These edited reports were originally posted to the Current Topics, Therapy Online, and Cyberpsychology list-servs, August 2003.  

2003 Convention Highlights:
Full Text | Aaron Beck 2003 | Quality of Online Health Info | Sternberg's Vision


INDEX OF 2002 APA Convention Articles:
CyberSex & Cyber-Infidelity | Beck & Ellis 2002 | Behavior Therapy | CyberPsychology | E-Ethics

 

"Asynchronously Live" from Toronto, Canada

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*DISCLAIMER*
I was very careful to take accurate notes during these presentations, using handouts and/or photos of graphics to verify my notes. While I believe these are accurate, and often literal real-time notes, I apologize for any mistakes or typos, or for reporting anyone else's unintentional mis-statement. I will be happy to immediately correct any errors and I welcome presenters' submission of additional online references which might be included in these reports. Thanks, and... Enjoy!

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APA CONVENTION REPORT #1
Friday, August 8, 2002

To: CurrentTopics@yahoogroups.com
Sent: Friday, August 08, 2003 2:27 AM
Subject: [CurrentTopics] Asynchronously Live from APA's 111th Convention (Toronto)


Greetings all (especially those who stay quiet on my lists for months or years but stay around to hear the occasional reports!)

       Asynchronously Live from Toronto.....

Despite weather forecasts predicting cool and wet times ahead, today was a gorgeous day in Toronto. There were sessions on Thursday and this morning and the exhibit hall was open, but the convention's official "opening session" and keynote speech were presented this afternoon, by psychologist-turned novelist Stephen White. But before opening session I sampled a symposium about the quality of online health information, and what was supposed to be the 3rd installment of Beck-Ellis Dialogue, about the origins and nature of cognitive therapy and/or REBT. Entitled, "Getting it Right -- Legends Albert Ellis (90) and Aaron T. beck (82)", unfortunately they did not have the opportunity to continue this wonderful discourse.

Sadly, and I'm sorry to be the one to break this news, Albert Ellis is currently in hospital, after a difficult summer, and was not able (or allowed) to leave the hospital to attend the various honoraria planned for him, nor this extraordinary ongoing discussion with Beck. He is scheduled for a "conversation" tomorrow (which is cancelled) and also for a roast entitled "Comedy Jam with Albert Ellis' 90th Birthday - No Joke". The latter is going to proceed, but without Ellis present. The hope is that tomorrow there can be some sort of video hookup to his hospital room so he can see all the entertainment planned to honor him and tickle our funny bones, and in turn he'd be able to thank the many people who all hoped to see him there in person, healthy and as ribald as ever. We all wish him well.... a true legend.

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Meanwhile, today's "Discussion" with Dr. Aaron Beck turned out to be quite an excellent interview of Aaron T. Beck solo, with 1/2 the time devoted to questions by the moderator, Dr. Frank Farley, and the other 1/2 to fielding a very diverse set of questions from the audience. Of course he was masterful and (as earlier in the day when I had the good fortune to talk with him) he was enthusiastic about talking in terms of new discoveries and fascinations, notably with borderline personality and also with regard to some related theoretical frames. Full report to follow....

DAY 1

As I say each year, it's never possible to attend more than a fraction of the myriad presentations happening at the same time, in every interesting topic related to psychology. I've tended in recent years to focus on my own areas of interest (cognition, clinical psychology, psychotherapy, personality theory, and Internet-facilitated communication, relationships & behavior). This year again I am trying to sample a little of each as well as some "mainstream psychology" and visionary psychology too, as portrayed by some of the great names in psychology today. [Coming soon: Robert Sternberg's thoughts on psychology. A treat.]

Quality of Online Health Information

As it happens, one of the first symposia of this year's convention was entitled "Evaluating the Quality of Internet Mental Health Information". Paradoxically, convention attendance this year was noticeably lighter than in the past (due to the SARS scare). In any event, two of the 4 presenters were not there, and the symposium was co-presented by Drs. Janet Morahan-Martin and Robert Kennedy. This was a presentation very dense-packed with graphics and research findings, so I'll need to take a look at some of the slides and possibly some of the source studies before reporting some of many interesting bits of information which were included. When I get the chance to look again at my original notes and slides I may add more detail as these e-mail reports evolve into web-based articles.

Speaking now of health information on the web, and noting before the impact of the SARS scare, Dr. Morahan-Martin began by noting that in April, the most searched for term in the Yahoo! search directory (which is actually powered by Google), was.... SARS. For the first time more people were looking for information about SARS than about Britney Spears! Wow. Serious. A major emphasis in the remaining presentation was a look at where we are in terms of assessing the accuracy and reliability of information which is out there, and how consumers may differ from physicians in terms of their attitudes and in relation to Internet information resources.

Dr. Morahan-Martin took a look first at some demographics and patterns world-wide, of Internet Use. Like my own presentation last year (so I can relate to these trends!), hers drew from the exhaustive research of the Pew Internet Research group and also Harris Interactive. One estimate is of 1/4 Billion people now online, and probably a 70-90% level in Japan. Specifically, she looked at "health seekers" who go online looking for health information, noting that more people go online looking for information than go to hospitals or clinics for it. There are several well-known advantages, including convenience and anonymity to name two big ones. But how accurate is the information people rely on? One major study (Eysenbach & Kohler, 2002) did a meta-analysis of research to date and concluded only about 30% of what's out there is reliable. Of course, one can question some of the conclusions based on others' research, and there are also some variations across cultures, in terms of the people's love of the Net and reliance on it for hopefully-accurate information. A "best-guess" is that in the US somewhere between 50-80% of Internet users seek health information.

I'd point out what may be another limitation of generalizeability in that the studies apparently looked at (physical) health problems rather than mental health. But certainly too, some of this "self-help" and knowledge seeking is valid for those specifically looking for mental health information as well. People know it's there for the finding on the Net.

So how do people look? Search engines! It is reported that it typically takes a seeker less than 6 minutes to find the information they want. Also, as website owners either love or hate, "people don't go beyond the first 10 sites" when there are good offerings right up top, and they may be unaware that many of these sites are there not for accuracy or relevance but because they paid for one of those top slots.

More skeptical than the consumer is the physician. A study by Diaz, Griffith, et al (2002) found that 60% of Americans think the quality of health information online is about the same or better than what they can get from a physician. Physicians apparently disagree. :-) Meanwhile, those who say they believe what they find online apparently don't necessarily do the things they say they do in focus groups: looking to see the source of the information, privacy statemement, etc. Among the most vigilant consumers (Fox & Raine 2002) are those who are the most needy for information -- people with an illness, parents of young children, etc. Also, people tend to take action based on what they find, reliable or not.

Dr. Kennedy followed with a change of focus to the physician-side experience, though as editor of Medscape's psychiatry pages he knows consumers and non-physicians are seeking reliable information too. (About 40,000 psychologists subscribe, including this writer. About 575,000 physicians are members of the Medscape community.) He takes the role of providing reliable healthcare information very seriously, harkening back to Hippocrates' view that medicine is a profession, not a job, and as such a profession must rely on valid information, whether direct or indirect. Perhaps reflecting this, Kennedy noted that currently about 90% of physicians go online to look for information, a huge jump since 1997.

Kennedy provided the audience with a virtual walk-through of the Medscape site, which features information in many forms from journal scans to newsletters on hot topics. He noted his own distaste for pop-ups, and Medscape's strict policies about avoiding drug advertisement except in a few places on the site. He also underscored, as did his co-presenter, how widespread Internet access is becoming, worldwide. Citing Nielsen Net Ratings, he reported that in 2002 there was an estimated worldwide Internet population of 580 million, whereas it is now predicted that in 2004 we'll see a population of 709.1 million (E-Marketer) and by 2005 about a Billion online people.

And for physicians online, the Net is also becoming an integral part of the daily work flow.

Kennedy concluded by noting that consumers and profesionals are well served to be aware of the HON code (and 3 others he named) as one way to build trust in the content a site offers, and he reiterated the hallmarks of essential elements which should be present, such as disclosure of the source and also any self-interests.

-- Disclosure: NOBODY pays me anything for my site; it is my personal public service to provide this compendium of INFORMATION. I rely on APA, prestigious healthcare programs, and other source material of high quality as my content, in addition to my own reports such as this. I have no sponsors, no advertisers. Only my eyes, ears, frontal lobes and keyboard. :-)

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Here's a coming attraction of what's up next in today's program, which is going to have to be continued..... [as sleep deprivation settles in once again!]

Beck-Ellis III

[See above - This was cancelled but became an hour with Aaron Beck, exciting in its own rite!]

Meanwhile, anyone who's interested in behavior therapy is strongly encouraged to read my report on their first-ever meeting (2000), which is becoming quite well-used in colleges as a basic introduction to both Beck and Ellis, and cognitive therapy in general:
http://www.fenichel.com/Beck-Ellis.shtml. At the 2002 APA convention I reported on another wonderful gathering, of "behavior therapists" including Arnold Lazarus and Ellis too, which is at http://www.fenichel.com/behavior.shtml .

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Getting it Right -- Legends Albert Ellis (90) and Aaron T. Beck (82) in Conversation with Frank Farley

[Albert Ellis has been in hospital and is forced to cancel his scheduled events, including a 90th birthday celebration, conversation hour, and discussion with Beck. :-( But Beck was here for another fascinating discussion, which follows.]

AARON T. BECK

"Getting it Right"
7 August 2003



This event was actually titled "Getting It Right -- Legends Albert Ellis (90) and Aaron T. Beck (82)". However, due to illness, Ellis could not be with us. Nevertheless, Beck - legendary pioneer in cognitive therapy for depression, and recently active in cognitive treatment of other serious disorders -- was there, and the audience was treated to a more in-depth Q&A with Beck than expected. After several questions by long-time moderator Frank Farley, Beck, who had been prepared to answer questions from Ellis and Farley, asked now if he could take questions directly from the audience. He got some excellent questions, diverse and often difficult. Beck unflinchingly complimented each question and proceeded to demonstrate a wide breadth of knowledge about a full spectrum of theories and approaches to treatment.

Before the presentation began, the audience was told about Ellis' health situation and how the discussion would proceed in his absence. Dr. Beck began by graciously acknowledging Ellis as "a major pioneer in the field of psychotherapy, a David who went out to slay Goliath he gave no quarter". [Non Americans: "give no quarter" is an idiom meaning he remained 100% firm in what he said, never backing off...]

Questioning began with a request for Dr. Beck to say a few words about his thinking on terrorism, a big topic now and the subject of a new book by Beck.

"I've seen the dynamics of couples who hate each other and observed how they feel vulnerable, victimized.... Both people feel this..... Cesar said the same thing [and] similarly with terrorists, the only way they can defend their ideals is to attack first."

[Anyone else see a great similarity between his observation and that of Robert Sternberg?]

The next question was about cognitive therapy as a treatment technique for schizophrenia. Beck notes that his preliminary work and that which he's seen elsewhere, such as a major work in the U.K., has been "very exciting.... the addition of cognitive approaches to standard treatment manages to take the patient one whole step higher" according to outcome analysis. For example, cognitive therapy, for someone with "some functioning but with delusions or hallucinations... it can help attenuate" the symptoms. If someone has "only negative symptoms" such as listlessness, "it helps too".

Now it was the turn, at Beck's request, to hear from the audience.

Beck, who is an MD, was asked how he understands the brain physiology and how he thinks his verbally mediated treatments affect the brain as opposed to say, pharmacotherapy alone. Beck replied that "the physiological, neurochemical changes are the same with cognitive therapy versus pharmacotherapy. However, the *root* was different. To simplify, with pharmacotherapy it's subcortical but with cognitive therapy it's via the frontal lobes. But [the changes, despite the root] ended up in the same areas."

Asked next about treatment of Borderline Personality Disorder, which is commonly considered one of the more difficult therapeutic endeavors, Beck replied that in his experience, "each of our disorders has a particular paradigm or profile. With borderlines , based on in-depth analysis, we see acting out a great a deal, being destructive, and doing damage to things important in their lives." He sees the dynamic as often entailing a viscious cycle of stress leading to self-defeating behavior. "If the stress is great, perhaps it will lead to suicide. If feeling put upon, perhaps they will attack". The cognitive style is characterized by a "certain extreme ways of thinking" and a "dichotomous way of carving up their own lives and those of others, while seeing situations through black and white lenses. Everything is extreme, with at least one crisis every day. Like terrorists, they're all good and others are all bad-- but they can be the opposite too. They're all bad and others are all good." This can lead at worst to "slit wrists" but also, in everyday life, difficulties with "affect control and impulse control".

Beck described the underlying beliefs which are at the core of many problems. He referred to... The 3 Attitudes:

1. "If I feel something strongly I should express it"
2. " I feel I shouldn't express myself but I have to" and
3. "If I express myself people will listen to me""

He might focus on this triad and has seen some successful treatments which entail a sort of "re-parenting" whereby discussion of these reactions might be underpinnings.

Beck answered some questions about Rogers (a "benign figure") and recalled that Ellis had ridiculed him once for being that benign figure during a session, someone who listens quietly and then returns the client to the same $!%# situation at home or work.

The next question came from someone who said that after studying Beck's work for years, and the work of Ellis, he's concluded that "Ellis talks a lot about must-erbation being the rock-bottom dynamic" which drives dysfunctional behavior. Beck recalled that "years ago Ellis wrote in a book that MUSTerbation causes mental problems", but the proofreader caught the "error" and corrected it, with the resulting statement not at all what Ellis intended. Beck went on to point out that the whole concept truly dates to Karen Horney's "Tyranny of the Shoulds" (one of my most profound influences, too!). "I should do this and others should do that... and they're tyrannized!" Beck noted that "shoulds are not inherently bad. We should get up in the morning, for example. But...we need to focus on rigid thinking with *dysfunctional* shoulds". As opposed to Horney or Ellis, for himself Beck said that "our rock-bottom is *fear*. 'I must avoid this'.... With borderlines, they feel very vulnerable so they have a whole series of demands on other people. As a way of protecting themselves." He said he's known patients who have made a point of counting and cataloging a long list of "shoulds".

Question: What about outcome research suggesting a role for the therapeutic relationship?

Answer: The relationship is *obviously* important. It gets lost in the cognitive approach. When I wrote my first book, the very first chapter was 'The Therapeutic Relationship'. A sense of affiliation has been worked out as very important. But where does it come in? Do I need to prove how wonderful I am or is it a technical problem? One study demonstrated the positive regard did not come in until *after* the technique. Or in other words, after the patient begins to feel better and see the therapy is working, they begin to feel better and to feel better about the therapist."

Question: Any long-term studies? How are the results?

Answer:"With pharmacotherapy sometimes very good, but with cognitive therapy, for example with depression, the relapse rate is lower. With schiziphrenia too, if in combination with pharmacotherapy." A five year study at his Center found continued improved functioning at 5-years follow up, which is a "very strong track record".

Question: Any thoughts on the role of "mindfulness" as it impacts on treatment?

Answer: Based on research it does have an important role and it may even be that meditation, in general, does. We need to do a controlled study", one group receiving mindfulness training and teaching to "decenter", and compare it with a control group.

A question was posed: Noting that Ellis tends to deal with surface cognitions while Beck tends to go deeper, how might Beck deal with a client's consciousness of splitting, aside from addressing the "victim"" aspects. For example, DBT [See http://www.fenichel.com/behavior.shtml for a basic primer] as I now understand it, looks at the issues of control but also tries to teach skills to see how everything is *not* black and white, and that sometimes there are middle shades which can be stress-reducing and acceptable. [My question, and happy he said it was a good one!] :-)

Beck noted that "the Borderline can switch momentarily" so a careful approach is required. One approach which in fact Ellis might use is to "dimensionalize", to make something more dimensional than a simple good/bad judgement. For example, "I'm a terrible mother beause I forgot to give my child lunch today. I deserve to die". OK, maybe "I'd say, on a scale of 100, where are you" in terms of being terrible. She'd say 100. So then he'd ask, "What then would you be if you cut off your child's arms and legs?" The hope is to force some "dimensionalizing", teaching her to "think dimensionally rather than categorically". He added that he might also offer an alternative conclusion rather than the mother being terrible and deserving to die. "Maybe I just forgot" to pack lunch on that day.

Question: How have cognitive approaches worked with pain management?

Answer: "Let's say someone thinks (1) 'I have a terrible back ache. I can't work on the yard.' The more thinking about it, the more pain. The next step is (2) thinking 'I'm a bad husband'. Finally this escalates to (3) 'I'm a bad husband and I can't do *anything*, I'm no good.' And then often this person begins exclusively focusing on pain." He is exploring this and currently co-authoring a book about this.

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And that was that, Aaron Beck at the 111th APA convention, taking questions solo, while several times acknowledging Ellis too.

Next APA's award for outstanding lifetime contribution was given to George Miller, who was there to graciously accept it and again there was a musical interlude, this time featuring a fantastic folk music spectacle by the Maritime Dancers and Musicians ("Fig for a Kiss").

A tough act perhaps to follow, but with great enthusiasm and respect, Sternberg introduced the keynote speaker, best-selling novelist Stephen White. He was as engaging as was promised, spinning the story of his own personal experience ......

And now, this ends installment #1 of Asynchronously Live from APA reports for 2003.

Stay tuned!

Regards from Toronto, eh....
Michael

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Photo by Fenichel: Robert Sternberg at APA Opening Ceremony

Opening Ceremony

At the beginning of the ceremony, the audience was treated to music from the Amaro String Quartet. After assorted welcomes (Norman Anderson of APA, Patrick O'Neil of CPA, and Ester Cole of OPA), Dr. Robert Sternberg read a mayoral proclamation, proceeded to describe his priorities and vision, and outlined several initiatives he has launched.

He spoke with wit and wisdom on the issue of defining "intelligence" and shared how he might himself have been a total failure rather than a Yale graduate and renowned scholar if he had continued to believe the results of his group IQ tests.

Sternberg noted in passing how in the history of the APA, there have been only 2 cancelled conventions and they were both during World War II.

I would add here that the president of the Canadian Psychological Association was quite charming and witty. He noted that "the times are a changin'" such that Canada was once thought of by its neighbors as "a boring place". But recently "there was a war and we decided not to attend, and a President decided not to come up and see us. And then we had SARS and a *lot* of people decided not to come up and see us. But then things changed... The Rolling Stones came up and things looked good!" And right now they find themselves at the center of a religious/gay rights dispute. Not a dull place any more! Point taken.

Toronto is a nice city, clean, with friendly people... one of whom told me today I erred in my spelling of the well-known Canadian "ay" (as I wrote) -- it is properly spelled "eh". Mea culpa.

And here are some final notes on little-known facts which Sternberg shared in his introductory remarks. For those who wonder where this expression came from, it was in fact George Miller who coined the slogan, "giving psychology away", referring to the importance of promoting and sharing our cumulative knowledge with the general public. And the Celtic instruments played were a uillean pipe chanter and drones. O.K., eh?

And now.... Robert Sternberg, pre-eminent Yale University scholar in the areas of intelligence, cognition, and love, and 2003 APA President.


Sternberg's Vision for Psychology

Dr. Sternberg said that his Presidential Theme has been, "We Should Unify", and he's been working with the organization's governance structure to make this happen. He's presented a proposal for a task force to bring together science in practice, and has a book coming out in 2004 (APA Press) entitled "Unifying Psychology".

Sternberg has a few major changes which he'd like to see come about in our (American, insuror-driven) society, describing a roadmap for "Good practice for Practice". Components of good professional practice and systems would include:

• Therapeutic decisions by therapists (not managed care bureaucrats)
• Prescription privileges
• Parity in insurance payments
• Removing stigma
• Expanding the practice job market
• Lobbying by all psychologists [as a united voice, not only one faction]

Sternberg is also concerned about more civility in peer reviews and public assessment of colleagues. He continues to be a determined advocate for "no more savage reviews -- including by us!", noting the tendency to be uncivil at times, rather than polite, in reviewing others' work. "It is improper to attack authors rather than what's written", he said. Sternberg added that he has another new book he's writing titled "Reviewing in Psychology".

Speaking of civility versus aggression, Sternberg shared that he has become generally more interested in the phenomenon of hate since the 1990's. He sees 3 primary components in the type of hatred which can consume whole regions and/or lead to the type of thinking commonly seen with "terrorists".

The 3 components of hate:

1. Negation of intimacy: "The hated group is less than human.... vermin.... and one can't even imagine intimacy" with such people. This is the thing that hate propaganda tries to foment."
   
   
2. Passion: "Unless you extinguish them.... it's us or them!"
   
   
3. Cognitive commitment to hate:"You take over the young people's education and a new history is created."

Sternberg added that "What I believe is that wise people don't hate".

With that, he segued from propaganda to talking about other closed systems, such as education and IQ testing, which have not been entirely successful in creating wise people, or identifying them.

Sternberg shared that his own motivation for studying intelligence and IQ so deeply was "motivation". His bias came, he said, from "doing poorly on group IQ tests". Like Zimbardo, he ribbed, he too only got a "C" in Intro to Psychology and had continuously low self-expectations.

"Our society is squandering the talents of young people, to their detriment and to the detriment of society." Why? Because of many bright minds not even recognized, and perhaps mislabelled as very slow because of standard test scores, or " ...because they're not really good book memorizers or lecture memorizers". Yet he noted there surely is "lots of overlap between IQ and achievement".

Sternberg went on to say that "closed systems work the same way, across societies, with family, religion, socially-defined race or ethnic group, and physical characteristics" (e.g., attractiveness and height). So, he concluded (tongue in cheek, demonstrating the lack of easy answer), "My own preference is to get away from all this subjective junk and go to height! [as a standard measure for potential in life] You can't cheat! If you wear elevator shoes you'll get caught. You can't *buy* your way in..." Please don't send him hate mail, height-challenged readers! He was joking to illustrate the difficulties with rigid standards!

"We have to be very careful of the closed systems we create! So, [in his own school experience, doing poorly on group IQ tests], they treated me like a loser, so I acted like one. I was dumb, and everyone just thought that too." Now he has a new idea about testing for potential to be successful, which he dubbed "successful intelligence".

"Successful intelligence is the ability to succeed in life, according to your own definition of success, within your sociocultural context".

Sternberg went on to propose a new set of "The 3 R's: Reasoning, Resilience, and Responsibility". And... (sorry to say this so often but...) he has another new book coming out, on Successful Intelligence. But this one is *not* being published by APA. ;-)

Future directions?

He's trying to create a partnership to transform education in the US. So many people would wish him well. (I wonder if he's partnering with Mel Levine?)

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Next APA's award for outstanding lifetime contribution was given to George Miller, who was there to graciously accept it and again there was a musical interlude, this time featuring a fantastic folk music spectacle by the Maritime Dancers and Musicians ("Fig for a Kiss").

A tough act perhaps to follow, but with great enthusiasm and respect, Sternberg introduced the keynote speaker, best-selling novelist Stephen White. He was as engaging as was promised, spinning the story of his own personal experience ......

PS/PD Apologies for any typos... late at night and long days!

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Note: Sorry it's taken a while between posting them to the lists and/or writing the reports, but... I've been travelling out of the country and a long way from Cyberspace. But I'm home now, and more articles are coming. Enjoy!


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