[From Bill Powers (2009.07.05.1902 MDT)]
David Goldstein (2009.07.05.12:57 EDT) --
DG: These methods don't apply in a clinical situation, do they? If so, explain how.
Even in a research situation, no one has studied the learning of pursuit tracking over time. How would the parameters estimated change as the person's performance approaches optimal levels of control? This would make a good undergraduate research project.
BP: Yes, it would. or even a doctoral thesis. You raised this question long ago, when you asked if there wasn't some way to do control-system experiments without a computer, and without needing quantitative precision of the kind we get in tracking experiments. I thought there must be ways, but never really tackled that problem. Perhaps it's something you or your colleagues in New Jersey might want to think about and collaborate on.
It can't really be that hard -- no harder than it was for you and Dick Robertson to do a simple direct test for the controlled variable when that variable was a person's self-concept. You didn't need a computer simulation for that -- all you had to do was show that people would counteract a threat to a self-image statement. As I recall, the design you ended up with resulted in positive results for 23 or 24 out of 26 subjects. If you were to represent those results in terms suitable for measuring a group correlation, I'm sure you would have ended up in very high 90s. maybe 99 or even better. Sure, it was a simple measure, but it was as solid as they get. I much prefer simple and solid to Fuzzy Wow.
The only problem, and it will be a problem until psychology wakes up to PCT, is that to get that result you need to do the experiment in PCT terms, not in terms of adjective lists or questionnaires or even Q-sorts.
DG: It occurs to me that the QEEG given before and after a number of sessions might serve as a measure of changes in the person's brain. The QEEG has the test/retest reliability that you like, high .90s. I have used it in a study of the effectiveness of Thought Field Therapy. See the attached pdf file.
The only problem with the QEEG is that it tells us only about electrical activity in various parts of the brain, and correlations among the waveforms in the different parts. It's no good for telling us what those parts of the brain do. Of course I like the high retest correlations; that says the measures are probably measuring something that's really there. But getting from that to saying "The output functions in Area 17 correlate with the reference inputs to control systems in area 6" is a long, long way into the future. I think we are pretty much stuck with behavioral and functional experiments until neurology catches up with our needs.
BP: I don't like them (Psychological Tests); it's impossible, for example, to verify by
direct examination that some internal condition like "depression" is
present or absent, so there is no way to know if it even exists
except as a diagnostic category. I exclude subjective reports for
now; that would bring up other subjects such as the trustworthiness
of introspection.
DG: You mean that the verbal reports of people are to be ignored? If someone says that s/he is very sad, that s/he has been crying much of the time, that s/he has no appetite and is losing weight, that s/he keeps on waking up at nighttime, that s/he wants to die, that s/he has thoughts about how to do it, and that s/he has lost interest in things which used to be of great interest, we are to ignore these verbal reports and think that they are based on imaginary things?
BP: We certainly wouldn't ignore such reports, but they tell us nothing about what is wrong. They describe the consequences of whatever is wrong. With only that kind of information, we could hardly do any better than the drug companies manage to do: try various treatments dreamed up more or less at random, and see if any of them alleviate the symptoms. If any do alleviate the symptoms, we would have no idea why they did -- we could only hope that the same treatments might help again when the symptoms return, or that they might benefit others who show what look like similar symptoms. I think of that as the prescientific approach to knowledge, the witch-doctor approach. It does have a certain success rate, but also a very high failure rate.
I think we have some encouraging evidence that in cases such as you describe, the problem is not feeling sad, crying, loss of appetite and weight, insomnia, suicidal thoughts, or apathy. It is probably some set of conflicts that are crippling some control systems at a higher level, with those symptoms being the consequence. So we don't need to waste our patient's time and money on attempts to alleviate those symptoms. Instead, we would explore the patient's hierarchy, expecting the process to be interrupted repeatedly while we pause to deal with conflicts that show up in the conversation.
In my experience, and I think in yours too, those conflicts ALWAYS show up, and they don't take long to do that. When we explore the conflicts to narrow down just what they are, and dwell on them for a while, they rather often (in my experience, always) die down, weaken, and disappear. The result of that shows up in subsequent sessions. Remember G. who was on valium and incapable of continuing as a pulmonary therapist after her husband died from lung problems, who showed up one day commenting that by the way she didn't use valium any more because she had learned how to step back and look at her problems from another point of view, and a bit later saying oh yes, she did apply for and get a position as a pulmonary therapist. You had not suggested that she do either thing. She resolved her conflicts and was able to resume a more normal life, all without official authorization from anyone. The symptoms automatically went away because the cause was removed.
BP: The most likely diagnostic category is identified in this way, after
which (by the usual medical model) the indicated treatment can be
looked up in the DSM and applied.
DG: The DSM-IV does not contain treatment information, only diagnostic information.
BP: Oh, I didn't know that. Where do the "indicated treatments" come from, then?
BP: As can be shown beyond much doubt, knowledge about "people" (a
population) is a very unreliable and close to completely invalid
basis for judging an individual. Past experience with unhappy people,
and with whatever events led them to feel better, is of severely
limited use in dealing with a single person, no matter what the basis
of selecting that person.
DG: "Severely limited use", something is better than nothing. Every Psychologist knows that the generalizations from the research literature may or may not apply to the individual in front of them.
Then why do they keep doing it? And who said that "nothing" is the only alternative? In MOL we don't do it that way. According to Warren Mansell, "transdiagnostic" methods, which don't rely on the diagnose-and-treat paradigm, are gaining popularity and importance, leading to recognition that each case has to stand alone rather than being likened to other cases. In MOL, every case is treated as a new case.
BP: I conclude that making a person feel better after a session is not a
goal that determines what is done during a session. It seemed that
you were saying it is a goal, but perhaps I misinterpreted what I read.
DG: A patient who does not receive some relief from distress after a few sessions will be an ex-patient. The patient must be present in the session to do MOL Therapy.
I agree with that, but MOL therapy does not aim simply to alleviate distress. Why do you assume that if you pursue background thoughts and conflicts, there will be no result to encourage the patient to stick around? Isn't there a similar risk, perhaps even greater, that trying to alleviate distress by offering solutions to problems may fail and lead the patient to abandon therapy? You appear to be claiming that standard methods are more effective than MOL, which I doubt is any better supported by current evidence than the opposite. In fact all the reports I have received, and my own experience, indicate that using standard methods like advice-giving and problem solving very quickly stops progress in therapy. Even I succumb to the problem-solving temptation occasionally, and for me it never works.
BP: How can you serve as a reorganizing system for another person? Can
you alter the organization of another person's control systems?
DG: No, except by asking questions or making comments or taking actions, the person may reorganize in a way that s/he would not have done without the therapists inputs.
That's the basic principle behind MOL: asking questions that require the person to examine different aspects of the hierarchy, at a higher level, which redirects any reorganizations going on to places where they are more effective. This does not determine what the result of reorganization will be, so the therapist has no influence over those results. But giving advice does not reorganize the other person.
A newborn baby can only cry and flail when in distress. In good parents, the parents take actions to relieve the distress. The parents make guesses about what the problem might be. They might check for a wet diaper, feed the baby, hold the baby, talk to the baby, etc.. until the baby stops crying. When this happens the parents concludes that the baby wanted X. The baby learns that crying and flailing results in feeling better. The baby also may learn more general things. Babies who are neglected or not responded to stop crying and flailing after a while.
That is a case where the distress can actually be alleviated and the cause can be removed by the caretakers (close the safety pin so it's not hurting the baby). It is the caretakers who are reorganizing: trying different actions until they hit on the one that stops the crying. Mothers come to distinguish different kinds of distress because babies, too, are reorganizing and trying different actions, within a very limited repertoire. But that is the beginning of communication. Nobody is talking about neglecting anyone here. Doing something that is much more effective than giving advice is not neglect.
A therapist does a similar thing with a patient. Fortunately, the patient can talk and so can give us a much better idea of what is wanted. But sometimes, this is not known. I have a case of a woman who is very depressed (sic!), and when I asked what would help give her life more meaning, she is not sure. The question is provoking some thought on her part, which she tells me is on her mind every day. She views her life as a big waste up to this point.
Does she wish it were less of a waste? What would make it less of a waste? What happens when she thinks of something that might make it better? Is this depressed feeling like a feeling of heaviness, or a sort of paralysis, or an inability to start an action? When she says she isn't sure, do you just quit asking? What is the conflict (or what are the conflicts) that are present right now and that cause this depression? Why not give MOL a try with her? It seems that every time you report a difficult case to me, you are using something other than MOL with the patient. I would find that difficult, too.
As I said long ago, it just doesn't work to mix MOL with any other approach. The assumptions are just too diametrically opposite.
DG: There has been very little PCT research in dealing with clinical situations, dealing with real people with real problems. I once asked you whether you thought that the modeling approach worked for higher level perceptions. You weren't so sure then. Are you sure now?
No, but I don't use the modeling approach with higher level perceptions -- I use the method of levels. So far that has worked most of the time, at least in face-to-face encounters. It doesn't work as well on the internet or the telephone. Actually I see no problem with modeling the higher-level systems, though devising experiments is somewhat difficult and I've focused on lower-level systems because they're easier.
And as far as real people with real problems go, I've given perhaps several hundred successful demos of MOL using real people with real problems, and other MOL practitioners -- PhD clinical psychologists -- have put in many hundreds of hours with real people having real problems in actual clinical situations. You can't say there hasn't been any research.
BP: So the most important thing is to avoid losing the patient? How
far are you willing to go in adjusting your methods to keep a
patient? Would you use acupuncture or Rolfing if the patient expected
it? Operant conditioning? Propofol?
DG: Ignoring the sarcasm, if the patient is not attending, MOL Therapy cannot be done, or any other therapy. I use Biofeedback Therapy when appropriate.
BP:I think you miss my point here. Does the patient's theory of behavior or idea about therapy have anything to do with what you think works best? I don't think so. I see no reason to stop doing what I think works best just because the patient has an idea I should be doing something else. But rather than argue with the patient, I simply change the subject to what the patient believes, and try to see what lies behind it in the background so we can talk about that. That works most of the time for me. When that fails I just say that the patient probably needs to talk with a different kind of practitioner (I don't call myself a therapist). Tim Carey says he does the same, and he has not had a scarcity of clients.
BP (earlier): I have to admit that in these exchanges, I do not consider
conventional psychology to be the senior science and PCT the
interloper. I see PCT as the future of psychology, and conventional
psychology as the past, to be discarded and replaced in almost every
aspect. Your position and mine are perhaps both understandable.
DG: I too believe that PCT will be the Psychology of the future. I don't believe that the body of research has reached a critical mass that would accomplish this result for conventionally trained Psychologists. It takes a long while to appreciate the computer demos.
True, but most people in PCT didn't join up because of the demos. They just thought the theory made more sense than other theories. What confuses me is how you can agree that PCT is the psychology of the future, yet still prefer the psychology of the past when it comes to actually applying theory. I think I understand this, but you don't discuss it as if you do. What is going on here?
Best,
Bill P.