Great Arguments in Clinical Psychology

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yeti2213

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Quite often a thread on this forum turns into a little battle over what different schools of thought want clinical psychology to focus on and how they want it to evolve. Great debates of that nature do move knowledge and practice forward, for that reason and as someone taking steps into the field I'm pretty curious about these debates are about.

Sometimes, in reading this forum, I feel like I'm eavesdropping on a fight in a restaurant, I get all the emotions, the general thrust of the arguments but I lack the context and nuanced understanding history provides. So without actually starting any one of these arguments can we talk about what the big ones are and what each camp generally says about the topic. Two arguments I have noticed (feel free to rephrase, or just come up with your them as you fit):

1. Evidence Based vs what ever the other sides should be called
I am imagining that the evidence based camp would advocate for something close to how medicine is practiced today, in that one determines the problem on the basis of pre-establish criterion, then choose a proven (and what constitutes proof?) method to address that problem. So for this group the skill of a psychologist is in having enough skill to identify the proper "problem" and modulate the scale of the response.
On the other side I've noticed various gradients. They run from the poster who seems be hostile to experimental methods as valid source of information to those that think, such evidence should be "integrated" into the wisdom developed from a practice.

2. Training Necessary for an effective practitioner
This seems to be another hot topic with several dimensions. I'm not even sure how to slice it up. Maybe the camps are: Doctoral Training with a research component is needed v other levels of training are ok, depends on how much feedback and supervision is provided.

Or maybe a better way to slice it up is, 1. those who turn on the level of supervision and rigor (they might say something like "some Masters programs produce competent therapists but the large number of PsyD and masters programs don't have the capacity to do so. Thus they should be clipped") and 2. those who turn on the exposure to/involvement in research ("you can't be a effective clinical psychologist without research participation" vs "performing actual research is not necessary to be a competent practitioner")

Maybe if there is some consensus on what the arguments are, we can actually start different threads to have the arguments properly 🙂
 
1. Evidence Based vs what ever the other sides should be called
I am imagining that the evidence based camp would advocate for something close to how medicine is practiced today, in that one determines the problem on the basis of pre-establish criterion, then choose a proven (and what constitutes proof?) method to address that problem. So for this group the skill of a psychologist is in having enough skill to identify the proper "problem" and modulate the scale of the response.
On the other side I've noticed various gradients. They run from the poster who seems be hostile to experimental methods as valid source of information to those that think, such evidence should be "integrated" into the wisdom developed from a practice.

Interesting thread idea.

I certainly don't claim to speak for everyone who holds the former position; what follows is simply a personal opinion. That being said, I'm not sure you capture my own take on evidence based practice in your synopsis. I don't think it is necessarily synonymous with the medical model. Accurate assessment is definitely important, no argument there. However, I would support a diagnostic system that is less "medical" (ie. categorical) and more dimensional in nature. So, instead of diagnosing someone as either having a disorder or not based on a pre-existing list of criteria, we would assess the strength, duration, and prevalence of various mental health symptoms without applying a label.

I also don't think the treatments psychologists provide are analogous to the medications that doctors provide. We are far from the "Patient has X, we must proceed with X treatment" type of set-up, and I'm not sure that we'll ever get there. The only example of this I can think of is phobias --> exposure, compulsions --> exposure and response prevention. Other than that, we have a handful of nuanced treatment models that have been shown to be effective across different patient presentations. We tend to learn only one or two in depth and hopefully refer out when these treatments are not appropriate.
 
"Evidence-based" means using the scientific process to determine what helps, what harms and what does nothing. That's not the same as using a medical model.
 
"Evidence-based" means using the scientific process to determine what helps, what harms and what does nothing. That's not the same as using a medical model.

Evidence-based psychotherapy treatments are much more flexible and multidimensional than the medical model. Most patients don't fit into 1 diagnosis/category and we often take into account and treat multiple problems. The clinician is always seeking and testing out hypothesis. When applying an evidence-based treatment, any good clinician will take into account the patient's strength and resilience, degree of motivation for change, insight and self-awareness, and capacity to tolerate negative emotions and distress. Any treatment will be tailored to meet individual needs. You also get continuous feedback from clients and constantly re-work your formulation of the problem in light of new information or mistakes you made.
 
"Evidence-based" means using the scientific process to determine what helps, what harms and what does nothing. That's not the same as using a medical model.

Just wanted to say that I love the new icon. Colonel Tigh is great.
 
prescription debate too.
 
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