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From Symptom to SynapseReview - From Symptom to Synapse
A Neurocognitive Perspective on Clinical Psychology
by Jan Mohlman, Thilo Deckersbach and Adam Weissman (Editors)
Routledge, 2015
Review by Maura Pilotti
Sep 8th 2015 (Volume 19, Issue 37)

In From Symptom to Synapse: A neurocognitive perspective on clinical psychology, Mohlman, Deckersbach, and Weissman discuss the likely future of clinical psychology.  The latter illustrates a shift from a discipline whose goal is to understand and address dysfunctions of the mind and behavior to one that is focused on understanding and addressing brain dysfunctions seen as underlying 'abnormal' cognitions and actions. Of course, the future of this field is a meandering journey that originates from scientists and practitioners who have acknowledged not only the weaknesses of current assessment and intervention practices, but also the advances made in the study of neurocognition. Their actions are guided by a sincere desire to add a robust scientific foundation to the field.  Their ultimate goal is to lead clinical psychology to adopt a truly interdisciplinary approach, whereby mental disturbances can be examined at different levels of analyses (i.e., genetic, neural, cognitive, behavioral, and social), hopefully integrated into a unified and inclusive conceptual framework.  Yet, it is a journey that is at its early stages and resistance to change (including content of training of future practitioners and current practice) is still palpable. Thus, please allow me to offer some insights into the controversies that have plagued the field and, as a result, have questioned its credibility and spearheaded calls for change.

Clinical psychology is a field that has relied on knowledge of abnormal psychology for treatment applications.  Since its inception, the field has been marked by controversies and challenges. Nothing has endangered more controversy though than attempts by scholars and practitioners to define the diverse manifestations of 'abnormal functioning'.  For instance, the validity and reliability of the diagnostic criteria and categories contained in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which has been published in 2013 by the American Psychiatric Association (APA), have been questioned by many as based on imperfect consensus about clusters of clinical symptoms (as opposed to objective laboratory measures), weak research and bias (see Koukopoulos & Sani, 2014; Rhebergen & Graham, 2014; Frances, 2014; Freedman et al., 2013; Greenberg, 2014; Insel & Lieberman, 2013; Lane, 2013). Thus, the most recent classification system, which now contains 541 diagnostic categories compared with the 128 of the first edition of the manual (1952), not only has failed to silence concerns regarding its scientific foundations, but also has led the National Institute of Mental health (NIMH) to deny funds to clinical studies that rely exclusively on the DMS-5 criteria.  Not surprisingly, the DSM-5 has maintained two powerful competitors: the International Classification of Disorders (ICD) supported by the World Health Organization and the Research Domain Criteria (RDoC) proposed by the National Institute of Mental Health (NIMH). The latter is currently more of a work in progress than a complete product, but one that captures most closely the future of clinical psychology if the field is to survive criticism and acquire firm scientific credentials. In fact, RDoC is an explicit attempt to ground mental health diagnoses in data about the human brain, including contributions from a variety of research areas (e.g., genetics, physiology, neuroimaging, cognitive science, etc.). Albeit concerns exists that a classification system where mental disorders are conceptualized as brain disorders may unduly enhance scientists' attention to biology at the expense of environmental and psychological factors (see Lane, 2013), its scientific foundation remains a considerable improvement over an approach largely based on consensus about patterns of symptoms expressed by a preselected group of experts (as exemplified by the development and testing of the DSM-5). 

Besides the widespread concerns about the scientific foundations of diagnostic criteria and categories, another concern that has endangered clinical psychology for quite some time is the need for evidence-based (i.e., empirically supported) assessment techniques and treatment interventions (Lilienfeld, Lynn, & Lohr, 2015). For instance, although a plethora of psychological tests are available to mental health professionals for assessment purposes, and standards exist for test development and administration, the vast and complex literature on psychometrics often makes it difficult for mental health professionals with little scientific training to discount tests that do not meet the basic standards of reliability and validity, especially when such tests are rather popular (see Rorschach Inkblot test).  Furthermore, although more than 400 types of therapeutic interventions exist (Wedding & Corsini, 2014), evidence of their effectiveness is not always available. In some notable cases, evidence collected does not support claims of the effectiveness of some techniques or even suggests potential harm (see rebirthing therapy and guided imagery).  When evidence appears to point to favorable effects, the critical issue remains how objectively to define and measure effectiveness (improvement over no treatment or placebo).  Can testimonial and anecdotal evidence provided by clients, friends, relatives, and mental health professionals be sufficient?  Consider that clients' desire to leave therapy, need to justify investment of effort and money, and the quality of the relationship with the therapist are likely to bias perceptions of all parties involved (including both clients and therapists).  Thus, if measurement is to support claims that can be trusted regarding the outcomes of a treatment, dependent measures are to subscribe to the principles of the scientific method. In science, irrespective of the specific field, measurement that is devoid of biases is the gold standard. Case studies of successful treatment interventions, albeit abundant, tend to fall short of it.

Although the content of From Symptom to Synapse stems from controversies pertaining to the effectiveness of existing modes of assessment and intervention, it focuses on the extent to which assessment and intervention of psychological dysfunctions can be improved by knowledge of neurocognition and neurocognitive tools. Undoubtedly, the demand for a novel approach to mental illness where brain sciences take the center stage has succeeded to grow from a whisper to a loud and articulated message. From Symptom to Synapse is an exemplification of the progress made. The introductory chapters offer a glimpse at the role that neurocognition can play in clinical psychology seen as an interdisciplinary field shaped by scientific findings concerning brain, cognition, and behavior. The key part of the text is organized into chapters devoted to specific psychological disorders (e.g., anxiety disorders, depression, schizophrenia, bipolar disorder, etc.). At times, disorders are examined in different age groups (children, young adults and older adults), thereby offering a lifespan perspective to the study and treatment of mental illness. Irrespective of the specific content, the text is well-written, bursting with valuable findings and punctuated with references to not only the limits of current knowledge, but also future opportunities. As such, the text can be successfully added to the reading list of graduate courses in abnormal psychology and clinical practice to recognize the changing nature of a field and enhance the training of future mental health professionals.  The clarity of its narrative makes the work even suitable to undergraduate courses and of interest to all readers who want to deepen their knowledge of forms of mental illness, and become aware of sensible practices of assessment and intervention. All in all, it is a good read. 

 

© 2015 Maura Pilotti

 

Maura Pilotti, Ph.D., Ashford University


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