PhD/PsyD RANT: Arguing with therapists with no research background is like screaming at the ocean and begging the waves to subside

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Just want to be clear that the “debate” which sparked this rant thread was not one in which I think the other party was arguing emotionally or in bad faith. It was simply a debate in which the person was seemingly unable to properly grapple with research evidence and critically evaluate why a yr 2000s paper with a sample of N=20ish healthy controls showing increased blood flow during EMDR w bilateral stimulation vs EMDR w/o bilateral stimulation didn’t prove that bilateral stimulation has any mechanism of action in a therapeutic sense. When confronted with a 2020 meta-analysis of many, many studies of EMDR which showed that bilateral stimulation wasn’t differentially effective when only low-bias and large samples are accounted for, the person (a midlevel therapist) was unable to understand why that evidence was stronger than her two citations, both of which were among the “low-N, high bias” studies mentioned in the meta. So while we have gotten derailed a bit, the original purpose of this rant was just express frustration that there are working therapists who don’t have any apparent competency to understand research, and not so much about people arguing in bad faith or with emotional reasoning.
Masters level counselors and social workers rarely have an understanding of how to critically assess research any more than the average lay person in my experience. Its not really their focus and many tend to be in the “ I hate research“ crowd that also seem to want to go to the large cohort PsyD programs too. I‘m sort of ok with the master level folk not being fans of research and when I have worked with them, they have tended to appreciate my ability to disseminate and evaluate research and also to help some of them who are more open to learn more about that process as well. I have also learned not to directly challenge a true believer whether it is EMDR or any of the myriad other more potentially destructive beliefs. although I do have to say that even though I have learned that, I still get sucked in. The other day I got into an argument with a massage therapist about the perils of promoting treatment of serious mental illness with diet. She had just read a book about it and was all excited and since I have seen how destructive those types of beliefs can be first hand, I got a little carried away in shutting that down. I did apologize a few days later.

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Masters level counselors and social workers rarely have an understanding of how to critically assess research any more than the average lay person in my experience. Its not really their focus and many tend to be in the “ I hate research“ crowd that also seem to want to go to the large cohort PsyD programs too. I‘m sort of ok with the master level folk not being fans of research and when I have worked with them, they have tended to appreciate my ability to disseminate and evaluate research and also to help some of them who are more open to learn more about that process as well. I have also learned not to directly challenge a true believer whether it is EMDR or any of the myriad other more potentially destructive beliefs. although I do have to say that even though I have learned that, I still get sucked in. The other day I got into an argument with a massage therapist about the perils of promoting treatment of serious mental illness with diet. She had just read a book about it and was all excited and since I have seen how destructive those types of beliefs can be first hand, I got a little carried away in shutting that down. I did apologize a few days later.
I hear you. It is very difficult not to get mad at people who believe this **** and will argue until they turn blue about how right they are about it. EMDR, Brainspotting, Diet, the whole crock of crap. It's like our profession is on the verge of becoming a multilevel marketing scheme that advertises on late-night cable TV or gets endorsed by that Dr. Phil dingus.
 
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And more adding to this view that people with PTSD are fragile and need floofy or fancy treatments.
 
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"Never argue with an idiot. He will just drag you down to his level and beat you with experience."
-Mark Twain?

Jean Cocteau, actually:

 
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And more adding to this view that people with PTSD are fragile and need floofy or fancy treatments.
Floofy - I’m going to have to use that one. One of my wife’s favorite things to do is to combine two words to capture two concepts. Floofy makes me think it’s fluffy and goofy which definitely applies.
 
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Floofy - I’m going to have to use that one. One of my wife’s favorite things to do is to combine two words to capture two concepts. Floofy makes me think it’s fluffy and goofy which definitely applies.

I think that "floofy" is just the best word to capture the stuff I see on the Div 56 listserv (bless 'em).

Edited because I can never remember the division numbers.
 
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I pretty much have to stick to the boarded neuro listserv these days. It's hard to stand the pseudoscience cults and amateur hour quality of most other listservs. I fear for the future of patient care.
 
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I fear for the future of patient care.
Speaking from the consumer side of things, it's already a nightmare, especially in markets saturated with graduates of programs that don't have decent baseline research training. It's made me think twice when suggesting therapy because the lay public already struggles with identifying the correct kind of mental health professional, and they may be going through an agency or service where they are assigned an available therapist and thus can't vet their therapist's credentials.

As much as companies like BetterHelp and Talkspace have made therapy "more accessible" (and the rants about those companies I'll reserve for another time), they're worrisome for kinds of therapists they attract. I don't want to throw shade on professional colleagues, but, based on my experiences with each company, they're flooded with therapists offering EMDR or other things that aren't exactly evidence-based. If they were like that for me when I know what to look for, I hate to think what it's like for someone naïve to psychotherapy who sees this, has a bad experience with therapy not working or resembling woo, and walks away thinking psychology is not a real science.
 
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Honestly there is better theory and technique for behavior change and distress tolerance in Dianetics than some of the stuff I see getting promoted on psychotherapy reddit.
Yes, but do you have to buy an E Meter?
 
I can imagine few things more terrifying than being relied upon that much.
One of my patients was telling me about a video game they are playing where you are a cult leader and I think the goal is to get the flock to follow you to the point where you can make them drink the koolaid. I’m just happy when I can get my employees to show up on time or do their notes. 😁
 
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One of my patients was telling me about a video game they are playing where you are a cult leader and I think the goal is to get the flock to follow you to the point where you can make them drink the koolaid. I’m just happy when I can get my employees to show up on time or do their notes. 😁

is this a reality game based on the VA?
 
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Oh God, someone on a professional listserv I'm on (not Reddit!) said that ABA causes PTSD.
 
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Oh God, someone on a professional listserv I'm on (not Reddit!) said that ABA causes PTSD.
I'd be tempted to reply by copying-and-pasting DSM-5 criterion A and calling it a day.

Reminds me a little of when I would on occasion have patients tell me they had PTSD from being yelled at by their boss or in basic training.
 
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I had someone claim they had PTSD from watching 9-11 footage on TV...
 
One of our listservs had some people arguing that CBT was white supremacy.

And this is why I just "can't" anymore with folks in our field. I think our field has skewed really far into a particular area of the political spectrum (won't use any labels). It's why I shy away from getting involved with advocacy for our field, and shy away from doing much in the way of teaching interns and post-docs.
 
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And this is why I just "can't" anymore with folks in our field. I think our field has skewed really far into a particular area of the political spectrum (won't use any labels). It's why I shy away from getting involved with advocacy for our field, and shy away from doing much in the way of teaching interns and post-docs.

It can definitely get rough on the advocacy side. I just stick to the traditional practice issues with my legislative advocacy, and let others in my organization deal with the nutballs who believe such things.
 
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One of my patients was telling me about a video game they are playing where you are a cult leader and I think the goal is to get the flock to follow you to the point where you can make them drink the koolaid. I’m just happy when I can get my employees to show up on time or do their notes. 😁
Are you talking about Cult of the Lamb? Haven't played, but footage sounds very similar to what you describe, and it's gotten really good reviews so far
 
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Are you talking about Cult of the Lamb? Haven't played, but footage sounds very similar to what you describe, and it's gotten really good reviews so far

I had the same thought, except that the objective is freeing the cthonic entity ('The One Who Waits') who saved you from being a literal sacrificial lamb in exchange for your devotion. You can choose to appoint 'Faith Enforcers', put up propaganda speakers, and imprison dissenters, so probably a touch more draconian than your typical VA.
 
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I just harnessed my minimal self-control to rage quit a local ADHD group full of occupational therapists slangin' biofeedback and other nonsense (e.g., sticker charts are bad because they're behavioral - I've never seen behavioral being used as a pejorative before) before replying. I'll see them when parents realize things the OTs recommend don't work in a few years. I had a good zinger, but stopped myself before saying "sure, it's effective at separating money from your wallet." Now that i've left that group and the testing psychologist community (also cancer), my feed is more about rockhounding, toyota tundras, and camping with your littles.
 
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I just harnessed my minimal self-control to rage quit a local ADHD group full of occupational therapists slangin' biofeedback and other nonsense (e.g., sticker charts are bad because they're behavioral - I've never seen behavioral being used as a pejorative before) before replying. I'll see them when parents realize things the OTs recommend don't work in a few years. I had a good zinger, but stopped myself before saying "sure, it's effective at separating money from your wallet." Now that i've left that group and the testing psychologist community (also cancer), my feed is more about rockhounding, toyota tundras, and camping with your littles.

I'm in the testing psychologist community and so far it hasn't been bothering me that much. Maybe FB is hiding the more controversial posts from my feed, lol.
 
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I just harnessed my minimal self-control to rage quit a local ADHD group full of occupational therapists slangin' biofeedback and other nonsense (e.g., sticker charts are bad because they're behavioral - I've never seen behavioral being used as a pejorative before) before replying. I'll see them when parents realize things the OTs recommend don't work in a few years. I had a good zinger, but stopped myself before saying "sure, it's effective at separating money from your wallet." Now that i've left that group and the testing psychologist community (also cancer), my feed is more about rockhounding, toyota tundras, and camping with your littles.

I've opted to just not really get involved with other psychologists; even through my own state psychological association listservs. I think SDN is about as much as I get involved with "professional advocacy" efforts. Maybe this is just me (and I can complete accept it if it is), but I find that I don't get along too well with other psychologists or mental health providers outside the professional context. I know several of my colleagues are often friends with one another outside of the office, but I suppose since I am the black sheep of the family, it makes sense.
 
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I've opted to just not really get involved with other psychologists; even through my own state psychological association listservs. I think SDN is about as much as I get involved with "professional advocacy" efforts. Maybe this is just me (and I can complete accept it if it is), but I find that I don't get along too well with other psychologists or mental health providers outside the professional context. I know several of my colleagues are often friends with one another outside of the office, but I suppose since I am the black sheep of the family, it makes sense.
This has been a lot of my experience as well (but I say this after spending a weekend away with a psychologist couple).
 
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How did this photo of me end up on the internet?


On a serious note though, I've met and worked with some pretty good LPCs MFTS, and LCSWs but overwhelmingly my experience with them is that they seem to be missing large gaps of foundational knowledge (both theoretical and interventions). Generally it's not their fault. Like many I went and earned a Masters before going back for my doctorate, and the depth and level at the doctoral level was like a different world in many ways. The good ones are receptive and open to learning and improving their knowledge and skills. And that's commendable of course. There's probably quite a few psychologists who could take a few notes on doing that as well.

But what really shows it glaringly, in my experiences , are the LCSWs (and some of those online diploma doctorates) that seem to end up as managers (usually as supervisors or middle managers). The worst of them not only want to tell you how to do therapy and scoff when presented with research findings or evidence based findings for various matters related to our work, they also want to label themselves as "experts" in about 27 different conditions and diagnoses. Had one years ago, nice person and seemed competent, then became a middle manager, they turned into "the sign on my door says I'm the manager so you listen to me" and often labeled themselves an expert and specialist on one particular population because they saw approximately 10 patients of that population at a practicum before and "they were interesting to me so I focused on them." They also were big on handing out handouts they found online they thought therapists should give patients "so you guys have some ideas on how to provide some interventions to them." On flip side, obviously most of my actual supervisors (when in school) were psychologists and I was fortunate that by and large they were well versed in research, competent, and great to work with.
 
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I wish I came in contact with more clinicians in appropriate settings to discuss these topics (e.g., not the internet). I really love to discuss how people understand what works and doesn't work. I have one acquaintance that is a master's-level clinician and loves EMDR but there has never been a right time to talk about this.
 
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Yeah, it's difficult for me with EMDR-loving colleagues. We have some True Believers in our clinic.
 
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Yeah, it's difficult for me with EMDR-loving colleagues. We have some True Believers in our clinic.
Superstition and popularity are so much easier than data and statistics (that some people never learned about or didn't understand), not to mention the cognitive dissonance associated with finding out that the expensive training you paid for turns out to be bull**** after all.
 
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I have had some discussions about this with MA level people, but only the ones seeking guidance be ause they recognize the level of knowledge and expertise that a psychologist brings to the table especially regarding the research. True believers, I don’t even bother.
 
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Oh God, someone on a professional listserv I'm on (not Reddit!) said that ABA causes PTSD.
I've seen some some stuff done in the name of ABA that was pretty awful. As long as we allow places like JRC a seat at our table, that statement ("ABA causes PTSD") is at least somewhat true.
 
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I've seen some some stuff done in the name of ABA that was pretty awful. As long as we allow places like JRC a seat at our table, that statement ("ABA causes PTSD") is at least somewhat true.
I've always thought that odd. (Natural) contingencies of reinforcement and punishment are 'as natural as the wind and the rain' (Timothy Vollmer's article: 'Punishment Happens?'). Yet, behavioral scientists trying to harness contingencies of reinforcement to help people live better lives is somehow 'evil' or 'causes PTSD.' There are certain ideologies that have seeped into the field that do more harm than good. As I think your post implies...it is important to separate out the moral soundness of the practice of a technology from the technology itself (or the utilization of that technology).
 
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I've seen some some stuff done in the name of ABA that was pretty awful. As long as we allow places like JRC a seat at our table, that statement ("ABA causes PTSD") is at least somewhat true.

"In the name of" being the operative word. These are all just tools, and any incompetent and/or malevolent provider can do things with a sprinkle of actual methods (ABA, CBT, IPT, etc) that can cause damage to people. So, it's not "ABA causes PTSD", it's "incompetent provider causes PTSD."
 
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I've seen some some stuff done in the name of ABA that was pretty awful. As long as we allow places like JRC a seat at our table, that statement ("ABA causes PTSD") is at least somewhat true.

I'm not arguing that malpractice done in the name of ABA can't cause PTSD. It can, just like medical malpractice or any harmful behavior done in a professional context can cause PTSD. But to say ABA as a whole causes PTSD (and usually with the citation of that one study with garbage methodology) is not accurate.
 
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I'm not arguing that malpractice done in the name of ABA can't cause PTSD. It can, just like medical malpractice or any harmful behavior done in a professional context can cause PTSD. But to say ABA as a whole causes PTSD (and usually with the citation of that one study with garbage methodology) is not accurate.
I don't think you understand what was said or why it was said.
 
Superstition and popularity are so much easier than data and statistics (that some people never learned about or didn't understand), not to mention the cognitive dissonance associated with finding out that the expensive training you paid for turns out to be bull**** after all.
That, and the inevitable "but this is the only thing that worked for my client!!!" Sure, I mean... exposure work works... you just didn't need all the tapping and finger waving and the $2000 you dropped on a sham training.

I used to be a huge whiny EMDR basher on /r/psychotherapy and some of the responses I got from defensive therapists... phew.
 
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I've seen some some stuff done in the name of ABA that was pretty awful. As long as we allow places like JRC a seat at our table, that statement ("ABA causes PTSD") is at least somewhat true.
The H8 for ABA is like blaming physics for the invention of nuclear bomb. ABA and behaviorism are just approaches to understanding and altering behavior. I recently rage quit a facebook group when the OT/creator of the group was discussing how sticker charts are bad because they're "behavioral" as if that means anything.

Personally, I understand the h8 for places like JRC and aversives. But also, families really like it and report that their kids make wonderous learning gains while there and it leads to massive improvement in life quality and reduction in medications.

I may be in the minority, but we need to view the life course of individuals when considering the use of aversives. In my opinion, we should do everything we can, including administering of adversives, before resigning and individual to the calm and easy to handle medicated stupor of antipsychotic medications. It is well known the metabolic impact of these meds and how they drastically reduce life through messed up hormones, impaired cognition (in those with a lower learning ability), movement disorders, obesity, and diabetes. What's better, a relatively short course of aversives, as a last resort only, or a lifetime of being on heavy hitting meds so the kid is easy to behaviorally manage?

Personally, I'm glad places like JRC exist - even though they cause trauma. But, you have to compare the trauma against other things in these situations.

Like, it's legit concerning to me that aversives are vilified, but antipsychotics are accepted and given out like candy.
 
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The H8 for ABA is like blaming physics for the invention of nuclear bomb. ABA and behaviorism are just approaches to understanding and altering behavior. I recently rage quit a facebook group when the OT/creator of the group was discussing how sticker charts are bad because they're "behavioral" as if that means anything.

Personally, I understand the h8 for places like JRC and aversives. But also, families really like it and report that their kids make wonderous learning gains while there and it leads to massive improvement in life quality and reduction in medications.

I may be in the minority, but we need to view the life course of individuals when considering the use of aversives. In my opinion, we should do everything we can, including administering of adversives, before resigning and individual to the calm and easy to handle medicated stupor of antipsychotic medications. It is well known the metabolic impact of these meds and how they drastically reduce life through messed up hormones, impaired cognition (in those with a lower learning ability), movement disorders, obesity, and diabetes. What's better, a relatively short course of aversives, as a last resort only, or a lifetime of being on heavy hitting meds so the kid is easy to behaviorally manage?

Personally, I'm glad places like JRC exist - even though they cause trauma. But, you have to compare the trauma against other things in these situations.

Like, it's legit concerning to me that aversives are vilified, but antipsychotics are accepted and given out like candy.
It’s easier to back seat drive than it is to be responsible to make the decisions and try to actually help people that are very difficult to treat. I think of last place I worked where a criticism was that we would seek guardianships for patients and have them stay against their will. We would also have them go to an isolated cabin as an alternative or adjunct to hospitalization. These were fair criticisms but also ways of helping when the person was engaging in behaviors that were life threatening. I tend to be on the side of letting them do what they want and let natural consequences occur and I’ll just help those who want it; however, that can arguably be just as harsh as forcible intervention. Natural consequences of untreated mental illness can be quite aversive and ofttimes fatal.
 
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I just feel like, as a society, it would SO nice if we could acknowledge that things can have negative impacts and be harmful WITHOUT being events that would technically qualify someone for a PTSD diagnosis, that mental health diagnoses other than PTSD can be equally devastating and hard to live with, and that saying something doesn't cause PTSD isn't invalidating or diminishing the harm said event caused.
 
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The H8 for ABA is like blaming physics for the invention of nuclear bomb. ABA and behaviorism are just approaches to understanding and altering behavior. I recently rage quit a facebook group when the OT/creator of the group was discussing how sticker charts are bad because they're "behavioral" as if that means anything.

Personally, I understand the h8 for places like JRC and aversives. But also, families really like it and report that their kids make wonderous learning gains while there and it leads to massive improvement in life quality and reduction in medications.

I may be in the minority, but we need to view the life course of individuals when considering the use of aversives. In my opinion, we should do everything we can, including administering of adversives, before resigning and individual to the calm and easy to handle medicated stupor of antipsychotic medications. It is well known the metabolic impact of these meds and how they drastically reduce life through messed up hormones, impaired cognition (in those with a lower learning ability), movement disorders, obesity, and diabetes. What's better, a relatively short course of aversives, as a last resort only, or a lifetime of being on heavy hitting meds so the kid is easy to behaviorally manage?

Personally, I'm glad places like JRC exist - even though they cause trauma. But, you have to compare the trauma against other things in these situations.

Like, it's legit concerning to me that aversives are vilified, but antipsychotics are accepted and given out like candy.
Totally agree. Life is full of 'aversives' as natural consequences. For someone who is intellectually disabled and engaging in daily repetitive self-injury to the point of tissue damage (and infection) and for whom every possible alternative has been (competently) tried to reduce the frequency/intensity/severity of said behavior...I think that mild 'aversives' should at least be on the table for ethical consideration and their use weighed in a careful cost-benefit analysis. To do otherwise would be to be more in love with one's own ego (and self-image) than to be in line with the true ethical principles of professional psychologists (including adherence to the empirical literature as well as an authentic spirit of beneficence). If I had a disabled child whose severe self-injury was causing serious medical problems (and associated pain/suffering) but could be effectively reduced by a brief intervention involving (among other things) mild aversive stimulation, I'd be all on board.
 
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It’s easier to back seat drive than it is to be responsible to make the decisions and try to actually help people that are very difficult to treat. I think of last place I worked where a criticism was that we would seek guardianships for patients and have them stay against their will. We would also have them go to an isolated cabin as an alternative or adjunct to hospitalization. These were fair criticisms but also ways of helping when the person was engaging in behaviors that were life threatening. I tend to be on the side of letting them do what they want and let natural consequences occur and I’ll just help those who want it; however, that can arguably be just as harsh as forcible intervention. Natural consequences of untreated mental illness can be quite aversive and ofttimes fatal.
Agreed. Worked at an ICF/MR facility where someone who was mildly intellectually disabled (with severe aggressive behaviors) had a behavior plan (learning-based supports) that came under scrutiny of an executive committee of non-clinicians (administrator types). Sure, there were other (non-psychologist) clinicians in the room but nobody who was behaviorally trained. This was also during the height of the 'no punishment' era. So, the folks who had written the plan (which I was defending, in their absence (whole 'nother story)) had written a plan that basically had a Path A and a Path B (in terms of the client's daily schedule of activities and opportunities for reinforcement) which was contingent upon the absence of aggressive behavior. Meaning, if the client exhibited certain clearly aggressive behaviors (hitting, kicking, trying to stab someone with a steel utensil), they were to go through 'Path B' (which was a relatively sparse daily schedule of opportunities to earn reinforcement, say (or less 'enriched') and also had the safety element of not allowing that person access to metal utensils (which she had, say, just tried to stab others with). So, I'm defending this plan and make the mistake of trying to explain to some non-professionals the thinking behind the plan and they kept objecting to the 'negative' consequences of the person being given a less enriched daily schedule of reinforcement because to them it was 'punitive' and not in line with our philosophy of 'positive behavior supports' which, ideologically (according to them), meant that we didn't consequate 'bad' behavior with 'punishment.' I tried (in vain) to make the distinction between how the term 'punishment' is used in lay language vs. the very technical meaning of the term to a behavior analyst (basically, a punishing consequence is one that, empirically, lowers the future frequency of the behavior upon which it is contingent) but to no avail. One administrator even smirked and sarcastically said, 'Oh, Dr. X is trying to explain to us that there are different definitions of punishment and when they use punishment it's not like when we use punishment.' I'm like...yeah, basically...that's right, jackass. He was a politician type and he thought that he had 'caught' me dissimulating and trying to somehow manipulate the audience. Whatever, the point is that to these people (and to anyone else who is so ideologically possessed by the idea that 'PUNISHMENT = DA DEVIL OMFG!!!!!!!!' even a slightly less reinforcing alternative is 'punitive' in their eyes and should never be implemented. By that logic, therefore, we should never treat ANY behavior any different than any other behavior.

Now all of these non-psycholgists were thoroughly drenched (and had been for more than a decade) in the philosophy of 'positive behavior supports' and the ideology of 'non-punishment' and the idiotically utopian vision of a world without pain, unicorn farts, and endless rainbows. They were so ideologically infected with the idea that they actually would argue (if you followed their reasoning) that a violent person who had just tried to stab staff with a metal knife had the right to not have their access to said metal knife taken away from them (even temporarily) because it would be 'inconsistent with a philosophy of positive behavioral supports.' This is the danger of such philosophies in the absence of either (a) competent professional training or (b) common sense.
 
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Agreed. Worked at an ICF/MR facility where someone who was mildly intellectually disabled (with severe aggressive behaviors) had a behavior plan (learning-based supports) that came under scrutiny of an executive committee of non-clinicians (administrator types). Sure, there were other (non-psychologist) clinicians in the room but nobody who was behaviorally trained. This was also during the height of the 'no punishment' era. So, the folks who had written the plan (which I was defending, in their absence (whole 'nother story)) had written a plan that basically had a Path A and a Path B (in terms of the client's daily schedule of activities and opportunities for reinforcement) which was contingent upon the absence of aggressive behavior. Meaning, if the client exhibited certain clearly aggressive behaviors (hitting, kicking, trying to stab someone with a steel utensil), they were to go through 'Path B' (which was a relatively sparse daily schedule of opportunities to earn reinforcement, say (or less 'enriched') and also had the safety element of not allowing that person access to metal utensils (which she had, say, just tried to stab others with). So, I'm defending this plan and make the mistake of trying to explain to some non-professionals the thinking behind the plan and they kept objecting to the 'negative' consequences of the person being given a less enriched daily schedule of reinforcement because to them it was 'punitive' and not in line with our philosophy of 'positive behavior supports' which, ideologically (according to them), meant that we didn't consequate 'bad' behavior with 'punishment.' I tried (in vain) to make the distinction between how the term 'punishment' is used in lay language vs. the very technical meaning of the term to a behavior analyst (basically, a punishing consequence is one that, empirically, lowers the future frequency of the behavior upon which it is contingent) but to no avail. One administrator even smirked and sarcastically said, 'Oh, Dr. X is trying to explain to us that there are different definitions of punishment and when they use punishment it's not like when we use punishment.' I'm like...yeah, basically...that's right, jackass. He was a politician type and he thought that he had 'caught' me dissimulating and trying to somehow manipulate the audience. Whatever, the point is that to these people (and to anyone else who is so ideologically possessed by the idea that 'PUNISHMENT = DA DEVIL OMFG!!!!!!!!' even a slightly less reinforcing alternative is 'punitive' in their eyes and should never be implemented. By that logic, therefore, we should never treat ANY behavior any different than any other behavior.

Now all of these non-psycholgists were thoroughly drenched (and had been for more than a decade) in the philosophy of 'positive behavior supports' and the ideology of 'non-punishment' and the idiotically utopian vision of a world without pain, unicorn farts, and endless rainbows. They were so ideologically infected with the idea that they actually would argue (if you followed their reasoning) that a violent person who had just tried to stab staff with a metal knife had the right to not have their access to said metal knife taken away from them (even temporarily) because it would be 'inconsistent with a philosophy of positive behavioral supports.' This is the danger of such philosophies in the absence of either (a) competent professional training or (b) common sense.

Certainly the customer is always right!

Gotta get good patient satisfaction scores!

Hopefully the family leaves a good review online!
 
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Agreed. Worked at an ICF/MR facility where someone who was mildly intellectually disabled (with severe aggressive behaviors) had a behavior plan (learning-based supports) that came under scrutiny of an executive committee of non-clinicians (administrator types). Sure, there were other (non-psychologist) clinicians in the room but nobody who was behaviorally trained. This was also during the height of the 'no punishment' era. So, the folks who had written the plan (which I was defending, in their absence (whole 'nother story)) had written a plan that basically had a Path A and a Path B (in terms of the client's daily schedule of activities and opportunities for reinforcement) which was contingent upon the absence of aggressive behavior. Meaning, if the client exhibited certain clearly aggressive behaviors (hitting, kicking, trying to stab someone with a steel utensil), they were to go through 'Path B' (which was a relatively sparse daily schedule of opportunities to earn reinforcement, say (or less 'enriched') and also had the safety element of not allowing that person access to metal utensils (which she had, say, just tried to stab others with). So, I'm defending this plan and make the mistake of trying to explain to some non-professionals the thinking behind the plan and they kept objecting to the 'negative' consequences of the person being given a less enriched daily schedule of reinforcement because to them it was 'punitive' and not in line with our philosophy of 'positive behavior supports' which, ideologically (according to them), meant that we didn't consequate 'bad' behavior with 'punishment.' I tried (in vain) to make the distinction between how the term 'punishment' is used in lay language vs. the very technical meaning of the term to a behavior analyst (basically, a punishing consequence is one that, empirically, lowers the future frequency of the behavior upon which it is contingent) but to no avail. One administrator even smirked and sarcastically said, 'Oh, Dr. X is trying to explain to us that there are different definitions of punishment and when they use punishment it's not like when we use punishment.' I'm like...yeah, basically...that's right, jackass. He was a politician type and he thought that he had 'caught' me dissimulating and trying to somehow manipulate the audience. Whatever, the point is that to these people (and to anyone else who is so ideologically possessed by the idea that 'PUNISHMENT = DA DEVIL OMFG!!!!!!!!' even a slightly less reinforcing alternative is 'punitive' in their eyes and should never be implemented. By that logic, therefore, we should never treat ANY behavior any different than any other behavior.

Now all of these non-psycholgists were thoroughly drenched (and had been for more than a decade) in the philosophy of 'positive behavior supports' and the ideology of 'non-punishment' and the idiotically utopian vision of a world without pain, unicorn farts, and endless rainbows. They were so ideologically infected with the idea that they actually would argue (if you followed their reasoning) that a violent person who had just tried to stab staff with a metal knife had the right to not have their access to said metal knife taken away from them (even temporarily) because it would be 'inconsistent with a philosophy of positive behavioral supports.' This is the danger of such philosophies in the absence of either (a) competent professional training or (b) common sense.
What a jackass. lol. I’ve had to work with a few people like that, one reason I started my own company. Typically the ones I’ve dealt with have been the opposite where I was the “nice doctor that is afraid to punish”, but either way, omfg is right. The whole utopian world and misunderstanding of reinforcement and benefits of negative reinforcement and how to extinguish unwanted behavior is rampant. I am always amazed at how many people are amazed by how quickly I can get kids to do what I want just by selectively attending to behavior and using operant conditioning. They actually think that you can convince kids with behavioral problems to behave if you just explain things better.

Parent: I’ve been trying to get my ten year old to see how their behavior A is affecting me and their siblings and potentially their future, but they won’t listen to me and they are getting worse. Maybe you could use your magic therapy words to convince them to do Behavior B instead of A.
Me: Maybe you shouldn’t waste your breath explaining things to a ten year old that they don’t care about and reinforcing behavior A with lots of attention and reward them when they do Behavior B.

It’s not that complicated.
 
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I fear I may have been the cause of this thread taking a turn toward the whole punishment topic, which is a bit of a detour and worthy of at least it's own thread (I have a full, 4 hour lecture on the topic in my basic ABA grad class, with probably twice that in lecture time devoted to the topic during the Ethics course). Sorry for the derail, but I do want to address some points brough up in some of the posts above:

-Yes- punishment happens. As such, and professional tasked with assisting others in reducing the frequency of a human's behavior needs to be skilled in it's application and knowledgeable of ethical and regulatory guidelines.

-If you are going to use or suggest that others use punishment (defined as the contingent addition or removal of stimulus which results in a reduction in the future probably of the behavior it is contingent upon), you should be able to, without much thought:
  • list the potential negative side effects (e.g., behavioral contrast) of both positive-punishment and negative-punishment procedures (and if you don't know the differenc between positive and negative punishment, don't use punishment professionally unitl you do)
  • identify, through an empirically supported FBA procedure, the function(s) of the target behavior
  • Identify and describe potential non-punishment stratregies for addressing behaviors with that function, including those related to manipulation of antecedent variables (SDs, AOs/EOs) as well as consequence based strategies
  • describe the difference in behavior change between punishment and applicable non-punishment strategies relative to things like immediacy of effect, rate of durability of effect (including in the absense of the contingency)
  • identify and program behavioral data collection procedures that allow for rapid identification of changes in behaviors (including those other than the behavior targeted for decrease) that my be sign that the punishement procedure is not effective or not being implemented consistently)
  • and- I beg you- be able to have a conversation about punishment without incorrectly using the term "negative reinforcment
Basically, if you don't know what you are doing, don't f**k with punishment. I do know what I'm doing, and I avoid it all costs- not out of some moral/ethical or regulatory reasoning (though those do exists), but for clinical reasons. For a myriad of reasons, it's simply not the best tool we have in our behavioral box. It is surely not something I would ask a non-trained and not-closely-supervised therapist/teacher/caregiver to do. I say that based on the empirical evidence (see how i sort of brought this back around to the OP?)
 
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...punishment (defined as the contingent addition or removal of stimulus which results in a reduction in the future probably of the behavior it is contingent upon),...

Come on, don't equate positive punishment with negative reinforcement.
 
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