in general. I much prefer cognitive testing as I feel more confident in the validity, reliability, and especially the utility.

Depends on the referral question. There is data that shows reduced emergency service utilization following npsych evaluation in the VA in general. A retrospective design with some methodological limitations, definitely more study needed. There is much stronger data for the role of the evaluation in guiding treatment and predicting outcomes in moderate and severe brain injury.

Just depends, sometimes I'm not asked to provide treatment recommendations, sometimes they just want diagnostic clarification, or updated testing. Sometimes, a dementia eval is simply normal aging and there are no treatment recommendations other than "enjoy your retirement."

Although, these are all cognitive evals. I don't do much personality assessment, I have extensive training in it, but don't find it all that helpful in most of my referral questions.
 
How on does this earth does that inform treatment?! Is there any support at all in the research saying that Rorschach-directed treatment is better? Is it more effiacious?

ON A SMOKE BREAK (and I don't even smoke):

Good morning, erg923: Do you want me to review the ROR clusters with you?

Basically, you gain information about how the person processes input data….which informs the ability to process information, processing effort and strategies. Don’t forget about scanning efficiency which is the ability to quickly scan material and form conclusions about that material. Then, we understand more about how one specifically relates to the way information is transformed and identified. Taking into consideration, we understand more about the formation of ideas (or ideation). In addition to endorsing responses that indicate the individual’s capacity for control and tolerance for stress…all the while identifying presence of situational stress, how one processes emotional stimuli, and finally, considering one’s self-perception and interpersonal style.

Again, I’m in agreement about questioning the efficacy of this instrument, but to gain knowledge about someone in terms of the abovementioned material in a snapshot….the use of the ROR diagnostically is unique and useful as projective assessment….in addition to other diagnostic skills. Makes for a richer report once someone can verify these data against other sources of information.
I don't do much personality assessment, I have extensive training in it, but don't find it all that helpful in most of my referral questions.

Well, that's you...and you're a neuropsychologist. Folks may not ask you to assess personality. We don't ask our Neuropsych Service to do psychodiagnostic testing...It's left up to the General Psych Consult team.
 
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I wasn't disparaging personality assessment in general. I just don't find it all that helpful in differentiating types of dementia or the late effects or cerebrovascular disease. I will use it in my younger patients frequently though, about 10-15% of my referrals.
 
Again, I’m in agreement about questioning the efficacy of this instrument, but to gain knowledge about someone in terms of the abovementioned material in a snapshot….the use of the ROR diagnostically is unique and useful as projective assessment….in addition to other diagnostic skills. Makes for a richer report once someone can verify these data against other sources of information.
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I'm honestly curious, is there research attesting to the increased incremental validity here that you are alluding to?
 
Second virtual cigarette for this non-smoker:

I am certainly alluding to increased incremental validity, and I do not yet know if there is research regarding this particular question...and it is another great research question, but again...what alternative is there for some relevant cases? You could pick apart my statements by saying this ROR (again, a projective test) is not valid or reliable ENOUGH for your purposes, but then, ask yourself what projective test would be? Most likely none, right? So don't use them, especially if you are not adequately trained in them. But to say that I (we) are doing harm by assessing the patient in these terms is incorrect. There is no malpractice going on. It is obiviously a test you do not support, and for me to get into a philosphical argument with you about this is pointless.

However, keep asking the questions, because I will keep them in mind and discuss with others who know more, and perhaps get back to you once I learn more about the scientific support for this measure because diagnostically it taps into something that other measures do not.

What is your opinion on the TAT? or CAT?

(FYI: I'll log off and check back this evening before I get busted for taking too many virtual smoke breaks...)

Edit: Look what I found...but, all things are not equal...it evaluates a scale derived from the Rorschach (RPRS), not the ROR itself. ;)
 

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Makes for a richer report once someone can verify these data against other sources of information.

And "a richer report" translates into....? Besides making the psychologist feel good/super accomplished?

You do understand this vaguery is exactly why projectives instruments are all but demonized in industry guidelines like Interqual, and its exactly why they are the first tests to cut out time when "reviewers" are looking for the "medical necessity" and appopriateness of your proposed psychological evaluation right?

But to say that I (we) are doing harm by assessing the patient in these terms is incorrect. There is no malpractice going on. It is obiviously a test you do not support, and for me to get into a philosphical argument with you about this is pointless.
Not "harm" in the tranditional sense, no. But, as I said before, I think you need to broaden your analysis here a bit. Someone is paying for this service/instrument adminstration, right? When you are spending other people money (essentially) I would suggest we need to take into account tangible cost-benefit ratios.

Would you care to address the "healthcare economics" I noted in my above points?
 
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Cheetah, that article doesn't really answer the question. You said it can guide and inform treatment and "improve" outcomes. That article just says that a score derived from it can predict certain outcome measures better than a score derived from the MMPI or intelligence. Where is the data suggesting improved outcomes from use?
 
Where is the data suggesting improved outcomes from use?

It just doesn't seem like the best use of time for either the clinician or the patient and also does not seem to be the best use of monetary resources.

Would you care to address the "healthcare economics" I noted in my above points?

Wow, I am in the hot seat ...now, on my lunch break. You all are making me realize that, no, I cannot address healthcare economics, and how the loss of productivity and resources due to administer/scoring and integrating the ROR into psychodiagnostic tests contributes to a compelling problem in delivery of services, especially in the VISN-3. And again, seems like the research on improved treatment outcomes would still be confounded by both the other tests administered and the treating clinician (as stated above), so a clear-cut study design of this nature would be extremely difficult.

Evaluating Teen Mom (reality show) participants seems like a walk in the park, now that I think of it.
 
Second virtual cigarette for this non-smoker:

I am certainly alluding to increased incremental validity, and I do not yet know if there is research regarding this particular question...and it is another great research question, but again...what alternative is there for some relevant cases? You could pick apart my statements by saying this ROR (again, a projective test) is not valid or reliable ENOUGH for your purposes, but then, ask yourself what projective test would be? Most likely none, right? So don't use them, especially if you are not adequately trained in them. But to say that I (we) are doing harm by assessing the patient in these terms is incorrect. There is no malpractice going on. It is obiviously a test you do not support, and for me to get into a philosphical argument with you about this is pointless.

However, keep asking the questions, because I will keep them in mind and discuss with others who know more, and perhaps get back to you once I learn more about the scientific support for this measure because diagnostically it taps into something that other measures do not.

What is your opinion on the TAT? or CAT?

(FYI: I'll log off and check back this evening before I get busted for taking too many virtual smoke breaks...)

Edit: Look what I found...but, all things are not equal...it evaluates a scale derived from the Rorschach (RPRS), not the ROR itself. ;)

I think I've said this before, but I dislike the TAT/CAT even more than I dislike the Rorschach.
 
Wow, I am in the hot seat ...now, on my lunch break. You all are making me realize that, no, I cannot address healthcare economics, and how the loss of productivity and resources due to administer/scoring and integrating the ROR into psychodiagnostic tests contributes to a compelling problem in delivery of services, especially in the VISN-3. And again, seems like the research on improved treatment outcomes would still be confounded by both the other tests administered and the treating clinician (as stated above), so a clear-cut study design of this nature would be extremely difficult.

Evaluating Teen Mom (reality show) participants seems like a walk in the park, now that I think of it.

Would you be willing to take our questions regarding "healthcare economics" to your supervisors? Not in a hostile or challenging way of course, but just to see what some of the rorshcarers think about us cold hearted business minded psychologists? :)

I would think that access issues and thoughtful use of clinical resources/time would be of specific interest to fellow VA psychologists?
 
Would you be willing to take our questions regarding "healthcare economics" to your supervisors? Not in a hostile or challenging way of course, but just to see what some of the rorshcarers think about us cold hearted business minded psychologists? :)

I would think that access issues and thoughtful use of clinical resources/time would be of specific interest to fellow VA psychologists?

What is your specific question on healthcare economics, again? Sure, I can discuss in our next psychodiagnostic seminar...but it's not scheduled for a couple weeks. And I will not forget (in addition to all the other conversations we've had on the subject).

cara susanna...I know. I threw the TAT/CAT out there as an red herring to move the conversation off the ROR. :)
 
Just wanted to get some discussion going. It's always a good idea to question your assessment methods and what they purport to do. I frequently have my trainees do some lit reviews for certain tests to see what the research says about it's sens/spec for certain diagnoses/populations and or how they relate to functional outcomes. If the data isn't there, you should question that instrument and seriously consider it's use in a clinical setting. There are plenty of npsych tests I don't use due to bad psychometric properties, personality tests should be no different.
 
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What is your specific question on healthcare economics, again? Sure, I can discuss in our next psychodiagnostic seminar...but it's not scheduled for a couple weeks. And I will not forget (in addition to all the other conversations we've had on the subject).

This reponse:
The Exner system aside, proponents never seem to stay there, rather opting to waxing philosophically about the "deep insight" that they gleam from using this "test." Well, thats all very exciting, really, but I do not see any evidence that this translates into tangible treatment recommendations that justify the time to admin/score AND the cost to whoever is paying for it. Cost-benefit analysis.

And this response:

And "a richer report" translates into....? Besides making the psychologist feel good/super accomplished?

You do understand this vaguery is exactly why projectives instruments are all but demonized in industry guidelines like Interqual, and its exactly why they are the first tests to cut out time when "reviewers" are looking for the "medical necessity" and appopriateness of your proposed psychological evaluation right?
 
...what it all boils down to, and as we all know, sometimes this ($$$) compromises appropriate clinical care, regardless of theoretical orientation, treatment approach or type of assessment used.

Well, luckily, the MBTI is mainly used in business settings. I have yet to run across anyone using it clinically, although I'm sure someone does somewhere.
 
I just backed out of a faculty development workshop at my institution (a large academic medical center) when the consultant asked us to take the MBTI as preparation for much of the first day's activities. I am so happy they forewarned us because it saved me the trouble of walking out during the workshop.

I have no doubt, though, that some participants will glean new "insights" from the MBTI that they will consider to be "highly beneficial." What's the use of going to a fortune teller if you can't try and make the best of it, right?
 
Many court clinics use the Rorschach, and the courts are sticklers for objective data. The Rorschach is also used at many major teaching hospitals. Insurance companies sometimes do, sometimes don't pay for projectives.

I don't think this is a black and white issue.
 
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Awwww, no one's going to step up and defend the Myers-Briggs?

Come on guys, there are "many" studies showing that proper use of the MBTI improves job applicant selection, retention, and employee satisfaction. OK, fine, I can't name any of those studies off the top of my head - what, do you think I studied this or something? - but I know they're out there. And lots of organizations use it, so it's got to be super rigorous and valid. Those "scientific" I/O psychologists think they know so much. They're just defensive because they haven't plumbed the depths of the singular insights afforded by the MBTI!
 
Courts are sometimes sticklers. Depends on who is involved and if they challenge the data according to Daubert-Kumho standards. The use of something is not evidence of its usefulness or effectiveness.
 
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