How scientific are the need-based theories?

[CheetahGirl]

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‎Folks, in the 'this vs. that' argument (which we are NOT having), I always bring up that we musn't forget the strongest predictor of treatment outcome is therapeutic alliance, and this comes from Stolorow & Atwood, Fonagy & Target, Safran & Muran and many other contemporary psychoanalytic researchers. Without their research, EBTs & their efficacy would be less understood if this very significant variable was not given the credence it deserves.

 

[Nahsil]

behavioral doesn't cover everything I mentioned though. I forgot to mention social/cultural context as well, that's important too.

I was just reading this from the APA:

http://www.apa.org/about/policy/resolution-psychotherapy.aspx

seems to be a decent amount of research pointing to CBT not being particularly more effective than other forms of therapy. I know I've seen research showing that client-therapist relationship, therapist personality/client personality, etc, had more impact on outcomes than technique or orientation.

I've heard good things about MI, looking forward to studying it. I'm also a huuuge fan of mindfulness, so DBT sounds really promising.

 

[erg923]

That's a standard aspect of case conceptualization regardless of treatment orientation/techniques.

How are you asserting that it ignores this and ignores that when you have never even seen a patient in a clinical context, much less run a basic CBT protocol with one?

 

[Nahsil]

That's a standard aspect of case conceptualization regardless of treatment orientation/techniques.

How are you asserting that it ignores this and ignores that when you have never even seen a patient in a clinical context, much less run a basic CBT protocol with one?

By definition it focuses on cognitive and behavioral elements. Are you saying it does have a more inclusive, integrative, systems approach? If so, why is it called CBT? I mean, that's awesome if it does.

You've got me, I don't have the clinical experience. I'm here to learn. If I have misconceptions about the approach, I'd love to be corrected!

 

[CheetahGirl]

Oh poop, erg923, Nahsil is super bright and hasn't even begun a clinical program yet. (Nahsil, can't wait to meet you here after your training).

And you, my friend (erg923), speculate about dynamic theory but may have never conceptualized in this way. Just wait until Nahsil runs that anti-climatic basic CBT protocol. Regardless, I'm all for helping the patient in the most appropriate manner; so if change proceeds, kudos to us all.

 

[erg923]

By definition it focuses on cognitive and behavioral elements. Are you saying it does have a more inclusive, integrative, systems approach? If so, why is it called CBT? I mean, that's awesome if it does.

You've got me, I don't have the clinical experience. I'm here to learn. If I have misconceptions about the approach, I'd love to be corrected!

I'm saying case conceptualizations are just that. Conceptualizations of the person. Thats why we do them before treatment. The treatment plan portion may be CBT, analysis, object relations, ACT, behavioral, or Eskimo therapy. Interventions, whatever they are, are implemented within a context. I don't run a treatment manual in a vacuum.

 

[Nahsil]

I have a hard time conceptualizing treatment as not being intrinsically linked with context, in a way that necessitates a more holistic treatment approach, but like you said I don't have the clinical experience or any real experience with CBT, so I'll try to reserve judgment.

Thanks Cheetah, lol, that should be a while since I'm doing a thesis track at my Masters program, probably not going to be involved in much clinical work until I get into a PhD.

 

[Ollie123]

Internship has me too busy to jump into this with my usual joy (I love these conversations - BTW Cheetah did we ever finish our previous discussion?).

However, I just had to jump in to say that any behavioral conceptualization which is not integrating systems-level considerations is a laughably half-assed attempt at behavioral conceptualization. Alliance is crucial and shouldn't be ignored under any modality. However, its still a pretty piss-poor predictor of outcome variance when you look at the recent and more rigorous studies. We used to hear what, 50% of treatment variance is accounted for by the alliance? Recent evidence suggests its a fraction of that.

 

[LPPSYD]

Are you guys familiar with George Atwood/Robert D. Stolorow of the intersubjective psychoanalytic school? I think their stuff is really interesting, they stress phenomenology as an alternative to the "medical model." But yes, they're very philosophically inclined as opposed to empirically inclined. I've seen Atwood go off on CBT a lot.

Totally not in line with the topic at hand, but just wanted to comment that I had Atwood as a professor in undergrad and his lectures/writings were amazing. I credit him with giving me a foundation for how to conceptualize and be present with clients. I also have always valued Humanistic theory. As a side note regarding this topic, my orientation is interpersonal integrated with CBT, not just because I'm expected to use EBPs, but also because they work wonders. I don't think the very different perspectives being discussed in this thread are so mutually exclusive. It's just important to keep in mind that you need to have the client working on SOMETHING in treatment or it just becomes "coffee talk."

 

[CheetahGirl]

Ollie, we (I) did. I responded but you didn't shoot back. So thought it was over. 😉

erg923, what is Eskimo therapy?!? Rubbing noses together? Is it a couple's thing?! I'm intrigued!

 

[erg923]

Yes. Running joke between wife and I. Bad day? Give me some Eskimo kisses and it will be all better...🙂

 

[Ollie123]

Oh no, must have missed it! I bet it was during the great internship moving debacle of 2014, was MIA for about 2 weeks. I'll see if I can dig it up once I'm through this weekend.

 

[CheetahGirl]

Ok, Ollie123. Be nice and have an open mind when reading. (Ha!)