Christopher J. Combs, Ph.D.

Wednesday, May 5th

La Salle and LaSalle

The diploma mill LaSalle made the new yesterday. It seems a number of teachers have obtained higher salaries by submitting advanced degrees from less-than-reputable universities. Both Philadelphia's La Salle and Louisianna's LaSalle are mentioned, about two-thirds through the article.

Christopher J. Combs, Ph.D. on 05.05.04 @ 07:24 AM EST [link] [5 Comments]

Monday, May 3rd

Final Exam - Multiple Choice Answers

1. c (duty to protect by warning - wording from the case)
2. c (specifically or readily identifiable - wording from the case)
3. d (a report is mandatory in PA only if the child comes before you in your professional capacity)
4. d (this is the only case where there is a statute of limitations in the CPSL - I threw out this question because I realized I didn't cover this aspect of the child abuse laws in this year's class, i.e., confused myself)
5. d (2 years, 30 CE credits, including 3 credits in ethics)
6. c (2 years - everybody knows this)
7. a (because the dissertation is intended to show the capacity for independent work, the student in almost all cases should be listed as first author; this new parr of the Code is to help students avoid exploitation)
8. b (test data - now defined as anything with the client's responses, scores, or notes about the client on it, even if it includes copyrighted questions or instructions)
9. b (HIPAA)
10. d (Jaffe v. Redmond)

Christopher J. Combs, Ph.D. on 05.03.04 @ 06:40 AM EST [link] [8 Comments]

Friday, April 23rd

I Need This Like Another Hole in the Head

Remember when I told you about how they used to do studies of cardiac bypass graft surgery by performing sham surguries on those assigned to the control group? Well, here's a summary of an article looking at the effects of fetal tissue implants on Parkinson symptoms. It appears that much, if not all, of the improvement can be attributed to the placebo effect. But mainly, I thought you would like to hear about patients in the control condition:

"NEW YORK (Reuters Health) Apr 22 - In a double-blind, placebo-controlled trial of fetal tissue transplantation for the treatment of Parkinson's disease (PD), clinicians and patients both reported greater improvement when they believed the patients were in the active treatment arm of the study.

"The results of the first double-blind study of embryonic dopamine-neuron transplantation for PD suggested some improvement with active treatment. Both groups received four burr holes in the forehead. In the sham treatment group, however, needles did not penetrate the brain."

Its seems that almost all of the patients, having received the burr holes and needles, were convinced they were in the treatment condition. Also makes you wonder about the effectiveness of the informed consent.

P.S. To read the article, registration at Medscape may be required.

Christopher J. Combs, Ph.D. on 04.23.04 @ 06:42 AM EST [link] [7 Comments]

Monday, April 5th

VIP Clients

Two items from the past week that discuss the benefits of disengaging from insurance and managed care for patients. Yesterday, the Associated Press published a story, Some Doctors Choosing Cash Over Insurance, describing a small number of doctors who have opted out of traditional insurance plans, letting them spend more time with patients and do medicine the way they always envisioned it. By dispensing with insurance, they argue, they are able to make roughly the same amount per office visit, because they save on the time it takes to fill out all the paperwork and the clerical time to file it and pursue reimbursement. The most interesting claim was that users of these cash-only doctors weren't restricted to the upper class; most clientele were from the middle class.

Lynn Grodzki, LCSW, the author of Building Your Ideal Private Practice, publishes a monthly newsletter on private practice issues. This month's lesson deals with Very Important Clients. She suggests converting some of your clients to full fee (i.e., no insurance), and by doing so, offering added benefits: no waiting for appointments, full attention from the therapist during sessions, and a therapist who is able to keep up with the last techniques because of extra time to engage in continuing education.

Here's how she presents it:

"Once you decide to have a VIC full-fee practice, you can educate
others, both new and existing clients about your service.

"When a new client calls asking, 'What do you charge? Will you take my
insurance? Do you offer a sliding scale?' let this person know that
you only accept clients who can pay your full fee.

"Then add a piece of education, by saying, 'My fee reflects the
special services that I provide. I keep my caseload small to give
extra attention and care to everyone I see. I also maintain a
dedicated level of expertise through continual training, so that my
clients get the advantage of the most recent research and techniques.
I offer a calm, healing environment, another benefit for my clients.'"

It's an appealing idea, for sure, but it begs the question (at least in my mind): Shouldn't all of our clients be VIP clients?

Christopher J. Combs, Ph.D. on 04.05.04 @ 06:26 AM EST [link] [8 Comments]

Monday, March 29th

The New School

There is a new movement among some philosophers to provide counseling, according to last week's New York Times. "A controversial new talk therapy, philosophical counseling takes the premise that many of our problems stem from uncertainties about the meaning of life and from faulty logic." Evidently, those espousing and practicing from this new model do not have any formal mental health training, although if you were converted by the Dawes chapter, you may not be so concerned about this, seeing as a formal degree or experience hasn't been shown to correlate with clinical outcome.

Christopher J. Combs, Ph.D. on 03.29.04 @ 06:43 AM EST [link] [8 Comments]

Wednesday, March 24th


A summary of an article from JAMA (the Journal of the American Medical Association) that indicates many people have difficulty understanding the concept of randomization when agreeing to participate in a clinical trial.

In this case, parents were recruited to enroll their children in a clinical trial for the treatment of leukemia. Even though 83% of doctors explained the idea of randomization in providing informed consent, as determined by audiotaping the conversations, about half of the parents who were interviewed right afterward did not understand the concept. Disadvantaged groups were particularly susceptible to an inadequate understanding.

As we discussed in class, part of the problem may be in the language used by doctors and researchers. It's difficult for them to remember and then consciously modify their language to the level of the patient's abilities. I'm sure many, if not most, patients are unwilling to interrupt or question doctors when they don't understand, out of respect or just not wanting to appear stupid. Another factor, I'm sure, is that most people want to hear they are being tested with a new, more powerful treatment, and they are hoping for a magical cure. As a result, it's hard for them to hear and internalize the idea they could be assigned to the no-treatment or standard treatment control group.

Christopher J. Combs, Ph.D. on 03.24.04 @ 06:36 AM EST [link] [24 Comments]

Tuesday, March 23rd

The Other Est

Information about charasmatic Werner Erhard and est from both sympathetic and critical sources.

Christopher J. Combs, Ph.D. on 03.23.04 @ 06:57 AM EST [link] [5 Comments]

Seizing the Moment

With yesterday's announcement by the FDA warning doctors to monitor their patients on SSRI anti-depressant medications for suicidality, it would seem like the perfect time for the American Psychological Association to step forward and promote psychotherapeutic methods of treating depression and other disorders.

Except I guess you can't do that convincingly if your official position is to advocate for prescription privileges.

Christopher J. Combs, Ph.D. on 03.23.04 @ 06:49 AM EST [link] [4 Comments]

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