Ace Psychotherapist Jim Davis on 'Research.'

Naughty-but-NICE: Research and cream cake.

Let me admit from the outset that I can be a suspicious person at times, and no more so when something is agreed by everybody as being thoroughly good! A bit like the ‘man in the crowd’ (see last issue’s Alterego column) I find myself taking exception.  Call me rebellious or simply curious, but certainly suspicious.  An example of this that’s been bothering me for some time is research.  The two most common sentiments I hear about research into psychotherapy is that it’s good and that it’s boring – unlike cream cake.  In fact research and cream cake seem the very opposite of each other - one moral but dull, the other immoral but enjoyable.  The cream cake however is definitely not good for us, whilst research apparently is.  But is it, and if so how?

Only 15% of factors responsible for change in therapy are about the therapeutic modality, and most therapies are roughly equivalent in effectiveness.  Why then is so much interest shown in research aimed at establishing the efficacy of any particular modality?  I’ve certainly never read any research project which concluded that the approach studied wasn’t effective.  There is of course a political and economic value of such research in terms of approval by the eponymous Mr. NICE.  His blessing might lead to the enhanced status of TA, with all the implications for the financial benefits to TA therapists and trainers.  But perhaps Mr. NICE is, like the cream cake, more naughty-and-NICE.  After all he’s wedded to that glamorous medical model Mrs. NICE and her modernist views on the causes and effects of objective truth.  Together they live off the outcome measured offspring born from randomized control trials.  Nice they are not!

Surely it’s impossible to design randomized control trial research studies that convince Mr and Mrs NICE that TA cures depression, for example, when there are several different schools of TA using significantly different theories and methods.  Even amongst TA therapists who belong to the same school of TA there will inevitably be significant variations in the therapeutic relationship, and thus the therapy itself.  In this sense TA is very different from Mr. NICE’s anointed ones - anti-depressant ‘therapy’, and the more regularized methods of CBT, EMDR, or mindfulness.  With these modalities clients do get the same treatment, a manual-ised conformity amongst practitioners (seen as a good thing!) and thus amenable to the trials (but also tribulations) of randomized control.

Do we really want to get into bed with Mr. (or Mrs.) NICE, and if so at what cost?  Is this where we want to invest our research energy?  Will we even be successful, or will it simply lead us up to a dark corner of a double-blind alley down a dead-end road?  More importantly, does it divert us from more valuable purposes of research?

For me there are two fundamental values of research, neither of which involve ‘proving’ the truth of the efficacy of particular modalities.  The first is the advancement of our understanding of psychological problems and how psychotherapy ‘works’.  There is a burgeoning development of qualitative research methods for pursuing this agenda that are gaining validity within the research community – methods that embrace relational principles of engagement (eg participant observation),  the importance of experience (of both client and researcher) and the inevitability of uncertainty (eg regarding ‘truth’).  This is the research I find more palatable, even if it’s not the NICE’s cream cake of choice, not their cup of tea.

This leads me back to the ‘research is good but dull’ point from earlier.  My second fundamental value of research is how it contributes too and enriches the process of informed discussion, intrigue and controversy within our therapeutic community regarding the development of theory and practice.  A paradigmatic example of this is the research of Daniel Stern which prompted a rich, wide-ranging and contentious discussion around key issues of child development and the implications for adult psychotherapy.  His critique of Margaret Mahler’s ideas was significant not because it established a ‘truth’ – in contrast to Mahler’s ‘errors’ – but rather because of the very rich discussion it fostered.  Stern’s ideas subsequently became the focus of further challenge and criticism in an ongoing turn of the epistemological wheel.  This is why the foundation stone of any good research project is the review of the literature, the main purpose of which is to locate the project within ongoing debates about the subject matter, to identify a problem, lacuna or interesting question remaining unaddressed etc.  In this way research is founded on what is of interest, controversial even, and thus much more likely to make research enjoyable - not NICE but simply nice!

And now back to enjoying my cream cake and reading both Kieran Nolan’s (PTSTA) fascinating Ph.D research dissertation on OCD, and Cathy McQuaid’s (TSTA) illuminating research based book on psychotherapy training.

FIRST GUEST POST BY THE AMAZING JIM DAVIS-SELECTIONS FROM HIS WRITINGS FOR THE JOURNAL OF TRANSACTIONAL ANALYSIS

Hair loss: a case study of mourning and melancholia in the countertransference.

Committed as I am to the significance of the body and countertransference in my work as a transactional analyst, I simply cannot avoid the painful subject of hair loss!   My column today constitutes a soul-searching examination and, hopefully, a working through of my issues around hair loss in the service of my more hirsute male clients, especially those sporting their newly fashionable beards.

Notice how, from the start, I use the anodyne term ‘hair loss’ rather than the darker, more shameful ‘balding’ or even the terminal ‘bald’.  There I’ve said it, Worden’s first task of mourning, ie acknowledging the reality of the loss!  The trouble with models involving stages however is that  treading on the first step  immediately raises fears of the following and worse, final steps – ultimately (qua Worden) presumably a wig!

Anyway, we talk about ‘losing’ our hair, but we don’t simply misplace it, like our keys, or as in ‘bloody hell it was there a moment ago’, or even ‘well it was on the top of my head when I went to bed last night’!  We don’t actually lose our hair, it simply stops growing.  Perversely it only stops growing on the tops of our heads – where we want it to be – and grows more in places we don’t want such as our ears and noses, like some sick weird proof that either god doesn’t exist, or is a woman!

And then there’s the I’m OK, you’re not OK discrimination against those of us ‘losing’ our hair, like the plethora of hair ‘care’ products for people with lots of hair – shampoos and conditioners giving it more body and shine so they can shake their lustrous locks, constantly sweeping it back from over their faces in faux annoyance – ‘cos they’re worth it!  No such ‘care’ for balding people, presumably ‘cos we’re not worth it!

Hairy heads and smooth heads - hairy people and smooth people.  If you think about it hairy people are more like our evolutionary ancestors, for example the apes and gorillas, who had hair all over their bodies.  We’ve all seen those depictions of evolutionary development, you know the ones where the figures gradually change from hairy creatures on all fours to hairy things gradually standing up, and onto the upright and smoother homo sapiens.  We’ve advanced in becoming smoother and less hairy.   I rest my case….or maybe not quite yet …..

As a contribution to this ongoing evolutionary progress I propose a raft of new policies for the next government to consider:

·       the more hair you have the more tax you pay

·       hair-free zones and banning of hairy people in public places - as with smoking

·       dedicated parking spaces for the sole use of bald people

·       enhanced evolutionary-friendly child benefits for families with balding fathers

·       creation of an Axis 2 DSM diagnosis – EHD (Excessive Hair Disorder)

·       establishment of special centres where hairies can get free hair removal, therapy and re-education classes about who’s worth it and who isn’t. 

However, persistent hairy ‘extremists’ would be banned from owning cars, bycicles and belts so they’d have to run for buses and fall over and everyone would laugh at them. (Let’s face it, I might as well give full reign to my envious Child ego state here).   By that time the  queen will have passed on, William will be king and called His Royal Hairless-ness, and a whole new generation of bald therapists will be trained up to work with Excessive Hair Disorder.  I will have worked through my countertransference, and the world will be a better place.

Alterego

Ignore history at the World's peril!

I think it was Winston Churchill who said the best argument against democracy was a five minute conversation with an average voter.  I guess he was referring to-stupidity or lack of imagination, maybe they're the same thing?

A recent episode on 15th January of BBC's 'Question Time' left me with a very similar feeling.  And also left me with the sour taste that I get often these days when watching television-that I am in fact watching a form of blatant propaganda.  That I am being sold an idea without foundation that is accepted as fact uncritically and is then foisted upon me by particularised use of language comprising linguistic signifiers that purport to be established world views.  These signifiers refer to 'the terrorists,' 'the insurgents', 'jihadists', or to the 'economy'  and to 'economic data' as if it refers to something concretised and actual whereas in fact it refers to wholly imaginary concepts devised at several levels removed for inclusion in a script.
The panel comprised:
Anna Soubry MP, Douglas Alexander MP, Baroness Brinton, Mehdi Hasan and David Starkey, chaired as ever by the wonderful David Dimblebly.
The question was to do with the murder of the journalists at Charlie Hebdo in Paris and what startled me was the almost incredible absence of the historical narrative that led us to these present conditions.

the is the real timeline:

• the Russian Invasion of Afghanistan
• The arming and support, by western powers, of the Mujahideen
• The invasion of Iraq 1
• The attempted capture in Somalia of General Aideed
• The invasion of Iraq 2 Desert Storm
• The continuing existence, illegally, of Guantanamo Bay
• The invasion of Afghanistan by the Americans and their alllies primarily UK.
• Abu Graib Prison and the sexual humiliation of young muslims by American guards some of whom were female
• The Bush Cabinet's legitimisation of torture and illegal rendition of 'suspects' with British security services cooperation.
• The ongoing American support for the illegal occupation and settlement of Palestinian Land by the State of Israel
• Assassinations by drone

Do we not understand that, by any marker of morality or acceptable diplomacy the American and UK governments have themselves behaved as terrorists?  That is, specifically creating fear and terror in the hearts and minds of entire populations.  But without the narrative of history we have no explanation for the madness that besieges us.

THE EVERY DAY CARRY (EDC)

THIS IS WHAT I CARRY ON A WORK DAY!

LIFEVENTURE THERMOS CUP/LEATHERMAN CHARGE MULTITOOL/TACTILE TURN PEN IN TEAL FINISH/IPHONE 5/RHODIA WEB NOTEBOOK WITH QUIVER PEN HOLDER/DOANE PAPER GRID+LINES NOTEBOOK/L10C LED TORCH/BOSE NOISE ISOLATING EARBUDS/MOLESKINE A5 NOTEBOOK/SPECTACLES CASE/TEETH FLOSSER/ASSORTMENT OF PENS IN PLASTIC WALLET

THIS IS WHAT I CARRY IT ALL IN:  AN OSPREY VIPER 13 LTR

New writers on 'The Art of Balance' blog!

Getting people to do stuff is really hard.  Particularly if they are really talented clever people and you're not offering them any money.  But I have managed to bag two really, really clever people who will be posting on this blog hopefully on a regular basis.
Our first post will be from Jim Davis, my beloved bro and friend.  I cannot begin to overstate how privileged I feel about Jim writing for this blog.  He is one of the most skilled psychotherapists in the field of relationship counselling.  He is probably one of the UK's best Backgammon players who only missed winning the British championship some years ago because I was mithering him about getting me to my train on time while he was playing the freaking final.  Yes that's the kind of guy I am!

My other contributor is Alan Moore, no, not the Northamptonshire comics wizard but a writer from Blackpool who writes with passion and grit like a modern Jonathan Swift with little time for the old Etonians screwing the country right now and their Bankster friends.

I truly hope you enjoy their contributions in the similar way that Lois Mansfield's brilliant post became one of the most popular on this blog.  Whatever happened to Lois?  Maybe I need to get her back here.  She's a lot prettier than Jim and Alan as well.  But what they have in common is they are all very smart and incredibly gifted writers.  Thanks for being here.