| Developing
possibilities for action
• Our recommendations are a best guess based on knowledge
of groups
• Feedback from the person based on the expert knowledge they
hold re themselves to develop optimum possibilities for them
Clinical recommendations involve making a best
guess based on emerging knowledge of the person consulting us and
a breadth of knowledge about other people from our experience, training,
reading, etc. Our information is based on probabilities. Thus feedback
from the person is very important, to the initial ideas and as treatment
progresses as to how it is going. This can be framed in a way which
values personal knowledge:
- “I have a lot of knowledge about depression in general
but am only just getting to know you. You know you. So it will
be very important in sorting out what is likely to work best
for you to hear your feedback. "
- “From my experience, what people have told me and international
research, the most likely thing to help someone in a situation
like this is X, Y, Z. What do you think of the sound of them?
What do you feel most interested in engaging in an experiment
with? It will be important for you to let us know how it is
working for you.”
Talking
about medication
• Engage in risk- benefit analysis
• Beware overstating level of certainty we have re effectiveness
of medicine
Overstating the level of certainty we have regarding
the effectiveness of medication is particularly tempting. Few of
our medications (except stimulants for ADHD) give a benefit in randomized
controlled trials to more than one in three people. Randomised controlled
trials can be explained, with the proviso that not everyone in the
treatment got better and that some of the people in the placebo
group got better. The person can then engage in a risk-benefit analysis
around whether or not to engage in a trial to establish whether
they are one of the people who will benefit. (Empirical research
on the effect of this approach on the placebo response would be
of interest.) |
