Demon Haunted World

An accessible argument in favour of the scientific method. The book provides tools for discriminating science from pseudoscience and knowledge from speculation.

The late Carl Sagan was a strong proponent of science and the scientific method. The Demon Haunted World (subtitle: Science as a Candle in the Dark) revises a number of his magazine articles into a larger argument.

Sagan’s central thesis is that we should take nothing for granted. We should acknowledge that what we “know” is a collection of theories which have not yet been disproved, but which should continue to be tested in order that, if they fail, they can be replaced by more complete theories. There is no place for ego or privileged beliefs in Sagan’s world.

The highlight of the book is the twelfth chapter, entitled “The Fine Art of Baloney Detection”. The earlier chapters cover phenomena ranging from crop circles to demons, faith healing to alien abduction. In each case Sagan highlights the personal and cultural biases which permitted or permit these memes to thrive.

“The Fine Art of Baloney Detection” lays out a series of tools for sceptical thinking. Sagan advises us not to get overly attached to an idea, but to examine why we like it and to ask ourselves if we can find reasons for rejecting it (because if we don’t, others will: in our case, our clients!).

The chapter ends with a list of fallacies of logic and rhetoric for us to avoid. These include arguments from authority (“trust me, I’m a doctor”?) and considering only the two extremes on a continuum of intermediate possibilities (biological or psychological?).

The Demon Haunted World is an interesting read for scientist and lay person. Chapter 12 is highly recommended to both therapists, clients and anyone hoping to make sense of the “evidence base”.

Reference

Sagan C (1997) The Demon Haunted World: Science as a Candle in the Dark. Headline: London.

To see ourselves as clients see us

Therapists should be aware that clients may see them in a very different light. They should also be aware that these impressions are a matter of perspective and there may be fewer real differences than either therapist or client imagines.

Robert Burns wrote

Wad that God the giftie gie us
To see ourselves as others see us

In principle we all have such a gift (except perhaps people with autism, but that’s another discussion). In practice, this gift tends to be underused, especially in the consulting room.

Continue reading

Be ready for clients’ companions

Be prepared to deal with the companions clients may bring to therapy. Dealing gracefully and helpfully with them can’t hurt your relationship with the client.

With the obvious exception of Marital Therapy and Child & Family Therapy, models of therapy tend to assume a 1:1 interaction between a therapist and a client.

In practice, most clients are accompanied, at least to their initial interview, by a parent, partner or friend (sometimes all three). Service information leaflets often neglect to advise clients whether their companion can join them in the consulting room, creating the potential for an awkward first interaction with the therapist: “can my Mum / husband / friend come in with us?”

Continue reading

Tell clients confidentiality has limits

Therapists often assure clients that the information they provide is confidential. Confidential is defined as “intended to be kept secret”. Whether the information will be kept as secret as the client (or therapist) imagines depends upon the therapist and the service.

Confidentiality in the strictest sense implies that only the therapist will be privy to the information provided by the client. In practice this level of confidentiality is impossible to offer, as therapists have professional and legal obligations to uphold.

Most professions and services require that clients give informed consent to all assessments and treatments, which includes basic information gathering. Clients must therefore understand the limits upon the confidentiality you can offer before beginning to discuss their case. Clients who provide information which necessitates breaking confidentiality may feel betrayed by their therapist if not first advised of their therapist’s obligations.

Continue reading

Improve rapport by allowing silences

Clients’ perceptions of rapport may be enhanced by silences. Therapists who are uncomfortable with silence should remind themselves that their client’s interpretation of the silence may be much more positive.

A client once asked me not to delay speaking once he finished a comment. He explained that his school report was always sent home in a sealed envelope. He would be forced to stand in silence while his father read the letter, not knowing whether the report was favourable or how his father would react. Three decades later, he experienced the same anxiety during silences in therapy. Agreeing that he was no longer a school child and that a considered response from me was likely to be better than a hasty response helped him overcome his anxiety about my silence.

Therapists may also be uncomfortable with silence in therapy. Time or results conscious therapists may feel that silence is not the best use of the limited time available in a session and may seek to pack as much into the discussion as possible. Other therapists may wonder whether silence means that their question or comment has confused, distressed or even offended the client. Rather than endure the silence, they may rephrase their question or seek to clarify or qualify their comment. Further silence may lead to further rephrasing.

Continue reading

Beware of unofficial diagnoses & double meanings

Some terms used by therapists to describe clients have meanings which won’t be found in textbooks. Use of these terms is rarely of benefit to the client, although the term may say as much about the therapist as the client.

  • resistant to treatment
  • lacking motivation
  • poor historian
  • manipulative
  • demanding
  • somatising
  • chaotic
  • personality disordered

As diagnostic systems have developed, common place words have been redefined more narrowly & precisely for clinical use (eg: anxiety, depression).

As therapeutic professions have developed, there has been a less auspicious development: diagnostic labels have developed double meanings and common place words have been elevated to the level of diagnoses without the scientific scrutiny afforded official classifications.

Continue reading

Know your client’s strengths

If you don’t know your client’s strengths, how can you capitalise upon them? Client factors account for 40% of the variance in outcomes and a wise therapist will play to their client’s strengths.

Clients are often defined solely in terms of their difficulties. “I’m seeing my obsessional woman this afternoon.” “When that guy with MS turns up, tell him I’m running late.” “Can someone attend to the broken leg in cubicle three?”

Modern medicine has come to be construed as an interaction between a physician and a disease rather than between a physician and an ill person striving to get well. (Scovern, 1999)

Continue reading

Rules of thumb are dumb

Some rules of thumb are derived from experience, accurate or otherwise, (eg: the praecox effect) and some from hard research (eg: people with memory problems don’t admit to them), but all have a common flaw: even if true, they are both generalisations across a population and specific to the circumstances of their origin.

In an undergraduate lecture over twenty years ago, a senior Clinical Psychologist described the “praecox effect” (as in dementia praecox, or schizophrenia):

if, after having spoken to someone for half an hour, you have no idea what they’re on about, they’re schizophrenic

To an undergraduate struggling to cope with the complexities of psychology, psychiatry and mental health, any simple rule was welcome. Reading the literature on the high rate of psychotic diagnoses in immigrant populations, it didn’t take me too long to see the problems with this rule of thumb.

Continue reading

Psychiatric Drugs Explained

A guide to psychotropic medication for therapists and their clients. This book lays out the pros & cons of mind-altering prescription drugs from a critical but balanced perspective.

Books considering psychotropic drugs tend to one of two extremes: either uncritical accounts of their effectiveness and the presumed biophysiology underpinning their action or highly critical “anti-psychiatry” polemics which damn the entire concept.

Psychiatric Drugs Explained, now in its third edition, manages to occupy the middle ground. Explicit details are given of the desired action of commonly used psychotropic drugs (with both UK and US names), but equal attention is given to their side effects and alternatives to their use (eg: in the management of sleep disorders).

Continue reading

My client is crying

Trainees (and clients) need to know that crying is common in therapy. Experienced therapists need to remember that crying may be common in therapy, but that crying in front of a stranger is probably a rare experience for any given client: you may now be relaxed about the situation, but they aren’t!

Every trainee dreads this moment: your client is crying. You probably are unaccustomed to strangers crying in your presence. The fear is that their distress is your fault, that you weren’t sufficiently sensitive or supportive: now you have to manage the situation you’ve “caused”.

More experienced therapists will have seen literally hundreds of clients cry. You know that people in therapy will cry for a variety of reasons, usually unrelated to the therapist. Knowing how common crying is, you’ve evolved your own set of responses. You’ve probably forgotten how awkward you used to feel…and how awkward the client still feels.

Continue reading