Not meant to offend

Dear Jeff,
I am sorry that you have taken my remarks personally. They were not intended as such, nor were they intended to be snide. I fear that you are reading more into my very brief post than was there.

Now that you have opened up on this, I feel obliged to respond. Most teachers, myself and yourself included, dine out out on our work. With Jim having addressed the other issues vis a vis Linda's posting, I was simply continuing to express an oft voiced concern regarding the need to be cautious about schema-based approaches. In retrospect, I realise that reference to schema approaches could be taken as implying you personally. That was not my intention, and I apologise that I have personally upset you.

I felt that it would be disrespectful to Linda not to make some reply, although Jim P had already dealt with most of what I would say. I therefore made the (for me) remaining points, to do with the long overdue empirical validation of such approaches, and the need to consider alternatives alongside.

Independent of any "ad hominem" issues, there are some important points which I stand firmly by. Some years ago, you and I "dined out" together in Oxford and we discussed many of them, so some will be familiar.

I remain doubtful of the utility of the term "personality disorder", and think that use of schema concepts may be helpful here. Yourself, Tim and Judy Beck and Christine Padesky to name but a very few have continued to develop schema notions which are potentially much more useful (and, incidentally) respectful of the people we try to help.

My comments about validation apply not only to schema-focussed therapy, but all such approaches. I know of few, yourself included, who would disagree with the need for validation. I personally am not happy that the validation is so long in coming. In the meantime, there have been a number of studies of much shorter term therapy approaches which call into question (call into question meaning just what it says) the need for very long term therapy. Kate Davidon's work is the obvious example of this, and the work on brief problem solving in repeat suicide attempters. We can and do critique psychoanalysis for taking about a century to get around to thinking about doing decent outcome research. We therefore should be equally self critical of the fact that it has taken us a fifth of a century to validate schema approaches.

You ask what therapists are to do. Again, I'm sure we agree that what we do is our very best. However, we need to also (i) systematically measure whether that person is benefitting from what we are offering and (ii) seek to evaluate overall outcomes. The technology is there within the scientist practitioner framework rather than the rather sad parody that Evidence Based Mental Health approaches have become (see article by myself in January issue of Cognitive and Behavioural Psychotherapy, titled
"Empirically Grounded Clinical Interventions: Cognitive-behavioural therapy progresses through a multi-dimensional approach to clinical science".

Norma Morrison recently published an excellent single case design type in Behavioural and Cognitive Psychotherapy, which was what sparked Ian James' article. It is possible to do this most basic of research without vast resources (other than vast mental resources!!!).

You are right, of course, about the diagnostic system issue, which is why your questionnaire and tim and judy's one are helpful developments. We also need good studies of psychopathology, the kind of thing which Mark Williams has done and the sort of thing we are seeing in problem solving work and so on.

I am aware of Arnoud Arntz's work. We were lucky enough to have him come to our centre (we being the Maudsley Hospital/Insitute of Psychiatry Centre for Anxiety Disorders and Trauma), so know about the work going on. You are probably also aware of his group's work empirically challenging the idea that comorbid personality disorders results in poorer clinical outcomes for anxiety disorders. As you will know, they found that this was not so. Until some more data is in (and it is very, very overdue) then we should be very very cautious about the efficacy and effectiveness of treatments we offer, whether they are schema focussed, psychoanalytic or CT for anxiety.

Jeff, please go back to the original post and think again about whether this was an attack on you personally. It was not meant to be. I'm sure that you know that am perfectly capable of making such an attack if I felt it justified, and not shy about doing so. I apologise that I posted something sufficiently ambiguous to mean that you could interpret it as personally attacking. If I wanted to personally attack you I would, but I don't if you see what I mean!! ;-)

Replies:

Re:Not meant to offend, by Jeff's Patient, 01/07/02 Please note that this is a forum for discussion by professionals, by Jim Pretzer, 01/08/02 Re:Please note that this is a forum for discussion by professionals, by Jeff's Patient, 01/09/02 Re: Re: Please note that this is a forum for discussion by professionals, by Jim Pretzer, 01/09/02 Re:a question, by Linda Nauth, 01/09/02

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