Confirmation Bias Works Both Ways

• The Case of Gary II: Things become more complex. by Jim Pretzer, 9/11/97
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    • Scientist practitioners and formulation by Paul Salkovskis, 9/18/97
      
      

The true enemy of the patient isn't necessarily a Personality Disorder diagnosis. Dr. Marsha Linehan would certainly disagree with the idea of a "hopeless borderline" as much as she would disagree with the idea of the nonexistence of personality disorders. One of the reasons her DBT treatment has been proven to be effective is because it doesn't invalidate the patient. What we're really talking about is the idea of being biased towards our patients because they've been labeled (the very point you make). Just because there are clinicians out there with a hurtful bias against patients exhibiting personality disorder behavior does not mean that all clinicians are likewise biased. That belief would itself be a bias. Similarly, just because the world is filled with poor therapists does not mean that Personality Disorders don't exist. I am frightened at the number of inpatient admissions(nonprison) I've seen which come in after working with "pleasant & caring" therapists who have no training in dealing with their dangerous, chronically suicidal or parasuicidal, personality disorder. As Jim might say, they have no apriori hypothesis (formulation) to test - probably because of their lack of training as Scientist Practitioners. I am the Director of Psychology at a 550 bed inpatient, maximum security psychiatric prison hospital. We have seriously ill Borderline Personality Disordered inmate/patients. Their behaviors elicit negative bias by some. Their diagnosis leads to bias by others. There are also, however, many on their treatment teams who treat them without judgement or negative bias and have taught them how to better tolerate the distress of prison without swallowing razors or cutting. The most important thing a clinician can learn is that he/she will be wrong about many of their hypotheses - and that's ok. It is better than filtering all stimuli through one set of confirmation biases.

• In support of Dr. Giles by Sisyphus, 9/19/97