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House of Cards Paperback – September 1, 1996
Purchase options and add-ons
- Print length352 pages
- LanguageEnglish
- Publication dateSeptember 1, 1996
- Dimensions6 x 0.9 x 9 inches
- ISBN-100684830914
- ISBN-13978-0684830919
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Product details
- Publisher : Free Press; 1st edition (September 1, 1996)
- Language : English
- Paperback : 352 pages
- ISBN-10 : 0684830914
- ISBN-13 : 978-0684830919
- Item Weight : 15.2 ounces
- Dimensions : 6 x 0.9 x 9 inches
- Best Sellers Rank: #413,064 in Books (See Top 100 in Books)
- #141 in Popular Psychology History
- #816 in Popular Psychology Psychotherapy
- #11,064 in Mental Health (Books)
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I dated a medical doctor and was surprised to hear that many of her colleagues had trouble learning and keeping up with the latest and best techniques once they left their university, research hospital or competitive hospital that pushed for empirical improvement. Learning and improvement doesn't stop with a MD or Ph.D. ;-)
Jason
The author, Dr. Dawes, cited two reviews and one trial to ardently contend that professional psychotherapists are no more helpful than untrained, non-professional counselors.
The review by Hattie (1984, Psychological Bulletin 95:534-541) was badly flawed by including studies which did not clearly distinguish between professional and non-professional therapists. As just one example, this review includes a study in which the “professional” therapists were students who had not completed their training.
The review by Berman (1985, Psychological Bulletin 98:401-407) falls far short of the standards for modern reviews and meta-analyses. First, the review did not clearly state how professional and non-professional therapists were defined. The average age of the professional therapists was only 31.8 years, meaning that on average these therapists did not have extensive experience. For example, if a person proceeded directly from high school through college, medical school and adult psychiatry residency, the person would complete training at the age of 30. Thus at the age of 31.8 years the person would have only two years of post-residency experience, whereas 10 years is needed to truly become expert. Second, the included studies were extracted from the review by Hattie. There was not an extensive search of the literature to identify other studies. Third, the review did not contain a funnel plot or other method to determine if relevant studies may not have been published. Fourth, the review did not state the total number of patients treated in the included studies. Nor did the review adequately discuss pertinent subsets of patients. Fifth, the review did not adequately discuss the quality of the included studies across a range of criteria. The review did not use a standardized measure of quality to eliminate poor-quality studies or to rate the quality of the included studies. Sixth, the review did not specify how ill the patients were on average. Given ethical considerations, it is likely that the included studies did not involve seriously ill patients. It would have been unethical to have allowed untrained persons to treat gravely or even moderately ill patients. Seventh, the review did not include a heterogeneity statistic. A heterogeneity statistic would allow the reader to assess whether the included studies had consistent enough results to make the results believable.
Dr. Dawes discussed at length one trial and endorsed it as proving that professional therapists are no more helpful than non-professionals. (Strupp, 1979; Archives of General Psychiatry 36:1125-1136) This involved patients being treated by trained therapists versus college professors not trained as therapists. This study is seriously flawed. First, the patients were all male students at Vanderbilt, that is, persons with significantly above average intellectual abilities. The patients had depression or anxiety of “mild” degree. The patients did not have serious mental illnesses. Such persons might be expected to improve spontaneously without treatment. Indeed, an included group of male Vanderbilt students who were not treated at all did improve significantly. Second, specific diagnoses were not made. The patients were designated by certain scores on the Minnesota Multiphasic Personality Inventory, which is not a diagnostic instrument. Third, the patients were not blind to treatment assignment. Fourth, although various rating instruments were used, the study did not discuss the extent to which the instruments were validated. Fifth, the patients assigned to the trained therapists had more serious symptoms than did the patients assigned to the non-professionals. Sixth, it was not specified whether the trained therapists used specific treatment protocols or followed a manual such as a modern expert therapist would do. Given that the study was conducted in the 1970s, it is highly unlikely that the trained therapists followed an empirically validated manual. Seventh, the numbers were small with only 16 patients being assigned to the trained therapists and 15 to the non-professionals.
House of Cards was published in 1994. Since that time many teams of bright, sincere, industrious researchers have demonstrated that various forms of structured therapy can significantly help patients improve their lives. See, e.g., Barth 2013; PLOS Medicine 10:e1001454. For some conditions, such as major depression, panic disorder and obsessive compulsive disorder, a combination of medication and therapy is better than either alone. (Cuijpers 2014; World Psychiatry 13:56-67)
That being said, unfortunately it seems that in the community very few therapists rely on manualized protocols when providing therapy. (Manuals are guides, not rigid rulebooks. An excellent therapist is a warm, caring person who works systematically according to a scientifically proven model.) Therapists often claim that they are “eclectic” and pick and choose the best techniques from various schools of therapy. However, there is no evidence that such eclectic approaches work. Therapists claim that they rely on their own experience, but as Dr. Dawes forcefully argued, personal experience is no substitute for scientific evidence. If you had cancer and consulted an oncologist, would you want her to prescribe chemotherapy according to her personal experience, which she very likely has not systematically and statistically studied, or according to the best scientific evidence?
If you plan to see a psychotherapist you might ask some questions to help you determine how likely it is that the therapist will provide truly evidence-based treatment.
What form of therapy do you plan to provide?
What is the evidence in favor of that form of therapy?
What are the steps of the therapy? [Can the therapist fluently and extemporaneously state at least several steps of the form of therapy?]
What skills will you try to help me learn? [Can the therapist fluently and extemporaneously state at least a few skills she plans to teach?]
Will you follow a manual?
Will you give me a workbook?
The final three words of the book are, “Just do it.” It is true that to change our brains and to change our lives we ultimately have to take action. However, it is not so simple as “Just do it.” If it were, people would “do it” and not struggle so much with their mental health. A skilled therapist who is experienced in following a scientifically validated manual can do a lot to help patients develop psychological skills that can help the patients take life-building actions.
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The one star rating Finn gives to the book under these conditions is a good example of the attitude that imbues the psychology industry: it is the realm of believers rather than people driven by a scientific mind. That is the precise target of Dawes' criticism: the practices and ways of doing things in psychology aren't those of a scientific discipline.
Psychotherapies do give results, but nobody knows why. The active ingredient of psychotherapy is still unknown, and yet the profession behaves like it knows for sure and can teach how to become an effective psychotherapist to students in psychology. This is a lie.
Psychologists, psychiatrists and all related professions in psychology present themselves to society as specialists of the human behaviour, the kind of people who have the knowledge about what makes individuals behave the way they do, but this is another lie. Psychologists and psychiatrists don't know better than anybody else the cause of people's actions and shouldn't be socially promoted as such experts.
The growth of psychology in our societies is unjustified, owing to the absence of evidence supporting the special knowledge psychologists and psychiatrists claim to have. Today they are everywhere, in the hiring processes of major companies, in court, in schools, in hospitals, in the government apparatus and what better society have they contributed to create? On the opposite, the number of myths they helped propagating are countless: from the frailty of children and women confronted to tragical events to the false memories they can implant in the mind of people in the setting of the psychotherapy.
Under these conditions, Dawes' book is a must and has to be praised.




