Archive for December, 2011

It is important to be as informative (i.e. as specific) as you can.

If your diagnosis actuallty fits diagnostic criteria is there a reason to NOT call it as it is?

Sure, you wouldn’t want to be wrong.

But caution considered, wouldn’t you also want to be right?

On this day in 1904 Pavlov made his acceptance Nobel prize speech.

In his own words:

“Essentially only one thing in life interests us: our psychical constitution, the mechanism of which was and is wrapped in darkness. All human resources, art, religion, literature, philosophy and historical sciences, all of them join in bringing light in this darkness. But man has still another powerful resource: natural science with its strictly objective methods. This science, as we all know, is making huge progress every day.”

From Nobel Lectures, Physiology or Medicine 1901-1921, Elsevier Publishing Company, Amsterdam, 1967

107 years later we are still finding our way out of darkness. Pavlov’s theory remains as solid today as back then and over time came to ciment the foundation of experimental behaviorism. While no longer popular with philosophers, behaviorism remains strong in modern counseling, as seen in the evidence about the efficacy of cognitive-behavioral therapy in a variety of mind-brain conditions.

Using a CBT framework, you might think of symptoms, including Axis I symptoms or personality traits, as habits or, in pavlovian terms, conditioned reflexes. The treatment needs to extinguish undesirable behaviors, while creating “better” conditioned behaviors.

How do you do it?

Lack of practice results in extinction.

Lots of practice results in new habits.

Certainly true but easier said than done.

The essential ingredient that is missing in the above picture is will. Which the behavioralist can think of just another behavior that needs to be modified. However, how can this be done in a world that banishes behavior modification based on the preeminence of free will?

Solution: you need to find a way to convince your patient to go on your hand, i.e. abandon free will till recovery. Which is a risky proposal. Strong handed approaches or advice giving are unlikely to work. Alternatively, you need to find a way to engage, motivate, or persuade your patient about the right course of action.

In other words, if you are to be an effective behavioral therapist you need to first master the skills of motivational enhancement.

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