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Top>Research>The Quest for Effectiveness of Clinicopsychological Support


Ryo Shimoda

Ryo Shimoda [profile]

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The Quest for Effectiveness of Clinicopsychological Support

Ryo Shimoda
Professor of Clinical Psychology, Faculty of Letters, Chuo University

The Field of Clinical Psychology

My area of expertise is psychology, a field which, contrary to general expectations, is not capable of skillfully defining the human mind. You may find it strange, but psychology is unable to define mind. Even if a definition were to be made, it would certainly be limited and lacking. Indeed, psychology can even be compared to researching the universe, for it explores the boundless realms of mind. Through technological advancements such as imaging of the brain and transcranial magnetic stimulation, psychology has connected mind with the brain. There is an increasingly strong trend in psychology to confine mind within the brain, but there is a limit to that kind of manner of research. For example, it is possible to list the nonlocal functions of mind which cannot be localized to the brain. This is even more apparent when considering that even elementary particles have proto-mind, as suggested by advanced physics and philosophy. The close connection between mind and the brain is an undisputable fact. However, it cannot be definitively stated that mind is equivalent to the brain itself. Mind may exist in those realms which surpass the limits of the brain. Therefore, strictly speaking, mind as expressed in psychology refers to "so-called mind." As such, it is necessary to also place the term "mind" in quotations. In the remainder of this article, I will do so. Although psychology cannot skillfully define "mind," steady advancements are being made in research related to the function and effect of "mind." In other words, psychology is a field capable of pursuing laws|psycho-logic|for how "mind" functions and how it affects behavior. The term behavior is not limited to deed or purposeful action; it is defined as pattern characteristics of changing states in the human organism. Behavior can be observed and measured, making it a superior index for understanding the workings of "mind."

Basic psychology is a field of psychology which examines how "mind" works in general; in other words, the normal way in which "mind" functions. This field is based on experiments and surveys. Next, the field of abnormal psychology researches how "mind" ceases to function normally; in other words, abnormalities of "mind." This field overlaps with the field of psychopathology within psychiatry. Clinical psychology, which is one of the various fields in applied psychology, examines how to return "mind" to a working state which is equal to or exceeds its original level and style of functions. Clinical psychology is a specialized field within applied psychology. In this field, research is conducted for psychological support and aid towards the troubled individuals experiencing worries or problems with their "mind," as well as significant others around them. Research focuses on support and aid for a variety of social aspects or clinicopsychological situations including medicine, schools, social welfare, justice, industry, organizations and private practice.

As I just stated, clinical psychology research focuses on support and aid in the application of psychology. This research is supported by the two major pillars of assessment and treatment. This is easily understood through comparison to medical practice, namely examination/diagnosis and treatment. Assessment and treatment contain a variety of methods based on psychological schools and theories. Assessment is performed in order to thoroughly understand the client|the person receiving clinicopsychological support. It is also known as psychological assessment or gmitateh in Japanese meaning diagnosis and prognosis. Assessment is performed using such methods as interviews, observation, survey of materials, psychological testing and checking against psychiatric criteria of diagnosis. Assessment is required in order to select the appropriate treatment. The term treatment refers to the actual provision of aid based on an understanding of the client via assessment. It includes aiding treatment such as counseling and psychotherapy. The appropriate treatment to be performed is selected based on the worries, problems, qualities and potential of the client which were identified through assessment in clinicopsychological situations. In summary, clinical psychology can be defined as follows: an academic field which explores theory and methodology to correctly understand psychological traits and states of the individual suffering from distress and problems, i.e. assessment, and then utilize that understanding for conducting support and aid, i.e. treatment, including counseling and psychotherapy, with the ultimate goal of developing and providing expertise needed in clinicopsychological situations.

Counseling and Psychotherapy

The terms counseling and psychological counseling have been widely used at schools and workplaces. As such, there is now understanding for the meaning of these two terms. They mean taking counsel as treatment. Specifically, the prevailingly familiar image for the terms is the act of resolving psychological distress and problems through conversation. Through the encounter and interaction of two people|the counselor and client, "mind" is soothed and undergoes change and growth. That process, theory and method are known as counseling. Actually, we experience something similar to counseling in our daily lives. When having someone listen to confidential subject matter, we experience the following benefits: 1) we feel refreshed after discussing our thoughts and feelings, 2) we feel reassured by understanding from the listener, 3) we recognize important points when explaining to others, and 4) we calm and resolve our thoughts and feelings by speaking to our heart's content. Counseling is an organized, systematic method for experiencing those things in a concentrated and intensive manner.

An extremely simple explanation for the working mechanism of counseling is as follows: through conversational interaction, 1) the client experiences acceptance of his or her true self by the other party, i.e. the counselor, 2) which makes it possible for the client to accept his or her true self (self-acceptance) and 3) spurs the client to explore various aspects of himself/herself (self-exploration). As a result, 4) upon seeing his or her true self, 5) the client recognizes himself or herself (self-insight/self-understanding) and 6) becomes capable of determining his or her own path through appropriate choices based on self-understanding (self-determination). Finally, 7) the client changes and grows to become capable of taking responsibility for his or her own choices.

In Japan, there is a trend not to strictly distinguish between the terminology "counseling" and "psychotherapy." However in this article, for the purpose of convenience, I will define counseling as stated above. On the other hand, I will define psychotherapy as all other helping methods in which the helper plays a large leading role. Among psychotherapy, there are slightly unusual methods which surprise the client. Through a somewhat strange method, the helper changes the framework of the client's existing viewpoint and way of understanding things, i.e. cognition. In other words, the client's rigid way of thinking, feeling and behaving is broken apart, and a frame of reference with a new basis is actively provided. However, in order to make this method effective, it is necessary to have the client become interested in the new framework, as well as to encourage the resolution and action needed for change. Surprise is one way to motivate the client. When combined with other measures, surprise heightens the client's motivation towards psychotherapy.

Paradoxical Psychotherapy

For example, in our daily lives, there are times when making an effort to resolve psychological distress and problems has the reverse effect. Fine examples are to get even more nervous when trying to suppress nervousness, or remaining wide awake despite repeated attempts to sleep. In such cases, problems can sometimes be solved by having the courage to take the opposite approach. In other words, if exerting an effort has no effect, try taking a step back. This approach is called symptom prescription as a paradoxical intervention. For example, assume that clients experience excessive nervousness during a specific part of their daily lives. When fighting to suppress nervousness, one of my clients becomes alert and directs all of her attention towards nervousness, consequently causing her to become even more nervous, which is called affective reactance. Upon being caught in this trap of reverse effect, the clients fall into a vicious circle. However, symptom prescription encourages them to embrace their tension by prodding them into situations which incite nervousness, saying to themselves like gGet more nervous!h In this way, the courage to take completely the opposite approach can lead to a solution called control/alleviation of tension through its acceptance.

When an inexperienced driver operates an automobile which starts to drift upon entering a curve, the driver will unconsciously turn the wheel towards the curve from fear. This will cause the automobile to drift even further and spin out. In this situation, spin can be prevented by taking the opposite action; that is, turning the handle opposite to the curve (counter steering). Another example is an inexperienced pilot flying an aircraft. When the nose points upward and the aircraft begins to lose speed, fear will cause the pilot to pull back on the control rod. This causes the nose to rise further and speed to decrease even more. In such a case, the pilot should take the opposite action of pushing the control rod forward, lowering the nose and thus increasing lift. In this way, problems sometimes arise when attempting to flee from uneasiness or fear; in other words, efforts to solve the problem actually have the reverse effect. This phenomenon is known as pseudo-solution or false resolution. In such cases, the true solution is to take the opposite action of the solution method previously used. People who continue to push a door that is designed to open when pulled will find themselves in a grave situation. However, if they recognize the design of the door, or even if they simply take the opposite without such recognition, the problem is solved extremely easily. In some cases, the same can be said regarding the driving or piloting of emotions. Taking the opposite action is an effective method for affect regulation or emotional adjustment of nervousness, uneasiness and fear.

My research theme is to understand the influence of a set of various conditions which apply during treatment; it is called therapeutic structure. This includes slightly unusual psychological treatment like the one described in the preceding paragraph. For example, I am working to clarify how the treatment relationship and treatment effects are impacted by interview fees or by the aforementioned various measures for motivating the client to undergo treatment and creating the resolution/action needed for change. Such clarification will indicate the treatment conditions for effective functioning. I am pursuing this theme through both reviewing preceding researches of master therapists and practical application of various conditions in clinicopsychological practice. In recent years, some evidence for a couple of psychological treatments using computerized programs and virtual reality images has been confirmed. These treatments are now being administered to clients in clinicopsychological practice. Of course, these treatment programs are not unconditionally effective. Instead, the effect is influenced by a number of conditions composing the therapeutic structure.

Ryo Shimoda
Professor of Clinical Psychology, Faculty of Letters, Chuo University
Prof. Shimoda was born in Niigata Prefecture in 1950. In 1976, he obtained a degree of Master of Arts in Education from the Graduate School of Education, International Christian University. After working as a technical official in psychology at the Japanese Ministry of Justice and then as a clinical psychologist in private practice, he joined the Faculty of Letters at Chuo University in 2005. His written work related to this article includes Theories and Methods in Practical Counseling--For Emotional Healing and the Hope for Growth (Fukinoto Publishing, 2005). Other related papers include The Significance of Setting Fees for Counseling and Psychotherapy II: The Way Client-centered Therapists See It (the Journal of Pedagogics, Volume 54, 2012), Cognitive Behavior Therapy in School Practice: Customizing Therapy for the Particular Needs of a Client (the Journal of Pedagogics, Volume 53, 2011), and The Significance of Setting Fees for Counseling and Psychotherapy (the Journal of Pedagogics, Volume 51, 2009) and more.