There are many people like Cho who are crying out for help - and the counseling and therapy profession seems determined not to respond! A brief look at the danger of 'best practices' in counseling. ______________________________________________________________________________________________
THE USE OF 'BEST PRACTICES' IN COUNSELING AND THERAPY
The problem with devising preventive/adaptive strategies to cope in advance with people like Cho, is that today, all counseling or therapy must be based in empirically driven research, resulting in what the social sciences call, "best practices." Thus, the best practices used in therapy/counseling are meant to be 'scientifically proven' solutions to specific client problems. The problem is, there are no 'best practices' that help counselors deal with individuals with needs like Cho's. Yet, as our culture becomes more driven by liability concerns than by helping our neediest citizens, counselors have less and less freedom to create new and perhaps very radical responses to match the desperation that people like Cho must feel.
This is an example of how our profession's 'best practices' are determined. Through research, we might discover that a certain approach to treating depression in college students produces results that indicate a statistically significant advantage over the use of some other method tested in the study. How do we apply statistics to such a nebulous subject? Simple: we ask the student-subjects to report on their experience with any approach that we want to explore. Typical questions include things like, "Do you feel helped by the treatment you received?" "Do you feel happier since receiving therapy?" Would you say that your relationships are doing better after receiving counseling?" ... etc. If we want to gather more data, we can ask for a responses "on a scale from 1 to 5," or ask subjects to rank their responses as "a little; quite a bit, very much"... etc.
Then, this data is 'treated' statistically. Through this process, it is hoped that we can discover things that really work - and have been empirically validated. Of course, any study is only as good as 1) the number of individuals in the study (bigger is better); 2) the thoroughness of the study's design and method; 3) the 'fit' between the study group and those we will try to help by applying our 'best practices.' Another thing to wonder is just how much the study group was helped by our new treatment method. Unfortunately, 'best practices' (like new prescription drugs) are often validated and then accepted after showing very little overall effectiveness - and the level of effect is too easily lost in the complexity of statistical processing. THERE IS NO WAY TO STUDY MASS-MURDERERS IN ADVANCE Problem: there is no way to conduct this kind of study on mass murderers who die in the course of their event. There is no normative data on serial killers or mass murderers that would allow us to preemptively deal with the emotional problems that eventually lead to such tragic actions.
Sure, afterwards, we can appear wise and learned. But before the tragedies occur, there is very little we can say that will help the unforeseen outcomes.
As in Cho's case, the police cannot act without formal complaints. Many who call the police refuse to complete the process by signing a complaint. After all, if you sign a complaint and the matter goes to court, your identity will be revealed to the person you might rightfully fear! Even with a complaint, the justice system cannot deal effectively with individuals who have not yet broken any laws.
This is often frustrating to members of the public who can see that 'something needs to be done/ For therapists and counselors, it can be an excruciatingly painful reality: even when very disturbed individuals come to the attention of classmates, teachers (etc.), as was the case with Cho, there is often nothing that can be done if we are compelled to stay within the accepted guidelines, when liability issues demand that we provide only 'empirically validated' treatment.
So, many professionals - college professors, teachers, counselors, therapists (etc.) are becoming absolutely limited by whatever current concepts of 'best practices' might be - or they run the risk of seriously endangering (or ending) their careers.
Sure, any counselor can go against these professional and ethical guidelines, if they feel they have something to offer the disturbed individual that lies outside the current understanding of 'best practices.' Cho, for example, might have responded to touch, hugs, after-class one-on-one social sharing, group interventions, going fishing with a local retiree (etc.). Who can tell?
But for any professional, offering such non-standard (and non-PC) contact is a very dangerous process. Because then, when a person like Cho finally 'pops' and commits mayhem, the professional who has offered non-standard help will be attacked for 'taking matters into their own hands' instead of following the approved process.
Unfortunately, the 'approved process,' as I have said, has nothing to offer these one-off, non-standard cases. The counseling profession openly challenges what they regard as 'untrained individuals' who think that they might help a truly disturbed individual with some 'informal' therapy. And yet, when these tortured individuals are referred to professionals, all too often we simply fail to act, hobbled by our delusion that we can somehow transform person-to-person helping into a 'real science.'
IN THE PAST PEOPLE COULD REACH OUT TO HELP PEOPLE IN NEED...
In the past, what we would now regard as counseling occurred mostly at informal levels: a compassionate individual - perhaps a caring teacher, a generous 'granny,' a pastor, a sports coach or a friendly neighbor would 'take someone under their wing,' offering friendship and guidance that often came through simply modeling successful attitudes. Through these informal connections, abandoned kids, troubled students, abused wives and many others in need received care and found they could feel supported within their communities.
Whenever needy individuals receive contact and caring from the community, of course the community itself is strengthened. In fact, caring for others can be said to be the very basis of 'community' itself, in all of its forms.
In the 60s, a study was done to answer the question, 'Which method of psychotherapy is most effective?' The answer was unexpected: the kindof therapy did not seem to matter. What mattered was the ability of the individual therapist. Some therapists could effect change consistently, no matter what 'method' they might be using. And those who lacked this undefinable ability, seemed to be equally ineffective, no matter what method they used. Is there a message here...?
Jai Daemion, M.S., M.Ed. (counseling) explores in the realms of integrative psychotherapy, psychophysical integration and the study of culture and consciousness, using eastern-western and inner-outer tools. Still holding Vision for the power of family, groups, circles, community and love, Jai hopes to help this poor ol' world keep breathing a little longer, despite humankind's highly questionable intentions.
Well said. The sad part about this whole story is that It didn't have to happen. Not only do we have the problem of evidenced based practices but we also have tax cuts to the rich that result in cuts to mental health services. Not only is the government demanding that we practice evidence based practices they are also demanding huge amounts of paperwork that must be typed in by the mental health professional. Due to tax cuts mental health workers have high case loads. The private contracts also are coming out of the woodwork. Just because a private company says they will supply wonderful services doesn't mean you will get what you pay for. Mr. Cho needed to be taught how to manage his mental illness and to be given hope that he had a chance to live a life worth living.
by
beccy (0 articles, 0 quicklinks, 0 diaries, 87 comments)
on Wednesday, April 25, 2007 at 8:41:46 PM
You have added the image of a more successful outcome...
Beccy - Thank you for adding some very salient points! Your compassion comes through and I appreciate having the positive image of Cho being helped to manage overarching my cataloguing of some of the lacks in our profession.
by
Jai Daemion (5 articles, 0 quicklinks, 0 diaries, 20 comments)
on Wednesday, April 25, 2007 at 9:58:43 PM
I fail to see how documentation is a burden to the client or practitioner. How are you to track what you have done and what is working if you don't document?
Yes, the lack of public funding shows an appalling lack of understanding of the importance of mental health, but I don't see how this is related to Best Practices. Cho has given this country a gift- that is to shine the light on the overburdened, underfunded state of the mental health system. With luck, people will be frightened enough to make sure that public health systems are adequately funded.
by
Bialto (0 articles, 0 quicklinks, 0 diaries, 5 comments)
on Monday, May 14, 2007 at 12:30:02 PM
I don't think that keeping records is an issue that has been raised pro or con - certainly not in the intention expressed in my original posting. My position is that records are wonderful to maintain contintuity with the many threads of meaning that typically flow through multiple sessions. Of course, practitioners face somewhat of a doublebind here (too) in that whatever records are kept are subject to subpoena, which means that any non-standard treatment that is recorded in those documents might be a liability risk at some point. But this is (for now, fortunately) a rare event. Still, non-standard therapeutic approaches need to be understood as carrying this and other professional risks. - Jai
by
Jai Daemion (5 articles, 0 quicklinks, 0 diaries, 20 comments)
on Monday, May 14, 2007 at 5:06:56 PM
With all due respect, the issue of what to do about Cho isn't resolved through the banishment or changing of best practices. Best practices was implemented to assure that clients receive a high quality of care and not just some hocus pocus treatment that doesn't work. I don't see how using a method to protect the public is a bad thing.
That being said, I am all for non-traditional methods of treatment and do not see any barriers to using them as long as the client is informed and competent to give consent. Best practices are required by insurance companies (who don't want to pay for things that don't work) and are in place for protecting the client from malpractice, but there is nothing that says you MUST utilize them for all clients and in all phases of treatment. I also do not see how not observing Best Practices would have made a single bit of difference in this case.
by
Bialto (0 articles, 0 quicklinks, 0 diaries, 5 comments)
on Monday, May 14, 2007 at 12:24:27 PM
zaqhareet - Regarding your second comment: I understand that your thinking is exactly in line with the orthodox position regarding 'best practices' and empirically proven treatment methods. What I was suggesting in my article, is that it is precisely this type of rather short-sighted belief in 1) the possibility of conducting any statistically meaningful qualitative research into areas of human emotional experience (though I acknowledge that such research can be done on behavioral treatment methods); 2) the possibility that psychotherapy can (let alone should) be administered like aspirin, so that any academically 'qualified' individual can ask the 'empirically proven' questions and do the 'empirically validated' treatment maneuvers and.. voila! The client is 'cured!' (Again, the notable exception to this absurdity lies with the cognitive-behavioral therapies which seem to be ideal for this kind of constant re-tailoring based upon research findings. Unfortunately, these techniques control/regulate behavior without always helping emotional experience.)
It is not that the marketing strategy of the empirically-based system is bad, it's just that it creates 'true believers' like yourself, perhaps, who somehow believe that if a study has been done... that they will better know what to do in their next session and that their clients will be somehow better served and protected. And of course the general public is not likely to discover that their subtle, inner, dramas and sometimes massive disorientations are being served with a 'cookie cutter' approach often applied by 'cookie cutter' practitioners.
This notion of control-based and pseudo-scientific practice is the equivalent of psychological fascism. It is based in a thinking error that permeates this profession, our social services generally, government services usually, etc. It's made by and for those who want/need to conform to those ways of relating to clients that are used by the greatest majority of lock-step therapists.
Unfortunately, therapy that proceeds along these lines far too often does not serve the real, human needs of clients; costs insurance companies more in the long run; causes therapists to have to cheat on their diagnostic coding in order to get funding for needed work that is not otherwise covered; and leaves many wondering where the 'magic' went that used to be associated with undertaking (or providing) psychotherapy.
Mass marketing of methodologies is no different from mass marketing of religion, social values, etc. However it's packaged and sold, it's all based upon and motivated by CONTROL and CONFORMITY. If that's working for you... that's wonderful.I hope for more - for my clients and for myself. - jai daemion
by
Jai Daemion (5 articles, 0 quicklinks, 0 diaries, 20 comments)
on Monday, May 14, 2007 at 5:35:59 PM
I don't think most people would even know what you are talking about, Jaed. And see how defensive the reaction of someone 'religious', and most likely in the field? I don't it even matters what you say, or what your point is, and how true, or otherwise. The 'critical aspect' of your argument automatically invited a 'blaming you' reaction. One does not even have to read the argument for that purpose.
So, what am I saying? I am saying that I understand what you mean, and what you are talking about, and yes, I am embarrassed myself to be part of this religion that calls itself a science, and has 'experts' testifying about the 'truth of the matter.'
And when you get to the PhD's, and the MD's, the damage is even worse, because they specialize in the truth, and even have a doctorate to prove their authority.
It's not just the 'policies', and 'politics' of the profession, as far as i am concerned. It's that these people memorized their notes, and never listened, or processed, or questioned anything on their own...never mind try learn from the patient.
Psychotherapy these days is practiced like a religion, and it often does more harm than good.
i won't even get into drug treatment, (both inpatient, and outpatient).
I don't think the people who are deprived of treatment realize just how lucky they are these days. I still have not recovered after almost six years, looking, feeling, and acting (disabled) like a returning Iraq soldier with severe PTSD, and blamed for crimes that are just too obvious, and too severe to be noticed, or could possibly true. Hard evidence is of no consequence outside of the court room, and any, and every expert witness who lies, or works undercover for the government, has totally, 100 % immunity. Same with the agencies.
PS: you may have to watch out that you don't accidentally use a wrong word in your charting, or something totally trivial. but if you want to commit murder, that's a piece of cake, and no problem. Those licensing agencies don't handle criminal matters, after all. Would have been nice had one known all this ahead of time, but then the police is not exactly the most attractive alternative, either.
Thanks, Katrin
by
Katrin R. (3 articles, 0 quicklinks, 11 diaries, 514 comments)
on Monday, May 28, 2007 at 6:07:24 AM
7 comments
How would you rate this?
You must be logged in (if signed up) to do ratings.
It's free to signup! And easy. And takes just a minute or two....
Must Read (
Well Said (
News (
Touching (
Funny (
Supported (
Interesting (
Inspiring (
Valuable (
