how do you deal with doubts about being to help people?

[indoubt]

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...about being ABLE to help people?

Hi all.

I have a bachelor's degree in psychology. I have considered grad school for several years but I can not come to any conclusion.

While studying psychology in my undergrad years, one is rarely faced with criticisms of psychology/psychotherapy. It's a lot of memorizations, then learning how to do research.

However, in the meantime, I have read several books/articles critical of psychotherapy.

In fact, if you WANTED to focus on the negative there is plenty.

What can a therapist CHANGE? Can you change someone's past environment/how they were raised/family dynamics? Can you change their biological makeup/genes? Can you in fact even change their present environment? Can you give them money if they're poor, help them move out of a terrible neighborhood, move into a new house, get a new supportive family? Can you even pay for fees so they can come to see you even once? Can you force their family, abusive boss, angry neighbor, unstable spouse, racist coworker to come to therapy with them? Can you change sociocultural forces, politics (e.g. war), disease, extreme financial disparity (In 2004, the top 0.1% in US made more money--before taxes--than the 120 million people at the bottom).

More importantly, can you make someone change when they can't or don't want to?

So what I'm saying is that there is a very small circle where we can make change. Now what are the scientific bases of that change?

Psychology is notoriously known as a soft science. Not only psychology is not very scientific, it is also sometimes simply wrong. For instance, until recently it was thought that Western principles applied to people all over the world and people were given therapy (potentially harmful) based on individualist assumptions of Western psychology. For instance, You can not just tell someone in therapy that you should think of yourself first because in the patient's culture it may be that others come first. Is the culture wrong? And how can we decide?

On top of that, psychotherapy is hard to study. A lot of times there are real difficulties (ethical, practical, etc) in conducting research.

And how do we know that psychological approaches to human problems are better than, say, philosophical or sociological? Could it be that "healthy" sociological changes occur only after individuals are pained psychologically? If we try to make people believe that their life is not so bad after all, maybe the broader social changes won't occur.

Another issue: we "help" only people who THINK they need help. Unless somebody is suicidal or gets in trouble with the law--in case therapy become mandatory--we only treat people who decide to come and see a therapist. For instance, often it won't be the psychopathic CEO but the abused employee. Or it will be the person who has been taught to frame his problems as psychological not, say, biological or problems of everyday living.

Okay I just wanted to put this out there. Sorry for the disorganized nature of my writing...I was not sure how to best present the various ideas I had.


Would welcome your views.

p.s. I forgot to even address the political, economic, social forces within psychology. Special interest groups, politics of power in psychological associations (APA, APS, etc) are brutal. There was this book--I can not remember now--that had some revealing information about removal of homosexuality from DSM and all the politics around it.

 

[Ollie123]

Where to start...

For one, to me, it sounds like your place is in politics or maybe public health more so than psychology. It seemed like a theme was that we can't help everyone, and even some people that come in we may not be able to do much for. That's certainly true, but that's true of healthcare in general. Doctors, surgeons, nurses, physical therapists, all of them encounter many of the same issues. The doctor may feel like he/she can't operate, the nurse will feel like he/she can't prescribe, etc. None of them can do anything about a disease until the patient comes in, and no one can provide health care for every citizen without health insurance. We're all professions focused on the micro, but you just need to make a decision on where you want to fit into the puzzle. I like the micro stuff more, and know that without people like me, no amount of healthcare form or other macro level changes will mean anything since there will be no one to enact them. Increased access to medical care wouldn't mean much if your medical care consisted of leeches and bloodletting😉

All forms of science have been wrong in the past, so I see that as a non-issue. If there is a field that has been right about everything I've never seen it. What matters is moving towards being right in the future. If no one was ever wrong, then its not called science, its called common sense.

Psychology is notoriously a soft science, but that's changing. I'm in clinical psychology, but some of my primary research interests are in genetics, pharmacology, and physiological measurement. I think that's the most exciting part of our field...our field encompasses alot of different things. A mathematician studying behavior would be pretty unusual, but a psychologist who specializes in mathematical modeling is not out of the ordinary in the least. You'll need to know quite a bit of stats to get through grad school so we all do alot of math🙂 You can still do "soft science" stuff, but I think in the coming years you'll be finding precious few psychologists who are able to make a name for themselves doing that entirely. Right now, most of the rockstars in the field are moving closer to hard science or are combining soft and hard science.

There's politics everywhere. Again, moot point in my eyes. I'm not sure there's a job out there without some form of either national or intra-office politics.

We can't make the decision for you obviously, but I can tell you I've never had doubts about the field. Many of the naysayers are folks who think psychology is all about dream analysis and other concepts that were largely outdated decades ago. Its far from a perfect field, but I think now is a very exciting time to be getting involved in psychology, with the field evolving as rapidly as it is. Out with the old and in with the new.

 

[erg923]

First of all, A THERAPIST CAN NOT CHANGE ANYTHING, PERIOD. That's the patients job/responsibility. And the answer would be no to every question in your first paragraph. Except some clinics waive fees for certain indigent clientel. To answer the rest of your question, Norcross's stages of change model (i.e.,Precontemplative, Contemplative, Preparation, Action, and Maintenance) was developed to assess a client's willingness for behavior change and is used frequently across the country to assess a patient's level of resistance to therapy. It is very important to identify which stage a client is in at the intake, because the treatment plan and directiveness of the psychotherpay varies depending on what stage someone might be in. Bottom line, if a person does not want to change, they will not. However, when a client is resistant to change, therapy modalities will change, and the quality of the rapport should be examined. Motivational Interviewing (MI) is a good technique for helping clients gain insight into the benefits of behavior change if they are mildly resistant. However, forming a good therapeutic rapport with your client is the single biggest factor in their cooperation with therapy and accounts for up to 70% of the variance in outcome studies. The scientisfica basis of behavior change comes in many forms depending on the situation. However, almost all direct interventions utilize some aspect of behavioral learning theory (stimulus-response or reinforcement contingency based leaning) combined with various other methods (e.g.,cognitive restructuring, etc).

One of the biggest misconceptions about psychotherpay is that it can not be studied scientifically. It can, there are just more nuance variables to account for. I would recommend reading some of Larry Buetlers work (as well as Bruce Bongar). He has done some very good and methodological sound working examining psychotherapy outcome. He also helped pioneer the empirically supported and integrative treatment model movement in the 90's.

I would take issue with many of your other points however. Psychology is very scientific actually. But it will never be a hard, black and white science like physics, nor should it be. The study of behavior simply has too many variables, and human behavior is predictable, unpredictable. Clinical psychology inparticular has become increasingly scientific in the past 20-30 years. However, at the end of the day, the practice of psychotherpay will always be an art form that is build from a underlying science. Nothing will ever change that. I would also add that, ALL SCIENCES HAVE BEEN WRONG ABOUT THINGS AT SOME POINT. This is just the the progressive nature of science, so I'm not sure why this would be an issue. I would also take issue that psychology has always believed western principles apply to all other cultures. I am not aware of anyone forcing western psychotherapy upon anyone, I'm not sure how this would be done anyway. If anything, our fault in the past has been ignoring other cultures. Only recently has cross-cultural research of a clinical nature begun to flourish. However, keep in mind that work has also provided support of the universality of certain psychological constructs throughout the world. For this I would recommend reading the work of Lazarus and colleagues and their research with emotions across cultures and the universal nature of their experience across cultures. Also, I have never heard anyone tell a client that that they should "only think of themselves" in the course of psychotherapy. I'm not sure where you have gotten this impression. During my training we are very careful and well educated on the preferences of different cultures and how they and their culture tend to view mental illness.

I am not sure what you are getting at with the "only help people who only THINK they need help" thing. What is the alternative? A psych gestapo to round up every narcissistic greedy CEO and force them in to therapy. I think not. Besides, people can be committed to psychiatric facilities against their will and receive treatment, (usually pharmacological) if they are deemed a threat to themselves or other. Just like Britney Spears....🙂 I think that's all we really have the right to do in this country. Basically, you have the right to a jerk, or mentally ill, as long as you are not hurting anyone.

As for the politics within psychology, this is nothing new. Politics are present in every field of every profession, you will not escape them here. The APA and APS are far from "brutal" about anything though. If anything, APA lacks the influence and power it should have in many respects. They are no where near as powerful as the AMA for example. And yes, homosexuality was taken out of the DSM in the early 1970s. Spitzer has spoken about this battle publicly as well.

 

[The2abraxis]

well to start off, im no expert (or anywhere close, but hopefully in the future I will be :-D), so I am speaking of what I know from my own studies:

a lot of therapies are different (behaviorists try to change behavior, psychoanalysts try to look at the unconcious feelings, CBT looks at assumptions/thoughts/interpretations of events, etc...) but I am mostly going to talk about the Cognitive-Behavioral aspect (at least from what I know so far, like I said, im not expert :-D).

when you say what can a therapist help change? well for one, all the things you mentioned were factors OUTSIDE of one's control (or at least most of them). so in the practice of CBT, a therapist and the person look at what is going INSIDE the person, mainly 1. View of the past, present, future 2. View of the world around them 3. View of themself. Overall it is the patient who must do the changing in the end

there have been clinical studies showing the correlation between "faulty" views/beliefs/assumptions, etc... (as well as other things), and also clinical studies showing the best techniques/manners of changing these views to fit reality closer (or to cope with reality in a better way). and again, there have been clinical studies showing the efficacy of certain therapies like this (and this was in the 60-70's, imagine how far it has come today!).

and yes you can never force someone to change. in fact, some people hate change, that is why therapy doesnt work for everyone. heck, some medical procedures dont work for everyone either. expecting a 100% (i dont think you stated this anyway haha) is demanding perfection in a world that is just not perfect (a fallacy that leads to depression as well ironically enough :-D). But, although a person may hate change or be resistant, through therapy a person may realize that change is a good way to overcome their disorder.

And when you say psychology is not very scientific, I would actually beg to differ. Although it is not as "hard" as some other fields (bio, chem, etc...), a lot of factors and "third variables" can be taken into account in a lab setting, although sometimes it is not possible. Psychology is evolving and trying to find better methods for research, but that does not mean today's methods are null and void.

Almost every study is published in a journal/online database which is then peer reviewed meticulously for any minor error, such as a variable that is not considered, bad statistics, etc... If something is found, people do what any scientist does; learn from the mistake, replicate while having the new information at hand, and getting the results. This process is gone through over and over until the study stands firm as being completed; oh, but no study is ever completed (even outside of psychology). there will always be the critics which is good, because more information and knowledge can be found through our mistakes. Like i said, this does not just happen in psychology, its basically the scientific method.

In a sense, a few of the therapuetic techniques are based on philosophy as well! Therapy takes a little bit of everything (sometimes chemistry, math, philosophy, psychology, english, etc...) into account and is used to fit the person and their personality/coping skills.

 

[Cosmo75]

Others have said much of what I would have.

From a purely clinical experience perspective, you never *really* know what happens to your clients after treatment is done. You can have a good idea based on how they did, but if they go back to their old ways in the future and never come back in, how could you know?

I don't know how to exactly explain it, but there are moments in therapy that really drive home why I do this. They're typically not the norm, but they're these times when you see a light bulb go on in the clients head when they come to the realization that whatever they may be doing may not be very productive. There's something genuine about the realization, almost like a child discovering a new skill. This to me is where you get the most reward and satisfaction from therapy. When you see the foundations being laid for change and your client excited about the new control they have over their lives. They're typically incredibly thankful to you as well, which is always nice to hear 🙂

 

[The2abraxis]

i think there is a book where a therapist went to find out how his/her patients were doing after several years of therapy. I have yet to read it, but it seems interesting :-D

 

[Therapist4Chnge]

i think there is a book where a therapist went to find out how his/her patients were doing after several years of therapy. I have yet to read it, but it seems interesting :-D

Tales From A Traveling Couch

I highly recommend it...as it is both reflective and entertaining. It is far from 'perfect', in that it raises some issues...particularly in regard to follow-up/closure on the clinician's part, but through this he is able to have greater insight into his role as a clinician, and how patients ultimately have the final decision in how to live their lives.

The polar bear pt. was my favorite, though it was heart-breaking as a person and professional.

ps. If anyone wants to buy it, feel free to use the AMAZON search box at the bottom of the forum...it benefits SDN. 😀

 

[Cosmo75]

Tales From A Traveling Couch

I highly recommend it...as it is both reflective and entertaining. It is far from 'perfect', in that it raises some issues...particularly in regard to follow-up/closure on the clinician's part, but through this he is able to have greater insight into his role as a clinician, and how patients ultimately have the final decision in how to live their lives.

The polar bear pt. was my favorite, though it was heart-breaking as a person and professional.

ps. If anyone wants to buy it, feel free to use the AMAZON search box at the bottom of the forum...it benefits SDN. 😀

Agreed. I recently read this. It's a great book.

 

[PsyChris]

I think Psychology as a whole is treated this way. Psychology is a relatively new branch of science and like all new ideas it's met with harsh criticism.

Psychology seems to get much of it's criticism from it's interdisciplinary approach. Not all of those disciplines are willing to accept us..yet.

I think it will be an uphill battle for many years to come and I would have it no other way!

 

[indoubt]

I think Psychology as a whole is treated this way. Psychology is a relatively new branch of science and like all new ideas it's met with harsh criticism.

Psychology seems to get much of it's criticism from it's interdisciplinary approach. Not all of those disciplines are willing to accept us..yet.

I think it will be an uphill battle for many years to come and I would have it no other way!

PsyChris: thank you for your reply. Psychology does not get "much of it's criticism from it's interdisciplinary approach". If anything it's the opposite. Critiques target the reductive assumptions of therapies such as those based on Skinnerian radical behaviorism that treat human beings as oversimplified mechanical beings. Moreover, it's the ignorance of economical, historical, political, sociological...factors that has lead to some criticisms. It's also the "soft" nature of psychological sciences as opposed to say physics. In addition, it's the mounting evidence that no particular therapy outperforms others and that all therapies work to a modest extent--maybe no more beneficial than a supportive relationship amongst some "healer" and his client and a persuasive philosophy of change they both trust.

It's also the terrifying history of psychology/psychiatry as a tool for social control in the hands of dictatorial administrations. This practice is used internationally though many countries deny it. For instance, see the article below, a current example from Russia. Before you do, note that some psychologists do have prescription privileges and significant others are fighting to get it. Regardless, both psychiatrists and psychologist diagnose illnesses based on DSM, such as the case below:

http://www.washingtonpost.com/wp-dyn/content/article/2006/09/29/AR2006092901592_pf.html

I quote:

On March 23, police and emergency medical personnel stormed Marina Trutko's home, breaking down her apartment door and quickly subduing her with an injection of haloperidol, a powerful tranquilizer...Trutko, 42, was carried out to a waiting ambulance. It took her to the nearby Psychiatric Hospital No. 14.
The former nuclear scientist, a vocal activist and public defender for several years...spent the next six weeks undergoing a daily regimen of injections and drugs to treat what was diagnosed as a "paranoid personality disorder."
"She is also very rude," psychiatrists noted in her case file.

 

[erg923]

Thats a sad case there, but I think this has alot more to do with the political climate/influences in Russia, rather than psychology/psychiatry in general.

 

[The2abraxis]

"In addition, it's the mounting evidence that no particular therapy outperforms others and that all therapies work to a modest extent--maybe no more beneficial than a supportive relationship amongst some "healer" and his client and a persuasive philosophy of change they both trust."


where is this evidence? im not stating that as a "no way, thats not right" kind of way, im just curious to see where it says this

 

[indoubt]

Thats a sad case there, but I think this has alot more to do with the political climate/influences in Russia, rather than psychology/psychiatry in general.

erg923: I did not get a chance to thank you for your earlier thoughtful reply but I do appreciate your views.

I do understand the view that one could see psychology/psychotherapy as merely a tool--inherently neutral--but one that can be put to good use or be abused depending on the political climate. Yet depending on public's level of trust in psychotherapy/therapists, the abuse can be potentially devastating.

Maybe it has to do with my uncompromising standards of expecting more from therapists. I used to envision therapists as honorable individuals putting patient's mental health above all. Yet for many it's merely a day job to pay the bills and nothing more. Maybe they never shared nor admired my idealism. Maybe harsh realism has hardened them. Yet I can not make peace with it, and in my real world, I am a person with a bachelor's degree and no job and no clear path😕🙂

 

[indoubt]

"In addition, it's the mounting evidence that no particular therapy outperforms others and that all therapies work to a modest extent--maybe no more beneficial than a supportive relationship amongst some "healer" and his client and a persuasive philosophy of change they both trust."


where is this evidence? im not stating that as a "no way, thats not right" kind of way, im just curious to see where it says this

I don't often quote from Wikipedia (it can be quite biased) but here's a little summary below. You can do a little research and learn more about it. The "mounting evidence" is certainly not shared by ALL therapists as some maintain that THEIR therapy is the best.

In psychological literature, Saul Rosenzweig (1936) coined this phrase the "Dodo bird verdict", and it has been extensively referred to in subsequent literature as a consequence of the 'common factor' theory. This is the theory that the specific techniques that are applied in different types and schools of psychotherapy serve a very limited purpose (such as a shared myth to believe in), and that most of the positive effect that is gained from psychotherapy is due to factors that the schools have in common, namely the therapeutic effect of having a relationship with a therapist who is warm, respectful and friendly.

p.s. The2abraxis: I also like to thank you for your thoughtful response earlier and I did not get a chance to do so.

 

[erg923]

"In addition, it's the mounting evidence that no particular therapy outperforms others and that all therapies work to a modest extent--maybe no more beneficial than a supportive relationship amongst some "healer" and his client and a persuasive philosophy of change they both trust."


where is this evidence? im not stating that as a "no way, thats not right" kind of way, im just curious to see where it says this

Actually, this is technically correct. But there are tons of cautions and modifiers for the interpretation and clincial implications here. The current literature (mostly meta-analytic studies) does not show drastically different effect sizes (Cohen's D) between various approaches to psychotherapy for many common disorders (eg.,depression, anxiety, etc). This again underscores the point in my last post that up to 70% of the variance (on average) is accounted for by qualities of the therapeutic relationship, not the specific methods employed. However, this is not to say that it would be cost effective, fair, or ethical to provide 2 years of psychoanalytic psychotherapy to a patient when CBT has shows the same efficacy in 12-16 sessions. Right? That gives CBT a clear advantage in my book, especially in a world where managed-care companies can dictate how many sessions a patient will be covered for. Moreover, what about that 30% percent of patients for whom the relationship factors alone are not enough to induce behavior change/successful outcome. These are the people where skills and methods DO MATTER A GREAT DEAL. And 30% is actually a huge chunk if you think about it. For about a 1/3 of your patients, your skills and the methods of therpay employed does matter a great deal.

Good reviews of the debate about the psychotherpay literature can be found in:

Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: A practical guide to systematic treatment selection. Oxford: University Press.

 

[erg923]

erg923: I did not get a chance to thank you for your earlier thoughtful reply but I do appreciate your views.

I do understand the view that one could see psychology/psychotherapy as merely a tool--inherently neutral--but one that can be put to good use or be abused depending on the political climate. Yet depending on public's level of trust in psychotherapy/therapists, the abuse can be potentially devastating.

Maybe it has to do with my uncompromising standards of expecting more from therapists. I used to envision therapists as honorable individuals putting patient's mental health above all. Yet for many it's merely a day job to pay the bills and nothing more. Maybe they never shared nor admired my idealism. Maybe harsh realism has hardened them. Yet I can not make peace with it, and in my real world, I am a person with a bachelor's degree and no job and no clear path😕🙂

Obviously, of all the professions, therapists need to be held to high ethical standards. Hence why the the APA ethics code steers many clinical decisions in this country. Trust me, when you actually work in the field (which you have not apparently), you will see that it does. So, I would argue that therapists act in accordance with the ethics code and work hard to protect and help their patients the vast vast majority of the time.

For the second highlighted sentence, I'm not sure what has brought you to this conclusion. Remember, your personal experiences are not empirical studies on the topic. Obviously, I'm sure this is the case for a very small minority of therapists, but general statements like this have no data behind them and only cloud the issue here.

I would also add the real clinical world is indeed rough. Its not all flowers and happy things. Idealism is good, and you need some of it, but pragmatic therapists tend to be the best, and the ones that really get things done. Being too idealistic lends itself to being a naive clinician and easily taken advantage of by certain Axis II patients. Pragmatism and scientific skepticism are core values of the well rounded clinical scientist.

 

[The2abraxis]

when the word "outperformed" is used, i dont think it is very clear by what that means (as you kinda stated erg). If two therapies "perform" the same (ex: psychoanalysis and CBT) and one does it in 2 years (psycho) and one does it in 12-16 sessions (CBT), I would defenitly view CBT as "performing better".

There are many aspects one can take into account when seeing which "performs better", but I am not 100% sure which we are talking about (time elapsed, relapse rate, percent "cured"-bad word, etc...).

And all I can really say is that (from my personal research) therapy has come a long way since the dodo bird verdict, with good techniques being honed on in (some have empirical data if i can remember right), and focusing on what works and what doesnt; although it is different for every person.

It seems silly to say that only the relationship helps and the techniques used dont serve much of a purpose. Both have to be used skillfully to help in the process. Ex: Say a person has a habit of demanding perfection in the world (in his job, his family, his social life, etc...), and whenever something does not fit right, they become enraged/depressed. It would make sense that having a person there to show that they are doing this and to use techniques to stop it would "perform better" than a family member who says "oh its ok, itll go your way next time" over and over. now it may not work for everyone, but the techniques used defenitly serve an important purpose (heck, Beck realized patterns in people's thinking and gave his clients a new apporach other than psychoanalysis, and he noticed - research based - that his clients were feeling better faster with fewere relapses, when before no change was really occuring)

 

[indoubt]

Obviously, of all the professions, therapists need to be held to high ethical standards. Hence why the the APA ethics code steers many clinical decisions in this country. Trust me, when you actually work in the field (which you have not apparently), you will see that it does. So, I would argue that therapists act in accordance with the ethics code and work hard to protect and help their patients the vast vast majority of the time.

For the second highlighted sentence, I'm not sure what has brought you to this conclusion. Remember, your personal experiences are not empirical studies on the topic. Obviously, I'm sure this is the case for a very small minority of therapists, but general statements like this have no data behind them and only cloud the issue here.

I would also add the real clinical world is indeed rough. Its not all flowers and happy things. Idealism is good, and you need some of it, but pragmatic therapists tend to be the best, and the ones that really get things done. Being too idealistic lends itself to being a naive clinician and easily taken advantage of by certain Axis II patients. Pragmatism and scientific skepticism are core values of the well rounded clinical scientist.

May I ask what you do and what is your educational background? As I said I have a bachelor's degree and I am unemployed.

Secondly, which Axis II patients do you speak of--those who would take advantage of the "too idealistic" clinician?

 

[erg923]

3rd year (well soon to be 4th) Ph.D. program in clinical. I have worked and done practicums in a variety of settings. I was a psychometrist for 2 years in a neuropsych clinic before my program. I have had therapy practicums in our universities counseling center and a state psychiatric hospital. I am the first to admit that psychotherapy is FAR from one of my favorite things to do though, and I am far from an expert on the subject. My practicum last year was at the epilepsy and memory disorders center at the local med center. That was ALL assessment. I also do diagnostic interviews and testing for my adviser's research studies at the med center. My advice would be not to let a skepticism for psychotherapy get you down on the field, or discourage you. Therapy is just one of the many things psychologists can do, and is really a small (but integral) part of your overall training in a Ph.D program.

I was mostly referring to Borderline and Antisocial PDs.

 

[indoubt]

3rd year (well soon to be 4th) Ph.D. program in clinical. I have worked and done practicums in a variety of settings. I was a psychometrist for 2 years in a neuropsych clinic before my program. I have had therapy practicums in our universities counseling center and a state psychiatric hospital. I am the first to admit that psychotherapy is FAR from one of my favorite things to do though, and I am far from an expert on the subject. My practicum last year was at the epilepsy and memory disorders center at the local med center. That was ALL assessment. I also do diagnostic interviews and testing for my adviser's research studies at the med center. My advice would be not to let a skepticism for psychotherapy get you down on the field, or discourage you. Therapy is just one of the many things psychologists can do, and is really a small (but integral) part of your overall training in a Ph.D program.

I was mostly referring to Borderline and Antisocial PDs.

Oh, the psychometrists! I have sat in and watched a few of those sessions in the past. A friend who has recently finished his masters in cognitive psychology considers psychometric testing a form of torture! It demands tremendous patience from both the therapist and the client. I actually like it in small doses. It's surprisingly clear-cut and certainly has the looks of being pretty scientific. I can also avoid some of the messy things I have been talking about if I limit myself to doing just that.

Unfortunately I can not find a masters program in psychometrics. Many programs combine psychometrics with theory/methods, far too much mathematical modeling and I don't have the mathematical talent to go for that. I want to get a license to administer and score tests. That's all🙂

I'm also looking for online programs in that area as various situational factors make it difficult for me to relocate.

 

[RayneeDeigh]

maybe I'm an island in this, but I think administering psychological tests is a heck of a lot more accurate if you have clinical knowledge too. You're testing real people (not robots) and as such they will exhibit behaviour during testing that can inform whether or not the testing was valid.

This summer I've been doing testing both with incarcerated young offenders and neurodevelopmentally challenged children. The two populations are SO different and I like to think that my knowledge about their psychological issues (in some cases diagnoses) helps me get valid test results.

 

[indoubt]

maybe I'm an island in this, but I think administering psychological tests is a heck of a lot more accurate if you have clinical knowledge too. You're testing real people (not robots) and as such they will exhibit behaviour during testing that can inform whether or not the testing was valid.

This summer I've been doing testing both with incarcerated young offenders and neurodevelopmentally challenged children. The two populations are SO different and I like to think that my knowledge about their psychological issues (in some cases diagnoses) helps me get valid test results.

I agree with you though people behind managed care would probably like to convince you that someone like me (bachelor's degree holders) can administer these tests just as well.

 

[erg923]

Oh, the psychometrists! I have sat in and watched a few of those sessions in the past. A friend who has recently finished his masters in cognitive psychology considers psychometric testing a form of torture! It demands tremendous patience from both the therapist and the client. I actually like it in small doses. It's surprisingly clear-cut and certainly has the looks of being pretty scientific. I can also avoid some of the messy things I have been talking about if I limit myself to doing just that.

Unfortunately I can not find a masters program in psychometrics. Many programs combine psychometrics with theory/methods, far too much mathematical modeling and I don't have the mathematical talent to go for that. I want to get a license to administer and score tests. That's all🙂

I'm also looking for online programs in that area as various situational factors make it difficult for me to relocate.

Well, that's because a knowledge of psychometrics without formal training of the theory behind what you are doing (both the clincial and the mathematical) is useless, frankly. Although some places will hire psychometrists with just a bachelors, they are in the extreme minority. Although psychometrists do not do interpretation of the results, I still agree with this policy. Formal clinical training insures that you know how to handle certain situations, understand certain behavioral observations and what they mean (especially in neuropsych), and to understand why you are doing what you are doing. Alot of tests require clincial judgment during the course of administration even. Do you know how to spot unusual test patterns during the course of testing that indicate suboptimal effort for instance? Generally, this knowledge can only come from understanding the tests on a deep conceptual level during formal clinical training and formal supervision of the learning process. I love assessment, but if it was just about administering tests, I (and most people) would get bored real quick. I had gotten a masters in clinical psych before that job, and I was alot more prepared and got alot more out of it because of this. I often used my clincial skills to intervene when several of my patients flipped out and became acutely suicidal, and knew I enough about psychopathology (particularly PDs) to understand how to adjust my behavior in order to maintain appropriate boundaries with my patients.

If you would like, I'm sure you can look for jobs that will hire psychometrists at the bachelor level, however, I think it will be a challenge. If you have good research experience from your undergrad (and if you don't, you would have to get some if you wanted to pursue doctoral study) you could apply for a research assistant (RA) position. Often times bachelors level RAs can do some administration of study protocols and some minor testing.

I think people are a little more willing to except masters degree via distance learning, but not doctorates. The online route for doctoral education in clincial psychology (there are 2 or 3 programs I think, that will cost you an arm and a leg) is misguided and lacks many of the fundamental elements that real graduate training is suppose to be. Namely, immersion in the field and immersion in the research. Matching for an internship (or even getting practicums), which is already highly competitve, would be a nightmare when you are competing with all the other applicants from more traditional scientist-practitioner programs. Would you wanna see a physician who went to medical school online? Would you want someone who is charge of diagnosing and treating your psychiatric issues to have gone to grad school on the internet? I wouldn't.

 

[indoubt]

Well, that's because a knowledge of psychometrics without formal training of the theory behind what you are doing (both the clincial and the mathematical) is useless, frankly. Although some places will hire psychometrists with just a bachelors, they are in the extreme minority. Although psychometrists do not do interpretation of the results, I still agree with this policy. Formal clinical training insures that you know how to handle certain situations, understand certain behavioral observations and what they mean (especially in neuropsych), and to understand why you are doing what you are doing. Alot of tests require clincial judgment during the course of administration even. Do you know how to spot unusual test patterns during the course of testing that indicate suboptimal effort for instance? Generally, this knowledge can only come from understanding the tests on a deep conceptual level during formal clinical training and formal supervision of the learning process. I love assessment, but if it was just about administering tests, I (and most people) would get bored real quick. I had gotten a masters in clinical psych before that job, and I was alot more prepared and got alot more out of it because of this. I often used my clincial skills to intervene when several of my patients flipped out and became acutely suicidal, and knew I enough about psychopathology (particularly PDs) to understand how to adjust my behavior in order to maintain appropriate boundaries with my patients.

If you would like, I'm sure you can look for jobs that will hire psychometrists at the bachelor level, however, I think it will be a challenge. If you have good research experience from your undergrad (and if you don't, you would have to get some if you wanted to pursue doctoral study) you could apply for a research assistant (RA) position. Often times bachelors level RAs can do some administration of study protocols and some minor testing.

I think people are a little more willing to except masters degree via distance learning, but not doctorates. The online route for doctoral education in clincial psychology (there are 2 or 3 programs I think, that will cost you an arm and a leg) is misguided and lacks many of the fundamental elements that real graduate training is suppose to be. Namely, immersion in the field and immersion in the research. Matching for an internship (or even getting practicums), which is already highly competitve, would be a nightmare when you are competing with all the other applicants from more traditional scientist-practitioner programs. Would you wanna see a physician who went to medical school online? Would you want someone who is charge of diagnosing and treating your psychiatric issues to have gone to grad school on the internet? I wouldn't.

I don't see a major problem with online programs, particularly those that are extensions of already established programs. It is inevitable that one will do practicum in a local setting so it's not like I'm going to do online therapy. However, as far as doing research or exchanging ideas, taking courses, writing exams, etc, I can do that in an online program just as well. They are also increasing, like it or not.

In the sessions I attended, the person administering the psychometric tests had a bachelor's degree only--though had been administering them for 10 years. I once brought up my concerns with the psychologist there and he appeared somewhat defensive when I suggested that the tester may not be educated enough to administer the tests. He said that was nonesense. This is not about subjective impressions, he said. If you follow the instructions, that's all that matters. In fact, he said, PhD students are more likely to be overconfident and use their incorrect subjective judgement whereas bachelor holders stick to the instructions.

 

[erg923]

Well Im not gonna rehash the whole online degree issue, as it has been discussed numerous times on various threads. I would just add that it's naive to think that one can do all that needs to be done and do the research from home. It not a "one man band," with occasional guidance on the side. It's the immersion in the experience that is the issue, and that's how one learns at the doctoral level. At the undergrad level that kind of stuff is ok, but not at the doctoral level. It's a whole different learning process and a whole different kind of skill set you're building at the doctoral level. It would be a constant uphill battle to defend that degree, and ontop of that, you are in the same competition pool as people from well established traditional programs. And the clincial market is already saturated in many areas of the country. You do the logic. Who would the practicum sites, internships, and employers choose? I would encourage you to check out the APA/APPIC predoc internship match rates from those programs and see if you want to gamble on them.

The psychometrist issue is simply the opinion of one psychologist, and it is certainly not the predominating one in the field. There are several different approaches to clinical assessment in the field, and it sounds as if this psychologist was not "process-oriented" at all. A strict psychometric view of test data is the minority view now days, but he certainly has the right to his opinion and approach as long as he is providing competent care. Standardization is ALWAYS very important, but most psychologists would agree that there is alot more to being a good psychometrist than that. Again, its not really about administration so much as it is the other issues I mentioned in my previous post (ethics, rapport building, clinical knowledge, behavioral obs, etc.). Again, these would be somewhat more important to process oriented folks, so his opinion is obviously going to be different than theirs. It just happens to be in the minority of those still practicing. Although, I'm sure after ten years, that particular psychometrist was indeed very competent in what he was doing.

 

[JockNerd]

And all I can really say is that (from my personal research) therapy has come a long way since the dodo bird verdict, with good techniques being honed on in (some have empirical data if i can remember right), and focusing on what works and what doesnt; although it is different for every person.

That would be the crux of the Common Factors position.

As for empirical evidence, there are a dozen (ongoing, not from the 70's) research programs devoted to this. I'm not sure how you could not be aware of this; every good intro psych book covers it and even my extremely pro-CBT, pro-EST list went into extreme detail on it. Bruce Wampold's research program might be a good place to start reading about it.

 

[The2abraxis]

That would be the crux of the Common Factors position.

As for empirical evidence, there are a dozen (ongoing, not from the 70's) research programs devoted to this. I'm not sure how you could not be aware of this; every good intro psych book covers it and even my extremely pro-CBT, pro-EST list went into extreme detail on it. Bruce Wampold's research program might be a good place to start reading about it.

which evidence are you particularly talking about?? There were a few previous posts I havent read and I dont know if you are relating back to those 🙂

edit- about the DoDo bird verdict (I have never heard of it before this thread; I must be a psych noob :-[ )- anyway, were the tests compared to non psychotherapy methods? In other words, did they compare psychotherapy to non-psychotherapy?

Because although the psychotherapy methods may have the same results, that does not mean psychotherapy is not effective (it seems like although they have different techniques, a good amount of them use the same: one study I saw compared REBT, CBT, CT, and BT- although different styles, they all sometimes use the same techniques, so it would make sense that they might not be as effective as others). For ex, REBT, CBT, CT, and BT could have en efficacy rate of say 50%-70%, all being around the same, but non-psychotherapy methods may have a 20%-40%. Although the therapies have the same numbers, they still do better than not having psychotherapy. Has this been found as well? Or has it been shown that non-psychotherapy methods have the same efficacy rate compared to psychotherapy methods? Im surprised I have not heard of this before either, but then again, I am a psych noob :-[

 

[JockNerd]

edit- about the DoDo bird verdict (I have never heard of it before this thread; I must be a psych noob :-[ )- anyway, were the tests compared to non psychotherapy methods? In other words, did they compare psychotherapy to non-psychotherapy?

Most research is between forms of therapy.

Rather than listen to the potentially biased opinions of myself (I know mine are) or others, I'd suggest you read some of the research for yourself and decide what the implications are.

Here are some good launch articles:

A meta - (re) analysis of the effects of cognitive therapy versus "other therapies' for depression.
Wampold, Bruce E.; Minami, Takuya; Baskin, Thomas W.; Tierney, Sandra Callen
Journal of Affective Disorders. 2002 Apr Vol 68(2-3) 159-165

Let's face facts: Common factors are more potent than specific therapy ingredients.
Messer, Stanley B.; Wampold, Bruce E.
Clinical Psychology: Science and Practice. 2002 Feb Vol 9(1) 21-25

A common factors revolution: Let's not "cut off our discipline's nose to spite its face.".
Chwalisz, Kathleen
Journal of Counseling Psychology. 2001 Jul Vol 48(3) 262-267

And there are plenty of articles criticizing the common factors approach, too.

 

[The2abraxis]

awesome thanks. ya I did a few look ups on PsycINFO and im getting mixed signals here (about the DoDo bird). Some people say it exists, some say it is no more (because of empircally supported therapies-EST). It seems like it would be kind of existent because maybe some common techniques (common factors may not be just the patient-therapist relationship :-D) are shared through many of the EST. The biggest differences may not lie in efficacy rates, but relapse rates (which is huge IMO) and time spent.

 

[Therapist4Chnge]

Administering a psychological assessment correctly is far more involved than following instructions. It is one thing to hand out self-assessment measures, but it is an entirely different animal to give a Rorschach. When do the limitations start to become problematic?

ps. I would strongly caution against online education in the field of psychology....as there is still quite a stigma, and because of the additional requirements for licensure (internship, etc), it could be very problematic down the road. I know people still do it, but it is a different animal than doing an MA in Creative Writing or something else that is more straight forward.

 

[indoubt]

Well Im not gonna rehash the whole online degree issue, as it has been discussed numerous times on various threads. I would just add that it's naive to think that one can do all that needs to be done and do the research from home. It not a "one man band," with occasional guidance on the side. It's the immersion in the experience that is the issue, and that's how one learns at the doctoral level. At the undergrad level that kind of stuff is ok, but not at the doctoral level. It's a whole different learning process and a whole different kind of skill set you're building at the doctoral level. It would be a constant uphill battle to defend that degree, and ontop of that, you are in the same competition pool as people from well established traditional programs. And the clincial market is already saturated in many areas of the country. You do the logic. Who would the practicum sites, internships, and employers choose? I would encourage you to check out the APA/APPIC predoc internship match rates from those programs and see if you want to gamble on them.

The psychometrist issue is simply the opinion of one psychologist, and it is certainly not the predominating one in the field. There are several different approaches to clinical assessment in the field, and it sounds as if this psychologist was not "process-oriented" at all. A strict psychometric view of test data is the minority view now days, but he certainly has the right to his opinion and approach as long as he is providing competent care. Standardization is ALWAYS very important, but most psychologists would agree that there is alot more to being a good psychometrist than that. Again, its not really about administration so much as it is the other issues I mentioned in my previous post (ethics, rapport building, clinical knowledge, behavioral obs, etc.). Again, these would be somewhat more important to process oriented folks, so his opinion is obviously going to be different than theirs. It just happens to be in the minority of those still practicing. Although, I'm sure after ten years, that particular psychometrist was indeed very competent in what he was doing.

Would you please elaborate on "process-oriented" and other approaches to assessment. Or else you can refer me to a good book or articles on the subject.

Thanks

 

[erg923]

I do not have time to delve into the history of clinical assessment and clinical neuropsychology. However, in brief, the process approaches to assessment examine the process by which the patient solves a problem, rather than only looking at the patient's numerical scores (i.e., the strict psychometric approach). People can fail tests for a variety of reasons. The score just tells us whether they did good or bad compared to the normative sample, right? Examining other factors gives you more information and allows you determine why they did poorly. Did they do did poorly because they did not understand the task directions? Or maybe they did well at first and failed later because they forgot what they were suppose to be doing or perseverated on one strategy/concept. The first example indicates a problem with comprehension, the second indicates more of a problem with sustained attention. Perhaps they actually got the item correct, but just couldn't finish within the time limits of the test. In that case, they still fail the item even though they could do the task. If a person gets every design correct on Block Design a few seconds after the standardized time, their perceptual reasoning (which is what that task measures) is actually pretty intact, right. But, I'd want to know why they couldn't finish as quickly as most of the normative sample. Maybe they just have poor dexterity with their hands? Maybe they have psychomotor slowing or slowed processing speed that is the real issue? I'd want my psychometrist attune to these issue and what they may mean. You wouldn't get that info from just looking at the score after the fact, cause they score is zero technically. But in this case, its not an accurate reflection of what is really going on.

Second, "how" did they do the test and what were they like when doing it? Were they overly elaborate or tangential when defining words on Vocab? A person who rambles on and on and stumbles across the correct definition is much different than a person who delivers the correct definition succinctly and immediately. The performance of the first person is indicative of word finding problems or possible anomia even though they may have gotten the same numerical score as the second person. Did they demonstrate circumlocution in their speech when having casual conversation with the psychometrist? I'd want my psychometrist to know how to pick up on this and know what it means. Did they try to stack the blocks ontop of each other rather than laying them flat on the table during Block Design? Were they confident in their performance, over confident maybe? Were they self-deprecating or self-handicapping their efforts during testing? Diagnostically, these are all very important issues to consider. When a psychologist is adamant that psychological testing is simply about administering a test with standardized directions, they are ignoring many of the important issues that i just discussed. According to this approach, in addition to standardized administration, a psychometrist's job is to be attentive to these behavioral issues and to be competent and knowledgeable of their implications. Doctoral level training in psychological and neuropsychological assessment is largely oriented towards this process approach to assessment, rather than a narrow and strict interpretation of the scores only.

Lezak, MD, Howieson, D.B., & Loring, D.W. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press.
-if you would like further knowledge of the subject.

 

[The2abraxis]

erg923, well said. since you have done this, I have a question: you mentioned someone would undergo self-handicapping, and this probably occured when they feel they were having trouble with the test, or if they felt they could not do well on the test before hand (or another factor). how would one asses that a person is undergoing self-handicapping behavior in that particular testing session?

 

[erg923]

I really didn't mean the formal social psychological construct of "self-handicapping." I really just meant the overall attitude towards testing, or towards certain tests. If they give up easily and constantly require prompts to continue, if they have insight into the level of their performance, do they get frustrated easily, differential task engagement, etc. However, formal effort and symptom validity tests are routine parts of a neuropsych eval as well, especially if their is the incentive for feigning or exaggeration of deficits (e.g.,pending litigation).

 

[WannaBeDrMe]

Indoubt, the others have put things far more eloquently than I can in my addled state... still, I wanted to comment on 2 things...

1. your doubts and concerns could be applied to absolutely any field from sanitation worker to US President... unfortunately, they are not unique to the medical professionals or even social sciences, they are pretty universal concerns and pretty much reflect a systems theory approach to the topic -- ie: how much control do we really have in any situation?

while I think it's great to question, and discover, and even ponder aloud, I hesitate to encourage such in depth exploration of universal "truths"... some people get stuck in the rhetoric and never make it to actual experience, I have no way of knowing if this could happen with you but I am of the mindset of nike... just do it... processing your thoughts via an experience is a much more efficient use of your time than contemplating every possible outcome... with appropriate consideration given to risks, of course, I'm not saying to blindly jump forward... but there aren't many job openings for the likes of Plato, Socrates and I really have forgotten my Ideas and Cultures philosophers... so the others...

you say you have been pondering this change for years... how many more years is it worth pondering? when is the point to "sh%t or get off the pot" ha... no offense intended, just saying, either you will take the risk or not... getting caught up in circular reasoning is useless to you and it doesn't move you any closer to a career... it really doesn't... not when you look @ the reality of the requirements for the position... a degree... not the ability to understand the impact of your field's contribution to humanity... just the degree... and that, well, you aren't progressing toward at all with regard to this posting.

I have seen a few people who get stuck in this same pattern in other fields and I've seen them seek truth in a variety of non-traditional ways... always to end up just as "thoughtful" as before their knowledge-quest began... for my money, experience is the best teacher... whether you are going for law, business, medicine, or social science, it can be overwhelming to jump into the water, but all you can do is your best, and commit to remaining open-minded, and commit to sharing your knowledge and absorbing the knowledge of others... and through practice, all fields can evolve... afterall, even if ancient man conceptualized the wheel and pondered it for decades before chiseling the first piece of stone, it would have been nearly impossible for them to foresee its pluses (faster transport, access to information, shared culture, expansion of species, etc) and its minuses (auto accident death, the breakdown of the nuclear family leading to increased stress/abuse, global warming)... they had to put pedal to the metal to better understand outcomes and then, facilitate change as needed

2. is it bad that I've seen 2 of my past clients on the news? that's how i found out what they were up to... one arrested (though, it turns out wrongly accused) and one run-away/amber alert I hope that doesn't reflect my skill level... I also keep bumping into one all over town, quite friendly and personable, though still clearly struggling... oh well, she chose to leave me, so I'll count that one as her loss.. ha.