Tami Chappell for The New York Times
Psychologists unaware of new
research "may be using
suboptimal and, in some cases,
even dangerous treatments," Dr.
Scott Lilienfeld says.
Posted on 03/09/2004 5:34:42 AM PST by Pharmboy
They have been called assassins and parasites. They receive hate mail from the proponents of a variety of popular psychotherapies. The president-elect of the American Psychological Association has accused them of being overly devoted to the scientific method.
Tami Chappell for The New York Times
Psychologists unaware of new
research "may be using
suboptimal and, in some cases,
even dangerous treatments," Dr.
Scott Lilienfeld says.
But the ire of their colleagues has not prevented a small, loosely organized band of academic psychologists from rooting out and publicly debunking mental health practices that they view as faddish, unproved or in some cases potentially harmful.
In journal articles and public presentations, the psychologists, from Emory, Harvard, the University of Texas and other institutions, have challenged the validity of widely used diagnostic tools like the Rorschach inkblot test. They have questioned the existence of repressed memories of child sexual abuse and of multiple personality disorder. They have attacked the wide use of labels like codependency and sexual addiction.
The challengers have also criticized a number of fashionable therapies, including "critical incident" psychological debriefing for trauma victims, eye-movement desensitization and reprocessing, or E.M.D.R., and other techniques.
"These guys are sort of the Ralph Naders of psychology," said Dr. David Barlow, director of the Center for Anxiety and Related Disorders at Boston University.
Yet the psychologists are hardly cranks. Their criticisms reflect a widening divide in the field between researchers, who rely on controlled trials and other statistical methods of determining whether a therapeutic technique works, and practitioners, who are often guided by clinical experience and intuition rather than scientific evidence.
"I started to become very concerned by the practices that I was seeing our field tolerating and, in some cases, actively embracing," said Dr. Scott Lilienfeld, a professor of psychology who has emerged as a de facto leader of the group.
In 1988, a group of researchers, concerned that the American Psychological Association, the dominant professional organization, was not placing enough emphasis on science, split off and formed the American Psychological Society. The society now counts close to 15,000 members, its executive director, Dr. Alan Kraut, said. The association has 155,000 members.
Dr. Lilienfeld, who resigned from the psychological association in 2001, after a dispute over the organization's handling of a journal article he had written, says many clinical psychologists are out of touch with research findings.
"As in the case of medicine, practitioners have to be informed about the most recent and most credible findings," he said.
One survey, according to Dr. Lilienfeld, who is an author of the 2003 book "What's Wrong With the Rorschach," found that a vast majority of practicing psychologists did not read even one scientific journal article a month and that some doctoral programs in clinical psychology no longer required research training.
"Many practitioners, because they don't keep up with the scientific literature, may be using suboptimal and, in some cases, even dangerous treatments," Dr. Lilienfeld said.
Two years ago, he founded The Scientific Review of Mental Health Practice, a journal whose stated goal is to present "objective investigations of controversial and unorthodox claims in clinical psychiatry, psychology and social work."
Two issues of the journal have been published. In it, authors have examined "fact and fiction" in the treatment and investigation of autism; a paper evaluated "neurotherapy," a technique used for attention deficit disorder; and a critique by Dr. Eric Mart, a forensic psychologist in New Hampshire, questioned the scientific and legal basis of Munchausen syndrome by proxy, in which parents, usually mothers, make their children sick to draw attention to themselves.
In a "mission statement," the journal's editorial board notes that "a wide variety of unsubstantiated or untested treatments" and psychological tests have flourished in recent years.
"Although some of these techniques may ultimately prove to be effective," the statement continues, "it is disturbing that the frequency of their use greatly outstrips their evidentiary base."
The muckraking has not always been welcomed by others in the field.
Dr. Richard McNally, a professor of psychology at Harvard who has conducted research on repressed memories, E.M.D.R. and other problems, said he had received threatening letters, e-mail messages and telephone calls from angry practitioners.
"All you're doing is your science," Dr. McNally said. "But in the trauma field, you're going to make somebody upset, period."
Dr. Mart, author of "Munchausen's Syndrome by Proxy Reconsidered," has drawn fire from psychiatrists who defend the diagnosis.
Dr. Marc Feldman, a psychiatrist in Alabama who has written extensively about Munchausen's, said Dr. Mart "makes his career" out of defending accused mothers.
"He has a powerful financial interest," Dr. Feldman said.
Dr. Mart said he did not disagree that some mothers abused their children by making them sick. But the term Munchausen's by proxy "has taken on a life of its own," he said, and the condition is grossly overdiagnosed. In most cases, Dr. Mart said, the proper term is simply "medical abuse." He added that Munchausen's experts like Dr. Feldman also received fees for testifying in court.
"I would be a much richer man today if I had gotten in on the pro-Munchausen side of things," he said.
Dr. Lilienfeld said he welcomed such give and take. "If you criticize people, you have every right to expect criticism in return," he said.
Still, his Rorschach assessment, written with Dr. James Wood of the University of Texas at El Paso and Dr. Howard N. Garb of the Wilford Hall Medical Center in San Antonio, drew angry responses.
An irate therapist, Dr. Lilienfeld recalled, wrote in an Internet posting that the the authors deserved "one bullet for each of the three assassins."
Such intense reactions, Dr. Lilienfeld and others in the group said, are not surprising.
"Many of the practitioners of these methods resent the notion that researchers should dictate or constrain what they do," he said.
That resentment, some experts said, has grown stronger at a time when psychotherapists are under increasing financial pressure and insurers are loath to underwrite the cost of talking therapies.
Some experts, among them Dr. Barlow of the Center for Anxiety and Related Disorders, have argued that psychologists can counter such pressures by building up the scientific evidence for the effectiveness of different forms of psychotherapy.
Like medicine, these experts contend, psychology should have clinical practice guidelines, and psychotherapists should favor treatments that are backed by evidence from controlled clinical trials over treatment whose effectiveness is supported by anecdotes and case histories only.
In fact, more than 50 leading doctoral programs in clinical psychology have joined to promote their training in "empirically supported" psychotherapies. At least two forms of psychotherapy, cognitive behavioral therapy and interpersonal therapy, have been demonstrated in studies to be effective for a variety of disorders. The two therapies have been standardized in manuals that describe how they are practiced.
Some clinicians say that their work with troubled patients can never be captured by experimental trials and that traditional science has little relevance in the consulting room, where psychotherapists often deal with problems far more complex than those addressed by "cookbook" psychotherapies.
Dr. Ronald Levant, president-elect of the American Psychological Association, said Dr. Lilienfeld and others had gone overboard in their enthusiasm for scientific vetting of therapeutic techniques.
"Their fervor about science borders on the irrational," Dr. Levant, a professor of psychology at Nova Southeastern University in Florida, said. "The problem in clinical psychology is that we don't have science to cover everything we do, and that's true for medicine, as well."
He added that psychologists "recognize that we need to find a way to show we are being accountable," but that many practitioners "question the very narrow standards that are being raised."
In fact, at an annual meeting of the psychological association, a Canadian psychologist reportedly began a session by asking, "How can I escape from the clutches of the psychotherapy police?"
The association, Dr. Lilienfeld said, has not done enough to shore up scientific standards and weed out pseudoscientific or potentially harmful therapies.
"The A.P.A. has been exceedingly reluctant to impose ethical limitations or sanctions on members who engage in either unvalidated or potentially harmful mental health practices," he wrote in the first issue of the new journal.
A spokeswoman for the association, Rhea Farberman, responded: "We do have an ethics code and we do have an ethics education and enforcement program. We put a lot of resources into educating our members about their ethical obligations and enforcing the code through a complaint procedure."
The debate is likely to continue, and the push for stronger evidence will gain ground.
"People resist change," Dr. Barlow said.
But the efforts of psychologists like Dr. Lilienfeld, he added, ensure that important questions are discussed.
"On some things, we'll come down on one side," he said. "On some, we'll come down on the other. But at least these things are seeing the light of day."
And where is the Times' usual dedication to the scientific method? It sounds as if these poor charlatans should be left alone--no need to demand proof from them.
All the weird theories and techniques really do come down to that difference, too. Mental illness is a medical problem, and we've done ourselves a terrible disservice allowing the likes of Freud and his descendants to distract us from finding medical solutions.
The Times is dedicated to scientific method? Seems to me they print a lot of junk science.
And, of course, if you don't do psycholanalysis, the shirks don't make any money.....
There are some good ones I'm sure. But most quality mental health services are out of the reach of affordability for the average person.
What type of practice is your husband in?
I remember in the 70's a friend of mine worked in the county courthouse in Vero Beach, Florida. She told me that the only requirement to be a "psychologist" at that time was to have a mailing address and to pay the fee.
HMO/PPO mental health services should just be dropped.
I have a family member who gets a psychiatrist to write her Prozac, Selexa, lithium, Adderal, Klonopin, Lorezapam, all at the same time. He has no clue wassup with her.
The doctor who treats grandma for an infection by prescribing an antibiotic follows up.
Mental health services are a joke in this country.
The APA is far to political to be scientific...
Indeed. Here are a few examples to document your statement:
Former APA President Condemns APA for Barring Research
"The APA is too goddamn politically correct...and too goddamn obeisant to special interests!" said Robert Perloff, 1985 President of the American Psychological Association.
Dr. Perloff delivered those uncensored remarks during a rousing speech to psychologists at the 2001 APA Annual Convention.
In an expression of public anger and frustration, Dr. Perloff condemned the APA's one-sided political activism. Of reorientation therapy with homosexuals, he said: "It is considered unethical...That's all wrong. First, the data are not fully in yet. Second, if the client wants a change, listen to the client. Third, you're barring research." (1)
Dr. Perloff is a recipient of the American Psychological Foundation's Gold Medal Award for Lifetime Achievement in Psychology in the Public Interest. In bestowing the award, the Psychological Foundation recognized Perloff for his noted "love of social justice" and his career-long struggle to champion "the rights and dignity of women, minorities, and homosexuals."
But, Perloff asked, "How can you do research on change if therapists involved in this work are threatened with being branded as unethical?"
Contacted by NARTH, Dr. Perloff added the following comment in an interview:
"I believe that APA is flat out wrong, undemocratic, and shamefully unprofessional in denying NARTH the opportunity to express its views and programs in the APA Monitor and otherwise under APA's purview." (2)
"APA past presidents sounded off about what they think the field, and APA, ought to value in psychology's second century at APA's 2001 Annual Convention.
They advocated wildly divergent--sometimes controversial--goals for psychology, from dismantling organized religion to lifting the stricture on conversion therapy...
Robert Perloff, PhD (APA's 1985 president), of the University of Pittsburgh, unabashedly charged that APA is "too politically correct, too bureaucratic, too obeisant to special interests." He called on APA to ease strictures against:
Conversion therapy. "It is considered unethical....That's all wrong. First, the data are not fully in yet. Second, if the client wants a change, listen to the client. Third, you're barring research."
APA Monitor Online - Letters, VOLUME 30 , NUMBER 8 September 1999:
"IN HIS JUNE 9 LETTER TO REP. Tom DeLay (R-Texas) discussing an article by Rind, Tromovitch and Bauserman (1998), Dr. Raymond Fowler, speaking for APA, asserts:
"We acknowledge our social responsibility...to take into account not only the scientific merit of articles but also their implication for public policy....Clearly the article included opinions of the authors that are inconsistent with APA's stated and deeply held position on child welfare...issues....Three inconsistencies between the conclusions the authors suggest and positions of the association should have caused us to evaluate the article based on its potential for misinforming the public policy process. This is something we failed to do, but will do in the future....We are strengthening procedures within the association to assure that journal editors will fully consider the social policy implications of articles on controversial topics."
This new editorial policy effectively transforms APA's "stated and deeply held positions" into religious dogma, immune from empirical or logical refutation. Any scientifically sound paper presenting empirical data or reasoned argument contrary to APA public policy positions will be rejected by the 37 journals published by APA on the grounds of its "potential for misinforming the public policy process." APA's public policies will reign unchallenged.
Fowler has it backwards. Scientific findings should help determine public policies, not the reverse. The flap over this article demonstrates yet again that the social policy stands of APA are dictated more by the ideology of its leadership than by science.
Gerald E. Zuriff, Ph.D
Cambridge, Mass.
And here's an excerpt from the letter that follows Dr. Zuriff's:
"... Such statements point to a political agenda that we are seeing all too frequently in APA journals..."
A. Dean Byrd, PhD
American Fork, UtahS. Brent Scharman, PhD
Salt Lake City, UtahEd D. Lauritsen, PhD
Phoenix, Ariz.
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