Christopher J. Combs, Ph.D.

Monday, March 29th

The New School


There is a new movement among some philosophers to provide counseling, according to last week's New York Times. "A controversial new talk therapy, philosophical counseling takes the premise that many of our problems stem from uncertainties about the meaning of life and from faulty logic." Evidently, those espousing and practicing from this new model do not have any formal mental health training, although if you were converted by the Dawes chapter, you may not be so concerned about this, seeing as a formal degree or experience hasn't been shown to correlate with clinical outcome.

Christopher J. Combs, Ph.D. on 03.29.04 @ 06:43 AM EST [link] [3 Comments]


Wednesday, March 24th

Randomization


A summary of an article from JAMA (the Journal of the American Medical Association) that indicates many people have difficulty understanding the concept of randomization when agreeing to participate in a clinical trial.

In this case, parents were recruited to enroll their children in a clinical trial for the treatment of leukemia. Even though 83% of doctors explained the idea of randomization in providing informed consent, as determined by audiotaping the conversations, about half of the parents who were interviewed right afterward did not understand the concept. Disadvantaged groups were particularly susceptible to an inadequate understanding.

As we discussed in class, part of the problem may be in the language used by doctors and researchers. It's difficult for them to remember and then consciously modify their language to the level of the patient's abilities. I'm sure many, if not most, patients are unwilling to interrupt or question doctors when they don't understand, out of respect or just not wanting to appear stupid. Another factor, I'm sure, is that most people want to hear they are being tested with a new, more powerful treatment, and they are hoping for a magical cure. As a result, it's hard for them to hear and internalize the idea they could be assigned to the no-treatment or standard treatment control group.

Christopher J. Combs, Ph.D. on 03.24.04 @ 06:36 AM EST [link] [No Comments]


Tuesday, March 23rd

The Other Est


Information about charasmatic Werner Erhard and est from both sympathetic and critical sources.

Christopher J. Combs, Ph.D. on 03.23.04 @ 06:57 AM EST [link] [No Comments]


Seizing the Moment


With yesterday's announcement by the FDA warning doctors to monitor their patients on SSRI anti-depressant medications for suicidality, it would seem like the perfect time for the American Psychological Association to step forward and promote psychotherapeutic methods of treating depression and other disorders.

Except I guess you can't do that convincingly if your official position is to advocate for prescription privileges.


Christopher J. Combs, Ph.D. on 03.23.04 @ 06:49 AM EST [link] [No Comments]


Monday, March 22nd

Fall From Grace


Remember the surgeon who left his patient in the middle of an operation to cash his paycheck? Here is his fascinating but tragic story, which also explores how personality traits can be double-edged swords: adaptive under some circumstances, but harmful under others.

Warning: it's a long and detailed account. But it's worth reading from so many perspectives.

Christopher J. Combs, Ph.D. on 03.22.04 @ 01:46 PM EST [link]


Friday, March 12th

EST's Hit Squad


The empirically-supported treatment debate in psychology makes the New York Times this week:

"They have been called assassins and parasites. They receive hate mail from the proponents of a variety of popular psychotherapies. The president-elect of the American Psychological Association has accused them of being overly devoted to the scientific method.

"But the ire of their colleagues has not prevented a small, loosely organized band of academic psychologists from rooting out and publicly debunking mental health practices that they view as faddish, unproved or in some cases potentially harmful."

By the way, these are the same psychologists who have called for a moratorium on the Rorschach, even suggesting its use is unethical.


Christopher J. Combs, Ph.D. on 03.12.04 @ 08:32 PM EST [link]


Tuesday, March 9th

A Modest Proposal


The Pope et. al. article cites the most frequently referenced statistics regarding therapist-client sexual intimacies: approximately 10% for male therapists with female clients, and about 2% or less of female therapists with male clients. Other surveys have been consistent with this one, including more recent ones (I chose this particular article because it was typical of the group but also so well-written). Some recent authors have offered numbers supporting the notion that the frequency of therapist-client sex has decreased, perhaps as the result of the publication of these surveys and the publicity from some high-profile cases. However, this remains controversial - other studies remain consistent with Pope et. al.'s. And we're presuming that anonymous surveys yield a true picture of the problem. It's quite possible the figures are actually higher, because some offenders may not believe the survey is truly anonymous and therefore not report the offense.

Should therapists who are found, by a proponderance of the evidence, to have had sexual intimacies with a client be required to register as sex offenders? After all, they are preying or exploiting a segment of society that is considered vulnerable and unable to consent. Do we need a national database of these therapists, or a website that notifies the public of their names?

Christopher J. Combs, Ph.D. on 03.09.04 @ 08:20 PM EST [link]


Another Investigative Report?


Another surprising auction item on eBay. I would try to describe it, but I don't think I can do justice to it.

Josh, want to take a crack a finding out whether she's a real, doctoral-level, degreed psychologist?

Christopher J. Combs, Ph.D. on 03.09.04 @ 08:02 PM EST [link]


Friday, March 5th

Online Counseling Auction


Comprehensive infertility management, with a starting bid of only $50.00.

Be sure to check out the list of services offered. Can these be offered competently via email?

At least this person's taut writing, fine grammar, and flawless spelling inspire confidence.

Christopher J. Combs, Ph.D. on 03.05.04 @ 08:44 PM EST [link]


Monday, March 1st

Assisting Physician-Assisted Suicide


I was reading an interesting article over the weekend in one of the psychiatric trade papers, the Psychiatric Times. The premise of the article, titled The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care, is that the more physicians are skilled and knowledgeable in palliative care and pain control, the less likely they are to endorse euthanasia and physician-assisted suicide.

The article captured my interest as a social and public policy issue, but I didn't think it would be relevant to psychologists, as it is medical doctors who would be supplying or adminstering medication that would bring on death. But toward the end of the article, this case example was presented:

"Lucas, an Oregon patient with amyotrophic lateral sclerosis, attempted suicide. Paramedics were called to her house, but her children sent them away, explaining, 'We couldn't let her go to the ambulance. They would have resuscitated her.'

"Lucas survived her attempt and was assisted in suicide 18 days later by a physician who gave interviews about the case to an Oregon newspaper on condition of anonymity. He stated that after talking with attorneys and agreeing to help aid Lucas in her death, he asked her to undergo a psychological examination. 'It was an option for us to get a psychological or psychiatric evaluation,' he told the newspaper. 'I elected to get a psychological evaluation because I wished to cover my ass. I didn't want there to be any problems.'

"The doctor and the family found a cooperative psychologist who asked Lucas to take the Minnesota Multiphasic Personality Inventory (MMPI). Because it was difficult for Joan to travel to the psychologist's office, her children read the true-false questions to her at home. The family found the questions funny, and Joan's daughter described the family as 'cracking up over them.' Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness--a completely normal response. His opinion is suspect, the more so because while he was willing to give an opinion that would facilitate ending Joan's life, he did not feel it was necessary to see her first."

Regardless of your position on this issue, I think you have to be shocked at how this situation unfolded. Anyone care to count the number of ethical violations?

The article is worth reading in its entirety. The author obviously has a position on the issue, but the information on how assisted suicide is handled in the Netherlands and Oregon are definitely useful to know.

Christopher J. Combs, Ph.D. on 03.01.04 @ 07:31 PM EST [link]




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