Letters, October 2008

Evolving theories, explaining facts

Sarah James takes exception to an item concerning a new chimpanzee enclosure at Edinburgh Zoo (News, July 2008). She says she is 'saddened and shocked at the writer's presentation of theory as fact' towards the end of the article (Letters, September 2008). This seems a bit over the top given the measured terms actually used in the original piece (i.e. 'evidence suggests' and 'remains unclear'). We can also see no basis for the assertion that the author was making irrefutable suppositions.

James goes on to question whether the human race hasa primate lineage and asks for evidence. One of the great figures in evolutionary theory, Ernst Mayr, notes that evidence supporting the descent of man from primates is 'simply too overwhelming' and based on three kinds of facts (Mayr, 2002). First, humans share all anatomical structures with the African apes, 'right down to minor details'. Second, fossils dating to five million years ago document the intermediate stages leading to modern chimps and humans. Third, although no hominid fossils have been found dating before five million years ago, the study of protein and DNA differences shows that the African apes are more closely related to Homo sapiens than to any other kinds of primate. Human proteins are closest to those of chimps. In fact, chimps are closer to humans than to monkeys.

The Homo lineage appears to have evolved from the mostly arboreal Australopithecus lineage. Australopithecus and chimpanzees are thought to have diverged from a common ancestor between six and eight million years ago. African apes and Asian apes diverged between15 and 23 million years ago.

In On the Origin of Species Darwin showed that evolution occurred through the mechanism of variation and natural selection. This basic account has been updated since the gene was identified as the unit of selection, and this modern synthesis is known as 'neo-Darwinism'. It is sad that many people still seem to have little or no understanding of this theory, or of how strong the evidence is. However, Richard Dawkins has recently described the inadequate coverage of evolution in schools as 'a scandal', so it is perhaps not surprising when people show little understanding of it.

Darwin himself was aware of the importance of evolution to human psychology, as indicated at the end of On the Origin of Species, in The Descent of Man and in The Expression of the Emotions in Man and Animals. By contrast, the BPS criteria for course accreditation show little recognition of the importance of evolution in psychology. As two notable anniversaries approach in 2009 – 200 years since Darwin's birth and 150 years since On the Origin of Species was published – we wonder what the BPS will be doing to celebrate and to bring the psychology curriculum up to date?

David Hardman
London Metropolitan University
Tom Dickins
University of East London
Mark Sergeant
Nottingham Trent University

 

Pitfalls of interpretation

In response to Jacob Empson's letter, 'Pitfalls of secondary sources' (September 2008) which was published as a response to 'Costs and benefits' (my media page discussion of Raj Persaud's plagiarism case published August 2008), I would like to raise several concerns.

Empson's response, which it should be noted is his own interpretation of the article I wrote, ironically reinforces the argument I made about intertextuality and the dialogic nature of academic work through providing a (mis)interpretation of my arguments and restating them publicly. His comment that 'Ceri Parsons of the Society's Press Committee believes it is acceptable to copy out other people's descriptions of "famous experiments" because of…intertextuality' looks very different from the point I made that 'there are classic studies such as Milgram's...that get recycled and referred to so often that it raises the question of whether it is possible to say that an academic "owns" a particular description of them...and the practice of using some "stolen words" in media contributions could in some contexts be argued to be an example of intertextuality' (emphasis added). It seems that Empson has fallen into the very trap he describes, 'quoting erroneous accounts…without realising it'. What I find most worrying however is the fact that a qualified psychologist would infer motivation from and make the claim that their own interpretation of the ideas represented in 'Costs and benefits' are Ceri Parsons' own personal beliefs, which also demonstrates a clear failure to grasp the overall message about authorship of ideas.

As an academic I am continually critical of plagiarism, publicising the issues and consequences to students on a regular basis, and I would not wish anyone to believe that I have a cavalier attitude to my professional responsibilities. At the same time I also recognise that in certain contexts, and in particular in promoting psychology publicly, issues such as plagiarism are not always clear-cut. My overall interpretation of Empson's letter is that is failed to provide a valid criticism.
Ceri Parsons
Staffordshire University

IAPT – an apt approach?

lark and Turpin provide an upbeat account of the 'rewarding and exciting' opportunities promised in the Improving Access to Psychological Therapies (IAPT) initiatives ('Improving opportunities', August 2008). The discerning reader may notice some disquieting implication. A new NHS profession of psychological therapist is being established, under the auspices of an organisation called the British Association of Behavioural and Cognitive Psychotherapy (BABCP), that essentially sidesteps and eclipses the existing BPS professions of both clinical and counselling psychology.

Whether or not this is intended by the IAPT Department of Health team, in NHS services around the country, where the IAPT programmes are being implemented, we are finding that experienced clinical and counselling psychologists are being told they are not qualified to provide treatment or supervision because they are not accredited by BABCP. In some cases it is suggested they undertake rather basic additional university courses in CBT. Indeed the BABCP proudly states on its website that it is 'the only government-approved organisation that accredits CBT therapists'. At the same time, individuals with BABCP accreditation, and their associated private organisations, potentially benefit financially by offering training and supervision in CBT, and by being employed on these new university courses. Recently the Society's Division of Clinical Psychology resorted to issuing, rather belatedly, a notice for NHS commissioners pointing out that clinical psychologists too can undertake CBT and do not normally seek accreditation by the BABCP.

How has it come about that CBT and one particular interest group called BABCP have been given such elevated authority and influence in relation to government policies on the provision of psychological therapies? There are, after all, a variety of other important psychotherapy organisations, including the British Association for Counselling and Psychotherapy and the United Kingdom Council for Psychotherapy, to name just two. Whilst not wishing to impugn the integrity of David Clark, is it entirely irrelevant that he is a committed CBT practitioner and closely involved with BABCP (a past chair of that organisation) and is also Clinical Adviser to the Department of Health for IAPT?

If a medical doctor, linked to a particular pharmaceutical company, were to be appointed as adviser to the government regarding prescribing policies, or were to write an article espousing the benefits of a new drug, it would be expected that potential conflicts of interest be made clear.

Whilst it is commonly asserted that the privileging of CBT is simply a reflection of scientific evidence, the reality is actually a good deal more ambiguous. One of the most consistent findings of psychotherapy research is the equivalent effectiveness of different modalities, along with the related observation that there is more variance in outcome between therapists than between therapies. At the recent international conference for person-centred and experiential psychotherapies, Professor Mick Cooper presented a review of over 80 studies demonstrating that other therapies are as effective as CBT and concluded that the IAPT emphasis upon CBT is 'scientifically irresponsible' and harmful to the public by restricting choice. He and three other professors of psychology issued a joint statement regarding the logical errors in the prevailing interpretation of the evidence (see tinyurl.com/66fp85).

For decades, psychologists and psychotherapists espousing various modalities have coexisted, debating, disagreeing, exploring, and, increasingly, finding common ground. There is now a vital new factor distorting scientific and clinical inquiry. Money and resources are at stake. The scientific data used in arguments regarding the distribution of hese resources are open to a variety of interpretations. Researchers and clinicians of equivalent eminence and expertise arrive at different perceptions of the available evidence – yet CBT is promoted in the official discourse as if it were the only viable form of therapy. As Professors Cooper, Stiles, Elliot and Bohart have stated: 'The government, the public, and even many health officials have been sold a version of the scientific evidence that is not based in fact.' It is not acceptable that psychologists have colluded, or even actively fostered, this mis-truth. After all, if a psychologist presents evidence in court as an expert witness, he or she is expected to draw attention to the existence of a range of opinion on controversial topics; to do otherwise would be considered a breach of ethics.
Phil Mollon
Head of Adult Psychology and Psychotherapy Services
Lister Hospital,
Stevenage

In Response

Mollon seems to imply that the Improving Access to Psychological Therapies programme is solely a vehicle for the promotion of cognitive behaviour therapy and its host organisation, the British Association of Behavioural Psychotherapy (BABCP). By doing so, he implicitly challenges the role of the Society and the Division of Clinical Psychology in particular, in relation to IAPT. In reply, we would like to clarify some common misunderstandings.

To be specific, it was stated in our 'Careers' piece that the Society is developing accreditation procedures for its postgraduate training courses, which will detail the specific therapeutic competences, including CBT that trainees have mastered during their training. In addition, the committee responsible for the Society's Register for Psychologists Specialising in Psychotherapy has established a working party to introduce new procedures to allow psychologists recognition of specific therapeutic competences. Before we can consider challenging the position of BABCP in accrediting CBT competences, if that is what Phil Mollon wishes the Society to do, we have to offer an alternative or complementary process.

It also appears somewhat ironic that 'an upbeat' account of the role of applied psychologists in the delivery of IAPT services, should be counterpoised by the complaint that commissioners are not recognising the value of what psychologists have to offer. Come on, Phil, you can't have it both ways!

Although IAPT's emphasis has been on implementing CBT due to a relative shortage of competent CBT practitioners, discussions are taking place under the auspices of the New Savoy Partnership (www.newsavoypartnership.org) and the New Ways of Working for Psychological Therapists project (see www.newwaysofworking.org.uk) about how future commissioning of services  and education can be broadened to include other evidence-based therapies recommended within the NICE guidelines. The Society is a signatory to this collective of psychotherapy and mental health organisations (including UKCP and BACP) and will be supporting its forthcoming conference in November.

It is important to realise that the IAPT programme aims to implement current NICE guidelines for the treatment of depression and anxiety disorders. The committees that generated these guidelines included strong representation from members of the British Psychological Society as well as other professions. Contrary to Professor Mick Cooper and colleagues recent conference paper and press release, NICE did not conclude that all available psychological therapies have demonstrated effectiveness in depression and anxiety disorders. Instead it concluded that a subset of therapies, which are listed in our piece, currently have sufficient empirical support to justify their recommendation. Future research will no doubt further clarify the effectiveness of other existing therapies and will also, hopefully, create some new therapies that are beneficial. When this happens, NICE will no doubt revise its guidelines accordingly.

Finally, a comment on the suggested monopolistic position of BABCP. The Society and BABCP have been working together collaboratively to see how psychologists with specific competences in CBT should be accredited and whether the procedures of each organisation might be linked and streamlined in some way. We should also like to strongly object to the inappropriate pharmaceutical company metaphor, since BABCP, like the Society, is a not-for-profit, charitable organisation. Moreover, the whole issue of the regulation of psychological therapists, including CBT practitioners, is likely to come under the auspices of the Health Professions Council, which has recently announced the formation of a Professional Liaison Group to review psychological therapies. This is usually one of the first steps towards statutory regulation.For further information about IAPT, the Division of Clinical Psychology is developing a IAPT discussion forum, together with an IAPT symposium at the its annual conference in December to discuss and debate progress to-date (see www.bps.org.uk/dcp).
Graham Turpin
University of Sheffield
David Clark
Institute of Psychiatry
King's College London 

 

Asperger's in adults
In 'A childhood disorder grows up' (September 2008) Lee Wilkinson describes available interventions following an 'accurate diagnosis' of Asperger's syndrome (AS). I found this article interesting and informative but felt that the complex issue of diagnosis and the difficulties associated with it also deserve attention. In my experience, the importance of correctly diagnosing AS cannot be emphasised enough because individuals with AS may otherwise be denied services if they are not given this diagnosis. However, getting an accurate diagnosis can be time-consuming (if there is a waiting list) and costly for teams (if local services are lacking and the person has to be referred to a specialised service outside the region). It may also be very difficult if no developmental history is available.

Further complications include that symptoms in adults may manifest in a wide variety of ways and mimic other disorders (e.g. psychotic disorders, bipolar disorder, personality disorder, social phobia). The existing literature reports that AS has some characteristics which may resemble positive and/or negative symptoms of schizophrenia (e.g. thought abnormalities, executive functioning problems, overvalued ideas, poor social relatedness, lack of pleasure in activities, flat or constricted affect or ability to show emotions, restriction of facial expressions, poor use of gestures, diminished eye contact, presence of stereotypic behaviours and mannerism). Preoccupation with unusual topics or interests, restricted, repetitive and stereotyped patterns of behaviour may lead to a mistaken diagnosis of obsessive-compulsive disorder. Hence, misdiagnoses are not uncommon and the high rate of anxiety disorders comorbid with AS makes differential diagnosis a complex task.

If we trust estimates that a significant proportion of undiagnosed (or misdiagnosed) adults with AS exists, psychologists working in adult mental health are likely to see someone with AS sooner or later. Whilst diagnosis should be left to those trained to do so, psychologists can use screening tests and devise individual case formulations to address the person's difficulties. In so doing, individually tailored interventions can be devised for
a large and heterogeneous group of adults with AS, who may not otherwise receive the interventions and support they need.
Susanne Iqbal
Trainee Clinical Psychologist
Salomons

 

Autism – robots not the answer

I enjoyed Mark Turner's article entitled 'Robots, mirror neurons, virtual reality and autism' (August 2008). He provided a good overview of recent developments in the current understanding of the cognitive neuroscience that underlies some of the differences observed in individuals with autism spectrum conditions. These include research that has found differences within the mirror neuron system, specifically in mu-wave suppression (Oberman et al., 2005).

I am, however, concerned about conclusions made regarding the potential use of robots or robotic action as an educational strategy for children with autism spectrum conditions. Given that individuals with autism can have differences in their flexibility of thinking (often taking an interest in specific detail, but having more difficulty when it comes to generalising information) it seems that exposure to robotic action with the aim of developing 'people skills' would only prove at best to be of little benefit and at worst could prove to be confusing and distressing.

In the rush to develop an all-encompassing theory of autism spectrum conditions (a possibly fruitless cause given that receiving a diagnosis of autism is based on exhibiting a diverse collection of behavioural differences that overlap with a number of other diagnoses) it appears that the process of understanding 'what works' in supporting this group has been side-stepped. It would seem to me that those working with individuals who have autism spectrum conditions need to focus on the already known differences that this group experiences. Increasing understanding of these differences would help us to promote an environment that is more understanding of individuals with autism spectrum conditions, rather than developing artificial environments that potentially provide learning that may be difficult to generalise to other situations.
Jason Crabtree
High Wycombe

Evidence first

We thank Michael Heap (Letters, July 2008) for raising the point that the term 'evidence-based' needs proper definition. Classification schemes for grading evidence do exist (e.g. www.nice.org.uk/ niceMedia/pdf/2006GuidelinesManualChapter7.pdf). At the Charlie Waller Institute we adopt these guidelines to ensure that we only offer training in psychological therapies that are supported by data from high-quality randomised controlled trials. Michael Church (Letters, July 2008) makes the point that no therapy has a 100 per cent success rate, and that people who don't respond to CBT deserve alternatives. We fully agree but believe that the first option should always be evidence-based interventions if they are available. Should these treatments prove unsuccessful then the client should of course have access to alternative interventions along with information as to their efficacy.

We are curious as to the level of debate an advert for training in evidence-based psychological treatments has raised, and we invite peopleto experience our training to form their own judgement
Roz Shafran
Craig Steel
Charlie Waller
Institute of Evidence-Based Psychological Treatment

 

Political affiliations of BPS officers
I was interested to read the letter of Ian Wray concerning statutory regulation (August 2008). I have sympathy with Ian Wray concerning the undermining of civil liberties in the UK and the fact that there seems to be an imbalance concerning the protection of the public as against the rights and independence of the psychologist (there are indeed very few complaints made against clinical psychologists when one considers the number of hours practised). But I do not agree that individuals who are candidates for office within the BPS should be required to state their political affiliations.

As far as I am concerned, an individual's political views, as well as religious views etc., are a private matter for that individual alone. It is only when those views or positions begin to interfere with how one carries out one's job that they become relevant. There may be many people who support the present government without necessarily supporting the government's positions on civil liberties. Most of us who vote for political parties have some disagreement with some of the programmes of each party.  A truly liberal view would be one where we have general tolerance of other people's views without proscribing them. Otherwise we become as guilty as the individuals who advocate censorship and control.

I hope and believe that there is a wide spread of political opinion amongst members of the Society and it is not up to the BPS to state what kind of political views each and any of us should have.
Ian Burgess
Psychology Department
Bristol General Hospital

 

A-level psychology evolves (again)
Students who have just started A-level psychology are studying new specifications. There are implications for the psychology community in terms of lending support and in preparation for some of these students beginning degrees in 2010.

Psychology is now officially a science at A-level, influencing presentation and assessment (but not changing the discipline itself). Every specification must assess How Science Works (in psychology) in each module. There's little new: the real change is of status and emphasis, highlighting these aspects holistically, but one addition is the inclusion of a range of contemporary examples. Psychologists could help by sharing contemporary psychology, demonstrating how psychology works now, in real contexts. The BPS Research Digest (www.researchdigest.org.uk/blog) already provides a valuable service here.

As with other A-levels (except the other sciences) psychology is streamlined to four modules, losing centre-assessed investigative coursework. At first sight regrettable, in fact the expectation that students will learn first-hand (and be assessed on) how psychology works means that good teaching will still incorporate practical psychology. Freed from coursework, some awarding bodies have found novel ways to encourage this, helping teachers use inquiry formatively and creatively. Psychologists might provide ideas and resources for accessible, genuine practical enquiries that students can undertake as they learn.

The prescribed core remains focused on key areas, approaches, research methods, issues and debates, without specifying particular theories, studies or even topics. This permits various interpretations from awarding bodies: some with a strong focus on applied areas (e.g. Edexcel); others centred on key studies as exemplars (e.g. OCR). But despite the tempting degree of choice, continued vagueness of the core does not help stakeholders such as HE to understand, value or build on undergraduates' prior learning. In biology, by contrast, an extensive knowledge base is shared across all specifications, with enough flexibility to allow some genuine competition; biology A-level is a pre-requisite for further study. This will not be the last revision: movement towards a definitive core of knowledge for A-level psychology will require compromise from stakeholders with vested interests. Psychologists should be instrumental in this negotiation.

Teachers need associated high-quality professional development, to which the Science Learning Centres contribute, with the help of the BPS, HE and other stakeholders. If any readers are interested in supporting this, perhaps by responding to my challenges above, I would be pleased to hear from them.
Jeremy Airey
Senior Professional Development Leader
National Science Learning Centre
[email protected]

 

Dominance of CBT

I agree with John Kelly's concerns (Letters, September 2008) about the increasingly widespread adoption by services of cognitive behaviour therapy. There are two main problems with CBT.It rests on a diminished view of what it is to be human, and, as Kelly argues, it ignores the role played by the social-political environment in the patient's problems.

There are other short, humanistic, interpersonal and psychodynamic approaches, based on a more adequate recognition of the complexity of human distress. Cognitive analytic therapy (CAT), for example, pays particular attention to the relation of such distress to the past and present interpersonal and social context, and involves patients in actively contributing to the formulation and resolution of their problems. Most forms of brief psychotherapy are effective in the short term, but there are few, if any, studies comparing the long-term effectiveness of different psychotherapies, and the superiority of CBT has not been demonstrated. Its domination of the field seems to be more a reflection of the public relations skills of its adherents, and other approaches should not be deprived of research and clinical resources.
Emeritus Professor Barbara Tizard
Thomas Coram Research Unit
Institute of Education
London

 

Classic misunderstandings

Christian Jarrett's article ('Foundations of sand?', September 2008) on the myths and misreporting of famous or seminal psychology was enlightening, if not a little disconcerting. As textbooks will often be regarded as an important outlet of accessible and succinct information for many psychology courses, whether A-level, undergraduate or postgraduate, it is worrying that textbooks can print erroneous information as factual, which will then be used as foundations for essays, or other research. Perhaps in the same way many undergraduate courses try to encourage free thinking and critique, textbooks should be discursive and critical.
Ian A. Sinclair
Undergraduate
London South Bank University

I write with reference to Christian Jarrett's article 'Foundations of sand?'. In the section 'The power of independence' he refers to the fourth edition of my textbook Psychology: The Science of Mind and Behaviour.

Quite accurately, he notes that I quote social psychologist van Avermaet, who interprets Asch's findings as revealing the impact of 'an "obviously" incorrect but unanimous majority on the judgements of a lone individual'. Jarrett then cites a paper by Friend et al. (1990) that assesses the way that textbooks have (mis)interpreted Asch's results and points out that Asch actually saw his results as demonstrating the power of independence. While my textbook will almost certainly not have been included in the review by Friend et al., Jarrett seems to imply that I, too, have overemphasised the power of the majority and overlooked important individual differences among Asch's participants, as well as Asch's own view as to the meaning of his findings.

I'd like to point out that I have evaluated Asch's research in some detail (including replications and Moscovici's (1976) reinterpretation of the findings in terms of minority influence), and on p.385 I say: 'Asch himself was interested in the social and personal conditions that induce individuals to resist group pressure' (italics in the original). I would not like any reader unfamiliar with my textbook (5th edition, 2005) to get the impression from Jarrett's article that I have merely contributed to one of the enduring myths of classic psychology (or added yet more grains to the foundations of sand).
Richard Gross
Newark
Nottinghamshire

I just wanted to say how much I enjoyed Christian Jarrett's 'Foundations of sand?' article in the September issue. I myself have got buried in some of that sand at times!
Professor Robert J. Sternberg
Tufts University
USA

 

Dyslexia support at university

In this age of increasing student numbers, and growing pressure to accommodate students from more varied educational backgrounds, academics sometimes get a bad press. However, having spent the last six months or so talking to lecturers about their experiences with dyslexic students, and their approach to supporting these students at university, I have to say that I found the majority of those I spoke to be open-mined, humble and proactive in their approach to support. Many of them went out of their way to make adjustments to their teaching styles, lecture notes, and methods of assessment in order to help students with dyslexia to participate on an equal footing with other students.

Students with dyslexia can lack confidence in approaching academic staff for help, especially if they fear a negative or cynical response. It was therefore encouraging that a lot of the lecturers
I interviewed showed a high degree of sensitivity towards these students and made time to discuss their needs with them in a non-judgemental manner. Academics also sought advice from learning support staff at the university and discussed standards of support regularly with other teachers in the department.

A very small minority of the academics I talked to did express some cynicism about dyslexia, and unfortunately their doubts appeared to inform their approach to support. It is perhaps of concern that the quality and amount of support given seemed, in this study, to be more dependent on the initiative of the individual member of staff rather than any central guidelines put in place; and this was a concern to many of the lecturers themselves.

Overall, however, the academics I interviewed appeared much different from the stereotype of academics sometimes portrayed in the media. In fact, talking to them has been a pleasant an enlightening experience, and one which has left me with more positive idea of how well students are supported; and I believed this was worth sharing with readers of The Psychologist. Harriet Cameron
Dyslexia Support Tutor
University of Sheffield