Try opening up your latest iPhone or Samsung mobile device. It’s near impossible.

That’s because tech giants are making phones harder to repair.

Apple insists that their iPhones are so complicated that third-party repairers can’t get it right, even if provided with manuals and tools.[1]

That’s because they don’t want you to fix a broken phone; they want you to buy a new one.

One of the reasons we fall for the trap of getting new tools and methods is because it’s much easier than to acquire new skills and deepen our thinking.

Any technique, however worthy and desirable, becomes a disease when the mind is obsessed with it. ~ Bruce Lee, martial artist (1940-1973)

“We Will Be Wrong”

If you can bear with the analogy, many of our psychotherapy models—as scientific and rigorously examined by scientific methods and clinical anecdotes—will be wrong.

The philosophy of science calls this the pessimism meta-induction bias.[2]

In gist, what we know to be true now will be wrong some years from now.

We must allow aspects of our theories to be inaccurate for some clients that you work with AND we must allow the flexibility for us to FIX IT. This can be done by updating our assumptions with a new way of thinking, based upon the result it has on our clients, as we go through the iterative process of recalibrating our first principles that guide us in our clinical practice.

What If Facts Have an Expiration Date?

Then we must first not be surprised when we are wrong. Second, we must constantly update our first principles. Third, we shouldn’t waste our time trying to inflat our confidence with certainty of our expert knowledge.

Have you wondered why parenting advice differ from one generation to the next?  

Or do you notice that meat was once good for you, then it became bad for you, then good again? (Same goes for red wine, coffee, and fat. Yes, fat is actually good for you.)

Part of it is due to what complexity scientist Samuel Arbesman calls the “half-life of facts.“

Facts change all the time. In his book, Arbesman points out the average half-life of facts in various domains (in years):

Physics = 13.7

Economics = 9.38

Math = 9.17

History = 7.13

Religion = 8.76

Now make a guess: how long does it take for half of a subject’s knowledge to be overturned in Psychology.

Psychology = 7.15 yrs.

A while ago I blogged about the topic on “What have you changed your mind?“

If we shouldn’t be surprised that we will not get some things right—and in fact expect to be wrong—we must afford ourselves “the uncomfortable luxury of changing our minds.”[3]

Polymath and internet pioneer Kevin Kelly said,  “Nothing gives me more joy than figuring out that I was wrong… to be surprised.”

~~~

In psychotherapy, besides the more obvious debunked theories, we have been wrong on the following:

1. We thought that cognitions affect emotions, when emotions can also impact our thinking;
2. We thought that exposure therapy works because of habituation, when it might be better explained by a change in beliefs;
3. We thought that EMDR worked because of the bilateral stimulation (i.e., finger movement guiding the eyes to move left and right, mimicking REM sleep; or tapping your shoulders left/right), when it could be better explained by dual-attention processing (i.e., juxtaposition of past and present, mismatch of contradictory information happening at the same time) and the structured ritual, and
4. We thought that there was something potent in the use of feedback measures to help us get better and improve, when all it does is provide us an attentional cue. While  feedback group performed better than control group[4] , the use of feedback tools do not help us get better over time. Also, we do not learn the fundamental first principles to help us generalise to other contexts.

Adhering to a Treatment Model?

When the intervention didn’t work with a client, we mustn’t immediately think, “Oh, I’m not following the protocol quite right,” or “”Maybe I missed out something that the “Master therapist” said I should do.” Instead, we must entertain that the latter could be true AND that we must a) Repair and Recalibrate our mental models and b) our thinking around the beliefs about the models that we are trying so desperately to adhere to.

I remember coming out of a treatment specific workshop that I thoroughly enjoyed, beaming with enthusiasm to apply some of the new techniques I’ve learned. Successes created confirmation and recency biases, while failures meant that I was doing the technique “wrongly”.

It was an embarrassing moment when I first picked up the method of “externalising the problem” from narrative therapy. Armed with big enthusiasm and increased confidence, my questions around externalisation were not only weak in the attends, but convoluted, confusing, and frankly, rigid. I lost my client. While I worked hard on the governing idea that “the person is not the problem, the problem is the problem,” I failed to see that the problem that I tried to “externalise” with my client, was not the key problem he wanted to work on.

(This is one of the reasons I do not recommend a therapist to seek supervision for a particular school of thought. We do not need help in developing skills in schools of therapies; we need a guide to develop and become the best versions of ourselves as therapists.)

The Deliberate Update

The point is: When we approaching learning in psychotherapy, we need to learn how to think instead of being told what to belief. We need to be the ones to readjust, recalibrate, and even repair models that we learn in psychotherapy. We can’t just sit and wait for the evidence to inform us. Too late. As we keep one eye on the existing evidence, we must keep the other eye focused on building our own evidence, through the iterative process of correction, when the null hypothesis is proven to be true.

I would even argue that at certain points of your professional development, we need to go lateral and explore knowledge outside of psychotherapy.

Don’t let anyone tell you that you need to adhere to a particular model in order to see therapeutic gains. The existing evidence holds contrary to this view.[5] Besides, I haven’t seen dogma take us very far.

Instead, our views of how we approach helping people in distress must be constantly “updated,” as often as the apps in our digital devices.

In order to update our mental models, we must continuously seek to go in the reverse direction to make clear the first principles that we can operate from. (see the previous post, Develop First Principles Before the Methods.)

Unfortunately, unlike our smart devices auto-settings, updating our mental models require active and deliberate effort.

Fortunately, we can exercise this choice. Seek to be proven wrong.

What has been your struggles when you learn a new model of therapy, or just attended a workshop? Do you face similar challenges of recency bias as I do? I’d love to hear from you in the comments below.  

Best,

Daryl

Footnotes:
[1] See the article “Time for a Smart Fix” in New Scientist Magazine, 29 July 2017.
Here’s a website that goes against the view that things cannot be fixed. www.ifixit.com. However, when we don’t understand the operating principles in-depth, we wouldn’t know what specific part that is broken.

[2] A useful article on the topic of pessimistic meta-induction brought to you by Edge, https://www.edge.org/response-detail/11135

[3] see Maria Popova’s Brainpickings: https://www.brainpickings.org/2015/10/23/nine-years-of-brain-pickings/

[4] see Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2015). Beyond measures and monitoring: Realizing the potential of feedback-informed treatment. Psychotherapy, 52(4), 449-457. doi:http://dx.doi.org/10.1037/pst0000031

[5] See this meta-analysis on Adherence: Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200-211. doi:http://dx.doi.org/10.1037/a0018912