The Myth of Clinical Experience

Clinical Psychology Common beliefs Childhood experiences are important in shaping who we are as adults Low self-esteem is the cause of a lot of problematic behaviors Must you raise self-esteem before they can make big changes in their lives?

Clinical Psychology Clinical Psychology as a new field Post WWII Ph.D. PsyD programs (1971) “We are graduating thousands and thousands of practitioners who are peripherally acquainted with the discipline of psychology”

Psychological Research Why research is so important All that we don’t know Implied ethic that we must do something Foundations in science constrain extreme claims

How To Evaluate Psychotherapy How do we know if psychotherapy works? Look at cases where it has Treat groups of people to see if they are better off ‘in general’ Regression to the mean Use of the Experimental Method! Radom assignment to control & experimental groups Critically evaluate success

The Myth of Clinical Experience What we DO know Evidence-based treatments Recovery is a base rate phenomenon Credentials & experience are unrelated to patient outcomes Length of therapy is not related to outcome

The Myth of Experience in Prediction & Diagnosis The Goal of predicting behavior Graduate school interviews, parole board hearings Actuarial versus clinical judgment People are bad at combining predictors Base Rate Psychology = behaviors & emotions are best predicted as members of an aggregate, and by learning what variables generally predict for that aggregate and how

The Actuarial Approach Is it “dehumanizing”? Ex. Admissions criteria The best predictor of future behavior is past behavior