{"id":484,"date":"2021-01-24T12:17:03","date_gmt":"2021-01-24T17:17:03","guid":{"rendered":"http:\/\/www.davidhowardpsychologist.com\/blog\/?p=484"},"modified":"2021-01-24T12:41:57","modified_gmt":"2021-01-24T17:41:57","slug":"so-does-it-work","status":"publish","type":"post","link":"https:\/\/www.davidhowardpsychologist.com\/blog\/?p=484","title":{"rendered":"So Does It Work?"},"content":{"rendered":"

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Is the sky blue? Is exercise good for you? Do politicians lie? One could say \u2018yes\u2019 to all of these \u2018universal truths\u2019 and be right . . . most of the time. But, like many questions that beg a one-word, absolute, black or white answer, some of the time that \u2018yes\u2019 would be wrong \u2014 or, minimally, too reductionist, unqualified, misleading.<\/p>\n

The house research muse happened on a podcast recently somewhat invitingly entitled Does Psychotherapy Work?<\/em> Right up there with is there a unified theory of everything?<\/em>. At some very basic level, a simple \u2018yes\u2019 is a pretty compelling answer. However, like those days when it\u2019s cloudy, daily workouts have inched towards \u2018positive addiction\u2019, or an elected official actually tells it like it is, the answer is, at the very least, more nuanced. <\/p>\n

Evidence-based<\/em> ______________. Fill in the blank as you will: programming, treatment, practice<\/em>. The list stretches to the horizon. The current \u2018buzz phrase\u2019 has popped up across any number of disciplines, generally attached to an increased need for accountability, science-based \u2018proof\u2019, appropriate resource allocation, program efficacy. Gone are the days of reading the bumps on someone\u2019s cranium, channeling Woody Allen as he sits with his analyst five days a week, exorcising evil spirits, and (dare I say it), intercessory prayer. Show me the beef<\/em> have belatedly become the new watchwords. Demonstrated proof of effectiveness, controlled studies are the foundation of evidence-based intervention. Injecting bleach evidently doesn\u2019t make the cut. Critical thinking over snake oil. <\/p>\n

An essential companion to an evidence basis is measurement of outcome<\/em>. I drop a glass of milk to the kitchen floor, the glass usually (in my case) breaks and the contents spill. I hit my thumb with a hammer and I feel something I describe as pain (and occasionally say some words). Pretty predictable, pretty reliable results. Basic physics and anatomy. Running these \u2018experiments\u2019 repeatedly isn\u2019t going to produce a different outcome \u2014 ever. Certainty, though messy and painful, is assured. <\/p>\n

Enter psychotherapy. The universe of \u2018what constitutes psychotherapy\u2019 has been being refined for well over a century. Study after study, meta analyses, and careful replications have created for practitioners a tool kit with a relatively reliable track record. Results not quite as predictable as losing grip of a glass or a misdirected hammer swing \u2014 but better than past life regression!<\/p>\n

A metaphor or two. I use an iMac with two terabytes of storage; and just for convenience, I carry a one kilo backup buddy that lets me take my office on the road. And, once on said road, my interactive sat-nav stares back at me from the car\u2019s dashboard. My Apple II+ with a brain now eclipsed by my watch and the comfortable satisfaction refolding a paper map are distant memories. I certainly have the equipment to do wonderful things (and rarely get lost!). But I\u2019m 74. Despite fancying myself pretty tech-savvy, I sometimes reflect on my \u2018facility\u2019 with these marvellous \u2018gadgets\u2019. In short, great tools do not, on their own make for great results. After all my now sainted mother stored her potato chips in the stackable clothes dryer and never did get the hang of that VHS machine. The tool is necessary<\/em> \u2014 but insufficient<\/em> in the absence of some very essential conditions!<\/p>\n

The most efficacious (I love the very sound of that word) of interventions, ever so thoroughly validated, are only as good as the practitioner<\/em><\/strong> into whose hands they fall. Only \u2018work\u2019 if they\u2019re the right match<\/em><\/strong> for a presenting complaint; brought to one\u2019s office by a client who\u2019s willing to engage<\/em><\/strong>. And only produce measurable, long-term change when the \u2018fix\u2019 facilitates the development of a sustained practice<\/em><\/strong>. The caution of a revered mentor continues to echo in my mind: Insight without action is bullshit!<\/em> <\/p>\n

Back to outcome, the elusive challenge of measuring it \u2014 and, perhaps, in the bargain offering an answer to the question at the top of this piece. The sine qua non<\/em> (another \u2018flows trippingly off the tongue\u2019 favourite!), of course is the \u2018tool\u2019, the treatment itself. And, for the sake of argument, let\u2019s assume all credentialed practitioners are created equal and competent. Which means they\u2019re all pulling the right screw driver out of the pouch for the job. We\u2019ve stacked the therapeutic deck pretty favourably. <\/p>\n

So I take out my ruler, stick it under my tongue for 30 seconds and note that my temperature is 10 inches (allowing for old technology and metrics). Hmm? Nothing wrong with the ruler; no problem with the protocol. Just a meaningless result. Welcome to the world of outcome measurement. Some age old issues remain. Principal amongst these: Are we measuring the right stuff? In a meaningful way? With a valid and reliable test? And, for good measure<\/em> (in the spirit of same), repeatedly and over sufficient time? <\/p>\n

Tests purporting to tap into the holy grail of psychotherapy abound, ranging from short and useless to long and unwieldy. The \u2018quickies\u2019 are widely employed and easily interpreted. And almost certainly measure your body temperature in units of length! <\/p>\n

One or two rungs up the ladder are longer, better normed, less easily \u2018fooled\u2019 instruments. Mapping the course of change is usually possible with these \u2014 with two important riders. They are typically \u2018self-report\u2019 which brings along all manner of client-based biases \u2014 intended or no. And with these, the hobbling of comparing a therapeutic technique\u2019s effectiveness across a client group<\/em> (not just measuring one individual\u2019s<\/em> progress over time). One person\u2019s \u201928\u2019 as it were, may be quite different from another\u2019s \u2014 an \u2018I feel pretty good\u2019 versus \u2018this is pretty much how I always am\u2019. Still, better than \u2018the ruler\u2019. <\/p>\n

Finally, the \u2018gold standard\u2019 instruments address most of the above concerns \u2014 but at a cost measured both in time (for completion) and dollars (expensive). Great information, reliably assessed. Just painfully impractical to administer repeatedly \u2014 not to mention client resistance (the \u2018Oh God, not again\u2019 dilemma). <\/p>\n

So does psychotherapy work? Yes it does. . . sorta, kinda, probably, I guess \u2014 with good tools, skilled mechanics, right \u2018gadget\u2019 for the job, and committed customers with an eye for future maintenance. How do we know? Well. . . that\u2019s the rest of the story, isn\u2019t it.<\/p>\n","protected":false},"excerpt":{"rendered":"

Is the sky blue? Is exercise good for you? Do politicians lie? One could say \u2018yes\u2019 to all of these \u2018universal truths\u2019 and be right . . . most of the time. But, like many questions that beg a one-word, absolute, black or white answer, some of the time that \u2018yes\u2019 would be wrong \u2014 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/484"}],"collection":[{"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=484"}],"version-history":[{"count":3,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/484\/revisions"}],"predecessor-version":[{"id":489,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/484\/revisions\/489"}],"wp:attachment":[{"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=484"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=484"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.davidhowardpsychologist.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=484"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}