Psychotherapy Blog

 

Statistics Don't Lie...Except When They Do

Posted by Howard Rosenthal, EdD on 9/22/15 - 2:27 PM
As I was working on my doctorate I became interested in home stereo amplifiers. Armed with a fellow doctorate student who possessed infinite knowledge in this area I began the search for the perfect amplifier.

My interest rapidly escalated into what could arguably have been diagnosed as a full-blown obsession. I visited stereo stores near and far. I read an endless stream of articles in the stereo magazines. I spoke with salesmen, saleswomen, and manufacturer's representatives. I attended stereo conventions. But most of all, I kept my eyes on the specifications of the various units. Ah yes, the statistics. Show me the evidence! My fellow grad student warned me not to put very much stock in specifications claiming that good numbers don't always translate to superb sound, but I knew better.

Statistics told the whole story. Finally, after nearly three years of nonstop research and spending at least as much time picking out a stereo amplifier as I did on my studies (okay, maybe a hairline more), I purchased a unit with "seriously good specs." A unit with triple digit distortion of .005—so low your dog couldn't hear it.

I hooked the unit up and to my chagrin, it sounded tinny! Convinced it was my speakers, I replaced them. It still sounded thin. (Stereo talk for tinny.) I bought speaker wire that cost more than my wardrobe and cables with a thickness rivaling my wrist measurement. No improvement was noted.

On a whim I purchased a used bargain basement priced amplifier for less than a twenty dollar bill at a pawn shop. To me it sounded much better than my expensive model. I could blame it on my hearing at the time except that everybody who auditioned the two amplifiers like the old cheapie with the "crummy specs" better.

While struggling with my stereo amplifier addiction I was able to secure my doctorate and a few years later I landed a job as a program coordinator at a major metropolitan suicide prevention center.

Because suicide was the one of the top three killers of teens (it still is) and one of the top ten causes of death for all age brackets (here again, it still is) I gave lots and lots of suicide prevention speeches. I often responded to crisis situations at schools, churches, and even major corporations, and helped run a suicide survivor's group for those who lost a friend or loved one. This continued even after I left the center. I stopped counting when I had lectured to approximately 100,000 people on this life and death topic including quite a few seasoned psychotherapists.

My point is merely that my lectures and professional activities allowed me to meet literally thousands of people who in some way, shape, or form, had been touched by the act of suicide or a suicide attempt.
Now one of the key points in my lectures was to tout the benefits of a suicide prevention contract or what experts and ethical bodies would later dub a "no suicide contract."

But, enter statistics or evidence-based practice (EBP) also known as evidence-based treatment (EBT). According to the purveyors of these numerical meta-analyses, suicide prevention contracts don't work. Even some major suicide prevention organizations and top experts in the world have adopted this stance.
What? Really? You're kidding, right? Tell that to the over-the-road truck driver who approached me after a public speech to share that he was only alive today because his eighth grade shop teacher made him sign a suicide prevention contract. Tell that to the woman in one of my college classes who volunteered that she would not be in my class if it had not been for a caring high school guidance counselor who insisted she sign a no-suicide contract in her sophomore year. "I'm a woman of my word," she told me. And what about the woman in group therapy with me who pulled a no-suicide contract out of her purse to show me. The white paper was yellow inasmuch as the document was now over 25 years old. "This saved my life," she said with tears in her eyes.

These are just three of the many cases I heard over the years. I could go on, but I think the point is obvious. Even if you can show me 100 more cases, or even 1000 where contracts didn't work, I will show you the ones where these simple contracts clearly did. Science is often what works and if a contract saves a single life then it was worth it.

Now in defense of the EBT crowd who renounces these contracts, many experts do recommend a beefed up version of the document called a safety plan. Others in this camp prefer a commitment-to-treatment document. Yes, safety plans and their second cousins, commitment-to-treatment plans, are possibly superior. But in the real world there are often times when a clinician does not have the luxury of drafting a long, drawn out, document.

In such instances, a therapist or hotline worker should do his or her best to get a short verbal, or better still written, no-suicide contract. I personally think it is downright unethical not to use the old tried and true contract. And my fear is that if we teach upcoming professionals this information they may well do nothing if they don't have the time or information to draft a full-fledged safety plan when a life is on the line.
If the average shoe size is statistically an 8M and you wear a 6W would you buy the 8M? Well, would you?

Statistics don't lie . . . well, except when they do. And a life, unlike a shoe size or a brand of stereo amplifier, is too valuable to base on a few research studies that could easily be refuted in the coming years.

The British Prime Minister, Benjamin Disraeli once quipped, "There are three kinds of lies: lies, damn lies, and statistics."

I think the Prime Minister might have been on to something.

Comments

Statisitics Don't Lie

Submitted by Heather Murphy on 10/3/15 - 12:44 AM
It is irresponsible to promote an ineffective method of suicide prevention and to justify it by claiming that you don't have time to do what is known to work. Most any undergraduate or graduate student is trained in the basic idea of not relying on anecdotal evidence above research, but apparently that has been forgotten here. This posting is acting as if the main take away message from the research advising against using suicide contracts is saying to do nothing at all in place of the contract. Of course we still need to act. It is not a matter of "luxury" but an ethical obligation to do the best practice of completing a full suicide assessment, creating a safety plan, and following up with commitment. That commitment goes well beyond the suicide contract of "sign your name on the dotted line [so that I can sleep easy tonight.]" And even in those instances that there is not time to do a full assessment, a safety plan and commitment can be worked out in about the same amount of time that you are coercing someone to sign their name to that contract.
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