Dear Paul,
Thanks for these suggestions. Epstein sound interesting. No relation to Bri I suppose?
Not surprisingly I am more likely to agree with a definition which I wrote myself than I am with some others but my position is reflexive i.e. applies to myself as much as to others. Assumptions, which may not be accepted by others, underlie my answer, which is itself a product of the time and place of its production and my own definition was used, like others definitions, to try to accomplish various outcomes. So consistency require me to problematise the representation of my own definition as a collective definition too.
David
-----Original Message-----
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Moloney Paul
Sent: 16 October 2007 15:14
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
One useful reference for the poor evidence base for CBT is a publication by William Epstein, a professor of social work at the University of Nevada. For anyone who has not read this excellent book, Epstein offers a rigorously argued and coruscating critique of what passes for 'outcome research' in relation to all of the mainstream psychological therapies - including 'CBT'.
His conclusion is that just about all forms of psychological therapy are routinely ineffective and sometimes harmful, and in fact serve as political bromides. It's true that the book is slanted toward the American scene, but Epstein discusses some British studies, and many of the American ones that he mentions are widely cited in the British CBT literature. And of course his methodological criticisms can be translated wholesale to the British research literature, including those studies featured in the NICE guidelines.
The ref is:
Epstein, William (2006) Psychotherapy as Religion: The Civil Divine in America. University of Nevada Press. Reno and Las Vagas.
In regard to David Fryer's point about the difficulties of providing a straightforward definition of CP to which all would assent: wouldn't it be possible to offer a general statement which points out how CP is all about understanding distress and wellbeing in the context of the social and material environment (and without getting into any difficult issues about post modernism versus critical realism, individualist versus systemic perspectives etc, etc).
Perhaps I'm being very naïve about this kind of thing, or perhaps I've misunderstood - (it certainly wouldn't be the first time!) - but, doesn't the following statement come close to a general definition that a lay person could make sense of? :
CP Attempts to find ... "ways to understand, prevent or reduce socially caused mental health and community problems defined from the perspective of people affected by these problems, and in the contexts in which the problems occur' (Fryer, 2003).
Best Wishes
Paul
-----Original Message-----
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Mark Rapley
Sent: 16 October 2007 13:30
To: [log in to unmask]
Subject: Re: [COMMUNITYPSYCHUK] The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
J
One or two obstacles indeed - though Manny Schegloff has done some very interesting CA stuff on non-linguistic communication by folks with commisurotomy (as has David Goode with non-hearing/non-seeing children with rubella syndrome). Of course, pace Wittgenstein and his beetle, in principle we can never have access to the "interiority" of _any_ other, whatever their linguistic abilities. But that's another question entirely!
As far as CBT goes, activities such as so-called socratic dialogue do rather presuppose a certain command of spoken language....(though Derek Edwards has done a rather nice demolition job on socratic dialogue too).
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of J.Cromby
Sent: Tue 16-Oct-07 13:18
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
A small aside re point 3: I've met people with profound and severe multiple impairments (both physical and cognitive) who had no expressive language, and who did not appear to respond in consistent ways to things that were said to them i.e. who did not seem to have receptive language.
Of course, neither I nor anyone else could know whether their thought processes were nevertheless structured by 'inner speech' in the Vygotskian sense, although Vygotsky himself might have ruled this out since their multiple impairments and the discrimation associated with them meant they had clearly not able to participate fully in the relevant social processes by which such inner speech might have been acquired.
For me, the interesting issue here is why we should consider it so important to 'have' language Perhaps we should follow Vygotsky himself and identify feelings arising from the body as the essential raw stuff of human thought and experience?
I do realise that this wouild raise one or two obstacles to conversation analysis...
J.
----- Original Message -----
From: "Mark Rapley" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, October 16, 2007 12:41 PM
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
D
Points well taken! Forgive me for my terminological incorrectnes, however, pace David S's comments, we are trying to communicate with folks who employ terms we may not like very much, but who either may not understand ours, or may read into some of them "extreme" (hence instantly dismissible) positions.... Vis a vis point 1 I was simply trying to strengthen the point that the implicit magic bullet status for all proposed by some CBT proponents is hollow; point 2. I think I'm on record re: the social model, but strongly suspect that the news editor of the Daily Mail etc. wouldn't have a clue - hence a term that may be understood in the target audience(I'm pretty sure that "retarded" or some such would do the job better, sadly). 3. Ditto re:
no
language. Us part time conversation analysts call it recipient design ;) M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of David Fryer
Sent: Tue 16-Oct-07 10:44
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
Dear Mark / Deborah,
I think your point, Deborah, is in general VERY important and very much like your suggestion Mark (R) of "It is bad enough to be depressed because you have been unemployed, have been the victim of routine racial vilification or of homophobic harassment, or to be anxious because you are subjected to regular domestic violence..." (though I would prefer 'heterosexism' to 'homophobic harassment' as I try to avoid refs to clinical individual level pathologising concepts like 'phobia')
BUT I have several reservations about: "the effectiveness of CBT and kindred interventions in any hands is widely exaggerated and they are impossible to apply in many situations, for example with people who have intellectual impairments, people who have no language, or people who are from many non-western cultures..."
1. we surely do not want anyone to be able to read our statement as saying we are arguing for the development the capacity to deliver CBT to ethnic minority or other groups .... we do not want any groups to be subjected to CBT!
2. At Stirling critical praxis in relation to disabling practices, procedures and policies is underway. This operates from within a social justice model of disability which rejects the hangover of the medical model of disability in the form of 'impairments' and finds the notion of 'intellectual impairment'
problematic.
3. Are there any people who have no language?
I suppose this illustrates the difficulties in agreeing beyond core principles
David
because
________________________________
From: The UK Community Psychology Discussion List on behalf of Mark Rapley
Sent: Tue 16/10/2007 10:23
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
Hi Mark et al
Thanks for all the hard work that you've put into this. Love the headline!
Would it work better with a question mark?
I thought I'd offer
(1) a suggested form of words to address Deborah's important point about treatment "eligibility"
(2) ditto re: other forms of inequality/discrimination
(3) just a couple of tiny, pedantic, fine-tunes and
(4) stick my hand up to be a contact point for enquiries: contact details are in my 'signature'.
So, could Point 4 expand slightly to say something like:
the effectiveness of CBT and kindred interventions in any hands is widely exaggerated and they are impossible to apply in many situations, for example with people who have intellectual impairments, people who have no language, or people who are from many non-western cultures...
And point 6...
It is bad enough to be depressed because you have been unemployed, have been the victim of routine racial vilification or of homophobic harassment, or to be anxious because you are subjected to regular domestic violence...
Pedantry now
Point 2 may read better as '... the scale of socially caused distress is so vast, and growing so rapidly, that it is impossible...'
Point 3 may read better as '..could train enough practitioners, there is little reason to think that one to one...'
Point 7 '...those treated go back into the psychologically toxic contexts which made...'
Over to you....
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Mark Burton
Sent: Tue 16-Oct-07 08:59
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been had? Final draft. please add your name.
Here then is what I hope will be the final draft. Of course we could go on fine tuning it, but I suggest that it is now good enough to go.
It is a Word attachment.
It looks like we are going without affiliations and titles (since we don't have them for everyone)
Main changes:
1. taken out reference to clinical psychologists in point 1
2. added further names - Jan and Paul I added yours as you seemed to imply support but didn't specifically state your support - some others have commented largely positively but had significant reservations so haven't added their names - let me know if you want to come in.
3. added reference to the stepped model in point 3
4. added a paragraph on what the network is at point 9
5. I've just seen Bob's suggested points and like them. If nobody objects I think they could helpfully go in too.
Still needed:
1. Any fax nos and other suggestions for good places to send it.
2. Someone to volunteer as contact point for enquiries - this can be to route them to other people
3. Still time to add your name to the statement
4. If anyone wants to add footnotes to references - e.g. Wilkinson and evidence on treatment effectiveness, I think it could bear two or three to show that this isn't just opinion.
5. I'll post it on the www.compsy.org.uk site too once finalised.
Aboslute final deadline is now 5.30pm today
And thanks everyone for the great response - feels like the list is really working - very constructive, respectful and action oriented debate.
By the way - I hope I don't seem to be taking over - I'm responding to David's request that I finalise it with Julie (who has now sent her stylistic contribution).
Mark
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