The Abstract Mind Written in Concrete

| March 31, 2014
myoutcomes feedback informed therapy, concrete measurements in psychotherapy

Changes in the mind are possible to quantify and there are concrete measurements in psychotherapy to bolster this!

René Descartes, often referred to as the Father of Modern Philosophy, created a model whereby behaviour could be investigated and described. His two main elements were the “body” and the “mind.” The body is essentially a machine that is responsible for involuntary behaviour and creating “sense impressions” of the world. The body is what we hold in common with other living animals and, therefore, like other animals, it is reducible and corruptible. The mind, on the other hand, is not reducible nor was it corruptible. To Descartes, the mind was the human soul that was responsible for voluntary behaviour and for receiving sense impressions from the body. As many people know, Descartes' mind-body dualism was interactive. As there is only one such structure in the brain, Descartes selected the pineal gland as the place for this interaction. The mind receives information about the world from the body and it sends commands for voluntary movement to the body via the pineal gland.

Various scientific fields, e.g. human anatomy, comparative anatomy and comparative psychology, have much to owe to Descartes. Many medical breakthroughs could not have occurred if it weren't for the Cartesian assumptions underlying these fields. There have also been less than welcome aspects to Descartes' model. To Descartes, the mind wasn't made up of matter like the body was. It couldn't decay. It couldn't be reduced. It was eternal. As such, it couldn't be measured or understood by the same means as the physical universe. To this day, there are those who believe that the mind can't be measured because it is somehow transcendent over the physical world.

Not that there haven't been those willing to challenge this idea. Since Julien de la Mettrie declared that it was quite reasonable to assume that the mind was a phenomenon derived from the matter of the brain, numerous scientists and philosophers have expressed a similar viewpoint through the centuries. Nonetheless, for some, the arguments of these scientists and philosophers have proven to be no more effective than those of an Atheist trying to convince a church full of fundamentalists that there is no God. There are those who refuse to consider that the mind, rather than transcending the physical brain, is simply a property of the physical brain.

During the first part of the twentieth century, this notion that the mind can't be measured was further extended by John B. Watson and B.F. Skinner. The argument of Radical Behaviourism was that the mind wasn't subject to the tenants of positivism. As such, it couldn't be measured. The mind, accordingly, wasn't a proper subject for scientific study.

Behaviourism dominated American psychology for nearly a half century. One of its most important contributions was that it forced those, who believed that the mind could be measured, to prove it. As a result, tools were developed that even the most hardcore sceptic came to agree could measure changes in psychological states or the mind; changes, that couldn't be directly observed or measured.

So the quantification of the mind would seem to be possible after all.

Still there are those who believe that the mind is too ephemeral, too abstract, to be measured or explained in concrete terms.  The irony is that many of those who hold this view typically find themselves as practitioners of psychotherapy; a field that begins and ends with a belief in change.  One question that needs to be answered is how can you change something you can't measure? The answer is, of course, that you can't. Another question is how can you determine if you have changed something if you can't measure it? Once again the answer is that you can't. The problem with the idea that the mind is an abstract construct that can't be measured is that it undermines the entire foundation of psychotherapy. Psychotherapy isn't possible if you can't “see” what you are doing.

The fact is that psychotherapists do believe that change is possible and that changes in the mind are possible to quantify. Whether they want to admit to it or not, psychotherapists are continually using concrete forms of measurements when assessing their clients. When they note a change in the frequency of their client leaving their home, or an increase in work or school productivity, or a reduction in the out-of-control conflicts with their significant other, they are using concrete changes in behaviour as a measure of changes in the psychological state of their client. The only problem is that these measures are not necessarily in and of themselves valid or reliable.

Numerous studies have demonstrated the validity and reliability of MyOutcomes, the web-based application of the Partners for Change Outcome Management System (PCOMS). Still, there are individuals who question the ability of tools, like the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), to measure the mind. Their argument is framed in the belief that the mind is abstract while measurement is concrete and never the twain shall meet.

What these individuals likely object to, is the use of the number produced from the ORS sliding scale to indicate the subjective experience of distress.

Using sliding scales to measure subjective psychological states has a long and accepted history in psychology. For example, research investigating anxiety as a motivational factor for alcohol consumption will use a sliding scale that the subject adjusts to indicate their subjective experience of anxiety.

The ORS and the SRS are only continuing this long tradition. The ORS measures how much distress the client feels they are experiencing and whether that level of distress is increasing or declining. The SRS measures how strong the client feels their relationship with their therapist is. Psychological states such as distress and relational states such as the therapeutic alliance can't be measured or observed directly. However, the values that the client gives to their own internal psychological states, provides the therapist insight into what the client is experiencing. And for the therapist who wants to help their client to successfully achieve their therapeutic goals, this insight will prove to have very concrete value.

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Category: Psychotherapy

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