GAS (Goal Attainment Scaling in Rehabilitation), GAS-light, and gaslighting.

Jonathan Edwards said:
To the treatment.

A priori just means first in Latin. It is a term of art in epistemology, as you say, but it is perfectly obvious what it means in this context if you know Latin.
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Though in current (or at least relatively recent, given my knowledge is decades out of date) scientific discourse ‘a priori’ has come to mean ‘from first principles’ or to work out an answer by logic from an established theoretical understanding or agreed premises, rather than by experimentation, which makes the use of it in this context more ambiguous.
 
Maybe Turner-Stokes thought she was being funny, like Esther Crawley and co obviously did with this
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Though Turner-Stokes may not have deliberately intended the double meaning of gas-light in this context and though it was in less popular use at that time, the pejorative sense was still reasonably widely understood, so its use in this context implies at the very least a casual disregard for potential patient sensibilities.

I would argue this reflects a pervasive callousness in this field where patients’ thoughts or feelings come a far second to researcher and clinician achievements based on an approach that presupposes the patients just don’t understand what is happening.
 
Jonathan Edwards said:
Perhaps the rehabilitationists should think about how they would begin to explain how evidence for trainmen of complex conditions should be assessed for reliability.

I think they would find that reliability is not something that moves about with criteria. Something is or is not reliable evidence. By and large to be reliable evidence you need a control of some sort. And if you are making controlled observations you would do well to randomise. And if you cannot blind then an objective measure will be needed.

What am I missing?
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GAS is conceptually different from standardised measures – if interval measures may be described as measuring with „a straight ruler‟, and ordinal measures as „a piece of string‟, then GAS is the equivalent of measuring with a piece of elastic. Many clinicians reared in the tradition of rigorous and objective measurement struggle with this concept.

From: Lynne TS piece on Goal Attainment Setting and GAS_lighting p6
https://www.kcl.ac.uk/cicelysaunders/attachments/tools-gas-practical-guide.pdf
 
MEMarge said:
GAS is conceptually different from standardised measures – if interval measures may be described as measuring with „a straight ruler‟, and ordinal measures as „a piece of string‟, then GAS is the equivalent of measuring with a piece of elastic. Many clinicians reared in the tradition of rigorous and objective measurement struggle with this concept.

From: Lynne TS piece on Goal Attainment Setting and GAS_lighting p6
https://www.kcl.ac.uk/cicelysaunders/attachments/tools-gas-practical-guide.pdf
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I would argue there is a place for flexible outcome measuring based on specific patient agreed objectives for short episodes of rehabilitation or intervention, as it can turn a long haul into lots of smaller steps hopefully meaningful to the clinician and the patient.

In such situations it does not matter that this does not fit onto an objective linear scale, however such should be placed in the context of more robust and communicable measures when evaluating the efficacy of the whole intervention or rehabilitation process.

(Added - For example, when working over several years to integrate an electronic communication aid into a nonverbal individual’s communication, at times you might have fairly concrete objectives like being able to request a desired drink in prespecified situations but at other times your objective might be getting the person comfortable with taking it on visits to their grandmother, but not getting too upset if she has problems with understanding the synthetic voice. However overall you need more objective communicable measures than just achieved x number of patient agreed goals in evaluating the efficacy of the aid in the individuals overall communication.)
 
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MEMarge said:
GAS is conceptually different from standardised measures – if interval measures may be described as measuring with „a straight ruler‟, and ordinal measures as „a piece of string‟, then GAS is the equivalent of measuring with a piece of elastic. Many clinicians reared in the tradition of rigorous and objective measurement struggle with this concept.
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Sounds like GAS is the right description then.
 
MEMarge said:
GAS is conceptually different from standardised measures – if interval measures may be described as measuring with „a straight ruler‟, and ordinal measures as „a piece of string‟, then GAS is the equivalent of measuring with a piece of elastic. Many clinicians reared in the tradition of rigorous and objective measurement struggle with this concept.
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But that is OK. You can do all sorts of things like that as long as you do it in a way that cannot be tinkered with later. GAS-light allows tinkering so that really is useless for gathering reliable information.
 
Peter Trewhitt said:
Though in current (or at least relatively recent, given my knowledge is decades out of date) scientific discourse ‘a priori’ has come to mean ‘from first principles’ or to work out an answer by logic from an established theoretical understanding or agreed premises, rather than by experimentation, which makes the use of it in this context more ambiguous.
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That is the epistemological term of art usage, argued about by Hume, Leibniz, Kant and Quine.
I was brought up as a scientist understanding a priori to be usable to mean decided or known in advance of some event (first) in a more general sense.


https://ludwig.guru/s/a-priori+stipulation

Sentence examples similar to a-priori stipulation from inspiring English sources

SIMILAR ( 8 )
But whether that is so should be settled by empirical investigation rather than by an act of a priori stipulation in survey design.
 
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JemPD said:
I first heard of the gaslighting term in the mid - late noughties, but it was then very 'localised' to fields of domestic abuse etc, and was only ever used to mean what it was originally coined for - what the husband did to the wife in the movie - ie an abuser trying to convince the victim that they are going insane/losing their grip on reality, for the benefit of the abuser - usually to gain power/control.
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Now more formally called 'coercive control' which I think accurately describes the brainwashing aspect of directive CBT and LP that persuades people to see real and disabling symptoms as 'normal'.
 
IT's my understanding that Coercive control may, or may not include gaslighting. Coercive control - Womens Aid

I would agree that the aspect of CBT for ME that seeks to make the patient doubt their own experience, to believe that the sensations they are experiencing as sensations of illness, are normal healthy sensations, until the patients accepts that their perception of reality is wrong, their own perception is unreliable & to take on the reality of the therapist, is a form of gaslighting.
I certainly term it as such.

However I generally term that CBT/LP as 'unintentional gaslighting' because in many if not most instances, the therapist (who is operating far downstream of the ideology that created the therapy they are delivering) believes that they are correct - they have been taught that there is categorically nothing organically wrong & they genuinely believe they are helping.

So there is a key difference there - an abuser who is manipulating you to make you think you are insane, so they can (for example) steal your money, is quite different than a person who genuinely (however wrongly) believes you are delusional & is trying to assist you to see reality.

Unfortunately the effect on the victim/patient is just the same.

N.B. I'm not suggesting that therapists who do that are absolved from responsibility, just that intentional gaslighting has to be where the person doing it knows full well that the victim is indeed perceiving reality accurately & is perfectly sane. That is the behaviour of the abuser in the movie Gaslight, from whence the term originated.

This is a hot button topic for me & i'm supposed to be resting up for something nxt wk, so i likely wont be back to respond (should anyone disagree/want to discuss further) for a wk or so - otherwise i will get all adrenalined up again & not be able to rest :)

Edited - to remove something personal in last paragraph
 
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MEMarge said:
GAS is conceptually different from standardised measures – if interval measures may be described as measuring with „a straight ruler‟, and ordinal measures as „a piece of string‟, then GAS is the equivalent of measuring with a piece of elastic. Many clinicians reared in the tradition of rigorous and objective measurement struggle with this concept.

From: Lynne TS piece on Goal Attainment Setting and GAS_lighting p6
https://www.kcl.ac.uk/cicelysaunders/attachments/tools-gas-practical-guide.pdf
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I think lots of the questionnaire stuff is like measuring with a ruler where each of the marks are placed at random intervals but numbered consecutively (a bit like a piece of elastic I guess)
 
Someone (on Twitter?) said:
"It’s inconceivable that psychiatrists don’t know the meanings and associations of these words so they either did it on purpose or don’t care."
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It really is, though. It's far from a new concept, especially in psychology. I mean, really, especially so in psychology. It's not even half-believable.

It's more stupid than anything, these people have shown themselves to be that clueless, but also shows how detached from reality they are, that they simply can't even factor in the patient's perspective even one bit and regularly say offensive things without understanding that it's wrong to do so.

This is coming from people who call us muppets, who aggressively work to classify ME as a common mental disorder then pretend they mean nothing by that, it's fully on brand that they simply cannot comprehend that being offensive is wrong. They do is so naturally it even comes out in official writing, same people who see nothing wrong with calling us bastards who just don't want to get better.
 
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Trish said:
Now more formally called 'coercive control' which I think accurately describes the brainwashing aspect of directive CBT and LP that persuades people to see real and disabling symptoms as 'normal'.
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Gaslighting is one 'technique' used by abusers to establish control. Gaslighting is specifically denying the victim's reality in order to make them feel like they are going mad and so start to doubt themselves and their own judgements. It includes making other people think that the victim's judgements are unreliable and that their version of events can't be trusted. Coercive control is a term to describe the wider pattern of behaviours that abusers use to coerce and control their victim.
 
rvallee said:
It really is, though. It's far from a new concept, especially in psychology. I mean, really, especially so in psychology. It's not even half-believable.

It's more stupid than anything, these people have shown themselves to be that clueless, but also shows how detached from reality they are, that they simply can't even factor in the patient's perspective even one bit and regularly say offensive things without understanding that it's wrong to do so.

This is coming from people who call us muppets, who aggressively work to classify ME as a common mental disorder then pretend they mean nothing by that, it's fully on brand that they simply cannot comprehend that being offensive is wrong. They do is so naturally it even comes out in official writing, same people who see nothing wrong with calling us bastards who just don't want to get better.
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I didn't say the following, myself:

It’s inconceivable that psychiatrists don’t know the meanings and associations of these words so they either did it on purpose or don’t care.
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someone on Twitter did. Can you adjust your post so that it's clear I was quoting someone else, please?
 
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Tia said:
I think the use of the term GAS-light is darkly ironic given the way that it's author behaves towards patients but personally I think it is unlikely that it was knowingly used.
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I've been trying to find the earliest references to the development of the "GAS-Light" modification.

The "GAS-Light" document on the KCL page was created in June 2012.


Extract from:

Turner-Stokes, L., Williams, H., Sephton, K., Rose, H., Harris, S., & Thu, A. (2012). Engaging the hearts and minds of clinicians in outcome measurement - the UK Rehabilitation Outcomes Collaborative approach. Disability and rehabilitation, 34(22), 1871–1879. https://doi.org/10.3109/09638288.2012.670033

"Within UKROC, we have developed a simpler, more user-friendly approach to GAS, which we have called the “GAS-light” model, or “GAS without tears” [37] for use within the clinical setting. In this model, we have sought to “de-myth” GAS. It is simply applied as an integral part of the normal clinical process for goal-setting and review, without the need for additional steps, other than simply entering the information into the UKROC software.

  • Instead of pre-defining all five levels, the team draws up a SMART definition just for the expected level of achievement (0 score). The level of achievement is then rated by the patient and team at the end of the programme, using the expected level definition at the reference point.

  • Instead of using the −2 to +2 numeric scale, clinicians are presented with a 6-point verbal rating scale, which includes the option to record partial achievement.

  • This is then converted back to the 5-point numeric scale by the computer software, which also automatically calculates the GAS T-Score.
etc.


37. Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23:362–370. [PubMed] [Google Scholar]


(So evidently the "Light" version of GAS was developed prior to 2012.)

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https://natspec.org.uk/therapy/tools/goal-attainment-scaling-in-rehabilitation/

Goal Attainment Scaling (GAS) in Rehabilitation: The GAS-Light model

(...)

Overview
Measurement of outcomes through goal attainment scaling (GAS) was first introduced in the 1960s by Kirusek and Sherman for assessing outcomes in mental health settings and later for effectiveness of brain injury rehabilitation. Since then, it has been modified and applied in many other areas, including the management of spasticity by Ashford and Turner Stokes.

GAS-Light is a simplified version designed to be used in routine clinical practice, adapted by the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King’s College London...


(But doesn't give a date for when the "Light" version was authored.)
 
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