CSU (csu@brain.wph.uq.oz.au)
09 Feb 1995 09:17:40 -0500

> A very neat example, and one which demonstrates the kind of
>decision making that drove some (of us) clinical psychologists
>out of the applied world into the safer world of theory
> Obviously, considering the social context in which we
>operate, you can call together the diagnostic team, label him
>as PARANOID SCHIZOPHRENIC, and feed him some neat chemicals
>which will "cure" his "disease." Of course, I envision a
>different world in which we see him more as you protray him --
>a person who does not respond to our invalidation of his self
>role definitions. Let's start with that.
> Who offers the RIGHT construction of his self role???
>Wow.... not me, not you, not him. Now we have a real dilemma!
>How about not worrying about who can offer the RIGHT definition?
>Why hestitate to regard it as a matter of working from a
>construction which will fit the context? And why not set up a
>rule something like this -- "If you can't get six people to
>validate your self definition, in actual social interactions,
>we must keep you under supervision. When we come down to it, do
>we act on a rule something like this???
> I look forward to your response???~!!!
> Jim Mancuso

Jim (though thanks to Jon and Devi for their comments and Beverly
for her comments/reference which I will chase up), my response is
as follows:

Can you elaborate what it means to work "from a construction
which will fit the context"? an issue Devi commented on.
In essence, staff are stating that Bill remains institutionalised
unless validation of his being well and calm occurs. How and
under what circumstances these dimensions are construed by 6
different individuals remains problematic (this also raises the
complex question of agreement). I believe key issues in Bill's
release will be his behaviour and/or the in/validation of the
institutional narrative concerning Bill. An effective team would
be able to harness the diversity of member's views as well as
viewing the totality of Bill, past, present and future (in
contrast to a review which focuses on the construction of Bill
around an assault and threats he made in 19whenever).

Beverly referred to usefulness: the question can be posed, in
whose interests is it that Bill be released. His local community
and probably a large segment of society would not see his release
as useful and would support the framework and authority provided
by the law for such decision making (in/validation). This is not
to suggest these views are "right", nor that the outcome of the
team prediction is "right" (more of this second issue later)

Some other thoughts:
1)the distinction made between applied and theoretical work
is an interesting one. My first job as a social worker was with
100 or so people who were in a long stay institution. My
professional training really did not greatly assist me in
responding to these folks. I largely attributed this to the
difference between ideas and practice, whereas I still see
colleagues from various disciplines who only identify the issue
as people not being suitable for rehab/ being unable to learn or
2)as I perceive it, a major challenge facing the clinican
sympathetic to PCT, is that in the sphere of public mental
health, services/society requires decisions be made about people.
There is talk of a "consumer" focus, though legislative
requirements still demand non-consensual RIGHT decisions which
can and do affect the lives of people. The consequences of
"wrong" decisions can wreck professional careers/ client lives.
3)I believe Paul Meehl was a contemporary (and Minnesota
"neighbour) of George Kelly. He wrote a very long paper "Why I
do not attend case conferences". Meehl has been critical of
clinical judgment and elsewhere wrote:

... we have no right to assume that entering the clinic has
resulted in some miraculous mutations and made us free from the
ordinary human errors which characterised our psychological

An example relevant to PCT concerns the contention that
anticipation/ prediction is based on likeness/difference.
Support for this view comes from judgment research into the
representative heuristic (Kahneman and Tversky). However, this
research also suggests that such representative-based prediction
may be flawed because the likelihood of an event occuring is
often ignored: eg, Bill and Ray may be construed as alike. As
Ray killed a relative upon release, staff construe Bill as
equally dangerous, despite it being unlikely that Bill would act
in this manner.

For my part I try to no longer impress upon others the rightness
of my views, while at the same time not swallowing all I am told,
by colleagues or by Bill. Rather than argue I am right because I
said it I prefer to adopt a "scientific" approach, i.e carefully
give Bill opportunities to test his/others' constructions. I
also believe it is incumbent on those in positions of
responsibility to examine their own processes and the perceived
basis of their predictive ability. Similarly, though perhaps not
carefully, I am currently putting to a test my constructions.

Bob Green.