Inaugural meeting

It was great to see everybody that made it to the inaugural meeting of the Sydney Hedge School last Wednesday evening. By my count 17 people came altogether! For those of you who didn't quite make it, the next meeting will be on Wednesday the 9th of April (same time and place). Write it in your diary now! I will post more information on the topic and paper to be discussed closer to the time.

At the meeting we discussed what it meant to critique psychology and then talked about some of the areas that we might be interested in critiquing.

What people seemed to value the most was the opportunity to talk in smaller groups. That way everybody got a chance to contribute and engage in conversation. 

As a brief summary of the discussions that took place a few people have written about how they experienced their group conversations. I have copied these below.

James wrote: 

"Our discussion broadly focused on the way in which political factors influence which research methodologies and therapy approaches are deemed acceptable in psychology.    

Ø  In attempting to emphasise it's scientific credentials, psychology has rigidly adopted certain quantitative methodologies  (e.g. RCTs) whilst often marginalised qualitative methods and other experimental designs (e.g. single-subject experimental designs).        

Ø  Problems of applying statistical averages of groups (derived from quantitative research) to individuals. For instance, identifying that on average therapy X is associated with a slightly better outcome on a particular symptom scale than other similar therapies, can lead to the fallacious assumption that therapy X would be the best therapy for an individual patient (or should be the "default" approach).

Ø  Pressure we experience to apply and advocate "evidence based treatments" in order to distinguish our training from that of other allied professionals (including registered psychologists) who also do therapy. At times we may do "token" CBT to feel as if we have used out "clinical skill set", even though it may not feel like the right approach for a particular patient.
 

Ø   Limitations of current DSM nosology in informing treatment approaches. We discussed often finding psychodynamic diagnosis more helpful in formulating and guiding treatment.
 

Ø  We discussed the "art" of therapy, the way in which scientific psychology and clinical training fails to explore this. How do we develop this component of clinical practice?"

Adele wrote:

"Our discussion went round in a circle many times, which I think reflects the basic tension we are all grappling with between valuing the scientist-practioner model and knowledge gained from RCTs (and other group-based research) to the limitations of this and need to focus on the art of therapy with individual patients.

We felt that the idea of 'informed ignorance' mentioned in the article was important.  We felt that it was important to bear in mind the idea of science as the best model we have right now.  It is a scaffold - not the absolute truth which is applicable in the same way to every patient.  For example, in group-based trials, there may be some people who did not find a particular treatment (e.g. CBT) helpful, even though overall, on average, people reported improvements.  We thought about how this might impact on our view of individual patients who do not respond to an evidence-based treatment and disliked the term 'treatment resistant' - which seems to imply some kind of failing on the patient's part.  It was felt that holding an awareness of the limitations of the scientific approach in mind meant that we might listen out for the expertise brought into the room by our patients as experts of their own lives and experience.  At the same time, we felt that having some idea about whether a treatment works overall is a very necessary thing - otherwise we could be doing something that is not at all therapeutic.

The idea of sincerity both in research and treatment also came up.  We wondered whether the professional façade which we feel ourselves adopting at times is helpful - for example, are there times when self-disclosure or giving advice (both things we are trained not to do) are actually more helpful to patients than for example, using Socratic questioning? 

These are some of my recollections of our discussion - perhaps if one of the other group members had written it you may have received a very different answer!  But I hope that helps just to keep at least some kind of record of the issues that came up."

I wrote:

My recollection of my group discussion is that we started talking about the pressures to adhere to certain discourses when working within mental health services. We spoke about the hierarchical structures within such services, where psychiatry and medicine were privileged and how this could leave some professionals from a range of disciplines feeling as though they must adopt that language and way of working. 

This lead on to the issue of diagnosis and if, how, and when it was to be used. Again, the group spoke about the way that they felt they must use psychiatric diagnoses even at times when they did not feel it was therapeutically helpful. The way diagnosis is used as a financial metric, with which to distribute resources, was also seen as problematic and meant that some people played the 'diagnosis game', assigning whatever would attract services irrespective of whether the person met criteria or not. 

Next we talked a bit about research- the conflict between wanting to produce something that was seen as scientific (such as quantitative data) and often preferred by academic institutions, as opposed to something more meaningful (perhaps with qualitative data).  

Lastly we spoke about the difficulty we had in speaking two different 'languages' when working in mental health services. One where we speak with management and write reports from a conservative and narrow frame, and the other where we explore context, meaning, and the experiences of the people with whom we work. 

I am sure that I've left some bits of the conversation out and of course presented the parts I have included with my own biased interpretation.