Review: Science and pseudoscience in clinical psychology (Lilienfeld et al)

Science and pseudoscience in clinical psychology – edited by Scott O. Lilienfeld, Steven Jay Lynn, Jeffrey M. Lohr.

 

Has a good discussion of the nature of science. som interesting discussions of varius dodgy and otherwise untested ideas in clinical psychology.

 

 

about the book:

 

As Bob Dylan wrote, “The times they are a-changin’ .” Over the past sev­

eral decades, clinical psychology and allied disciplines (e.g., psychiatry,

social work, counseling) have borne witness to a virtual sea-change in the

relation between science and practice. A growing minority of clinicians

appear to be basing their therapeutic and assessment practices primarily on

clinical experience and intuition rather than on research evidence. As a

consequence, the term “ scientist-practitioner gap” is being invoked with

heightened frequency (see foreword to this volume by Carol Tavris; Fox,

1996), and concerns that the scientific foundations of clinical psychology

are steadily eroding are being voiced increasingly in many quarters

(Dawes, 1994; Kalal, 1999; McFall, 1991). It is largely these concerns that

have prompted us to compile this edited volume, which features chapters

by distinguished experts across a broad spectrum of areas within clinical

psychology. Given the markedly changing landscape of clinical psychology,

we believe this book to be both timely and important.

 

 

Similarly questionable practices can be found in the domains of psy­

chological assessment and diagnosis. Despite well-replicated evidence that

statistical (actuarial) formulas are superior to clinical judgment for a broad

range of judgmental and predictive tasks (Grove, Zald, Lebow, Snitz, &

Nelson, 2000), most clinicians continue to rely on clinical judgment even

in cases in which it has been shown to be ill advised. There is also evidence

that many practitioners tend to be overconfident in their judgments and

predictions, and to fall prey to basic errors in reasoning (e.g., confirmatory

bias, illusory correlation) in the process of case formulation (Chapter 2).

Moreover, many practitioners base their interpretations on assessment in­

struments (e.g., human figure drawing tests, Rorschach Inkblot Test,

Myers-Briggs Type Indicator, anatomically detailed dolls) that are either

highly controversial or questionable from a scientific standpoint (see Chap­

ter 3).

 

the cite is: Grove, W. M., Zald, D. H., Lebow, B. S., Snitz, B. E., &c Nelson, C. (2000). Clinical

versus mechanical prediction: A meta-analysis. Psychological Assessment, 12,

19-30.

 

abstract:

The process of making judgments and decisions requires a method for combining data. To compare the accuracy of clinical and mechanical (formal, statistical) data-combination techniques, we performed a meta-analysis on studies of human health and behavior. On average, mechanical-prediction techniques were about 10% more accurate than clinical predictions. Depending on the specific analysis, mechanical prediction substantially outperformed clinical prediction in 33%-47% of studies examined. Although clinical predictions were often as accurate as mechanical predictions, in only a few studies (6%-16%) were they substantially more accurate. Superiority for mechanical-prediction techniques was consistent, regardless of the judgment task, type of judges, judges’ amounts of experience, or the types of data being combined. Clinical predictions performed relatively less well when predictors included clinical interview data. These data indicate that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances.

 

seems interesting.

 

 

 

 

What are the primary sources of the growing scientist-practitioner gap? As

many authors have noted (see Lilienfeld, 1998, 2001, for a discussion),

some practitioners in clinical psychology and related mental health disci­

plines appear to making increased use of unsubstantiated, untested, and

otherwise questionable treatment and assessment methods. Moreover, psy­

chotherapeutic methods of unknown or doubtful validity are proliferating

on an almost weekly basis. For example, a recent and highly selective sam­

pling of fringe psychotherapeutic practices (Eisner, 2000; see also Singer &

Lalich, 1996) included neurolinguistic programming, eye movement desen­

sitization and reprocessing, Thought Field Therapy, Emotional Freedom

Technique, rage reduction therapy, primal scream therapy, feeling therapy,

Buddha psychotherapy, past lives therapy, future lives therapy, alien abduc­

tion therapy, angel therapy, rebirthing, Sedona method, Silva method, en­

tity depossession therapy, vegetotherapy, palm therapy, and a plethora of

other methods (see also Chapter 7).

 

….

 

 

The major criticism of the Smith and colleagues (1980) meta-analytic

study is that it is too inclusive; using all studies necessarily requires that

good and bad pieces of research are taken into account (e.g., Howard,

Krause, Sanders, & Kopta, 1997). Nevertheless, Smith et al. compared ef­

fect sizes on the basis of research quality. The rigor of the research had lit­

tle or no impact on effect size (Smith &c Glass, 1977; Smith et al., 1980).

The results, thus, were not artifacts of including methodologically weak in­

vestigations in the meta-analysis.

 

As efficacy research has burgeoned, so have the number of meta­

analyses. The primary findings of Smith and colleagues (1980) have been

repeatedly affirmed (Wampold, 2001). Not only does psychotherapy

appear to be effective, but there is little evidence that one therapy is signifi­

cantly better than another. The most comprehensive meta-analysis (Wam­

pold et al., 1997) and a meta-analysis of 32 meta-analyses (Grissom, 1996)

have corroborated the conclusion reached 65 years ago by Rosenzweig

(1936). He characterized the apparent uniform efficacy of psychotherapies

at the time as the Dodo bird verdict, after the Dodo’s observation at the

end of a race in Alice in Wonderland that “Everybody has won and all

must have prizes” (p. 412). This conclusion bears profound implications

for the field of psychotherapy, which for the past five decades has been pre­

occupied with unearthing the essential, specific findings of behavior

change in the form of the best therapy. The verdict so far is that psycho­

therapies appear to share common, not specific, therapeutic features.

 

 

Recovered memory therapy (RMT): Therapists operate on the as­

sumption that their client’s psychological distress, lack of success, failed re­

lationships, and so forth are due to traumatic experiences, typically under

the control of their parents. RMT often involves the belief that the inten­

sity of the childhood trauma was so great as to cause dissociative “ split­

ting” into multiple personalities, now known as dissociative identity disor­

der (see Chapter 5). In RMT, the process of therapy often consists of

diverse methods of recovering the “ lost memories,” including hypnotic in­

duction, administration of “ truth serum” (sodium pentathol), group ther­

apy, guided fantasies, religious-based prayer, and assertions by therapists

that the client’s symptoms could only have been caused by a traumatic

event (see Chapter 8, for a critique of these and related methods). Given a

New Age therapist’s belief in RMT, therapy becomes unending as the client

is taken back into earlier past lives, additional alien abductions, and addi­

tional split-off personalities (known as “ alters” ; see Chapter 5). Alien ab­

duction therapy, one variation of RMT, holds that extraterrestrials landed

on earth and abducted and then molested the individual, thereby causing

the past trauma. Past lives therapy, another variation of RMT, holds that

all of life’s travails are due having lived a series of past lives and having

“ unfinished business” from past lives invading one’s current life.

 

such ideas seem to dovetail beautifully with blank slate ideas. if it isnt genes or the persons own fault, it has to be somthing els. past traume fits the role nicely, yes?

 

 

Satanic Ritual Abuse: The Case of Patricia Burgus, the

Satanic Princess”

The most widely publicized case of SRA is that of Patricia Burgus, who

won a $10.6 million settlement (Acocella, 1999; Ofshe & Waters, 1993b;

Pendergrast, 1996). In 1995, Frontline, a national TV documentary, aired

a program titled “The Search for Satan.” The program chronicled Ms.

Burgus’s treatment with Dr. Bennett Braun. She originally sought treatment

for postpartum depression, but was hospitalized for 3 years by Dr. Braun

in the Dissociative Disorders unit of Rush-Presbyterian Hospital in Chi­

cago. Ms. Burgus was labeled as a “ satanic princess.” At Braun’s sugges­

tion, her two sons, ages 4 and 5, were also hospitalized for over 3 years.

Each son was told that he was a multiple personality (see Chapter 5), that

he had been in his mother’s satanic cult, that he had eaten babies, and that

he had felt what it was like to bite into a baby while it was still alive. As

part of therapy, both sons “ learned” that they were practiced killers. Ms.

Burgus was led to believe that she had molested them. While in treatment

with Dr. Braun, she was led to believe that she (1) had 300 personalities,

(2) had been raised in a satanic cult, and (3) was a “ satanic princess” in

charge of a nine-state region, and (4) had eaten more than 2,000 dead bod­

ies per year in whole or part. Dr. Braun instructed her to have her husband

bring a hamburger from a family picnic to the hospital so that it could be

tested for human tissue. After 3 years, when her insurance was almost ex­

hausted, she was released from the hospital. The insurance carrier paid

over $3 million in hospitalization costs for Ms. Burgus and her two sons.

Acocella (1999) indicates that other patients of Dr. Braun initiated similar

lawsuits based on similar grounds.

 

wtf

 

 

Space Aliens: Myra

Myra was referred to a psychologist for relaxation training by her treat­

ing physician. The referral was to a psychologist who specialized in pain

relief. During Myra’s initial visits, the psychologist took virtually no his­

tory. Nevertheless, after hypnosis, the psychologist informed Myra that

her back problems were a result of her having been molested by her fa­

ther. The psychologist further informed Myra that she mentioned visiting

her favorite uncle while she was hypnotized. The psychologist shifted to

saying that her uncle had molested her. While in a normal waking state,

Myra had no memories of abuse, either by her father or her uncle and

took issue with the therapist’s claims of such abuse. At her next session,

the therapist indicated that, during another hypnotically induced state,

Myra had remembered being abducted by a UFO while at her uncle’s

home. The UFO descended into her uncle’s backyard and had taken her

onboard a spacecraft that looked like the white “ inside of an eggshell.”

There, she was reported to have been sexually examined by aliens. This

examination and subsequent examinations, performed while she was ly­

ing on an table, were the cause of her back problems. The psychologist

hypnotized Myra in each of her sessions, maintaining that hypnosis was

necessary with clients abducted by space aliens because the aliens hypno­

tized humans to force them to forget their alien encounters. Over the

next 3 years, the psychotherapist focused on uncovering all of Myra’s al­

leged encounters with aliens. Myra felt that the therapist only seemed in­

terested when she cooperated by producing information concerning these

purported encounters. She reported that she began “ to feel foggy, tired

all the time, and out of touch with my feelings about anything.” The

psychologist significantly enlarged the boundaries of the therapy, eventu­

ally seeing her in 3-4 hour sessions held 3 days a week. The psychologist

also forbade her from taking medications prescribed by her physician be­

cause the medications would interfere with her “ recalling all the experi­

ences on the UFOs which were central to the therapy.” When Myra’s

savings were depleted, she was forced to terminate therapy. After she re­

flected on what had occurred in her therapy, she sought out legal coun­

sel. After a lawsuit was filed, the therapist settled out of court.

 

 

ther ar mor cases than the abov, equally disturbing and insane.

 

 

Hypnosis

Like many guided imagery procedures used in clinical situations, hypnosis

often involves eye closure and relaxation and, when used to recover memo­

ries, guided imagery or mental review of past events. Accordingly, many of

the concerns that have been raised with respect to guided imagery apply to

hypnosis. However, an added problem associated with hypnosis is the pop­

ular (Loftus & Loftus, 1980; Whitehouse, Dinges, Orne, & Orne, 1988)

yet mistaken belief that hypnosis can improve recall. This belief can result

in the tendency to overvalue the use of hypnosis for purposes of memory

recovery. Survey research (Poole et al., 1995) reveals that approximately

one third (29% and 34%) of psychologists in the United States who were

sampled reported that they used hypnosis to help clients recall memories of

sexual abuse. In contrast, this figure was only 5% among British thera­

pists.

 

USA -.- even their sycologists ar wors

 

 

Although the popularity of dream interpretation has, along with psy­

choanalysis, waned in recent years, survey research indicates that upwards

of a third of psychotherapists (37-44%) in the United States still use this

technique (see also Brenneis, 1997; Polusny & Follette, 1996). These statis­

tics are of particular interest given Lindsay and Read’s (1994) observation

that no data exist to support the idea that dreams accurately reveal auto­

biographical memories that fall outside the purview of consciousness.

When dreams are interpreted as indicative of a history of child sexual

abuse (Bass & Davis, 1988; Fredrickson, 1992), the fact that the informa­

tion is provided by an authority figure can constitute a strong suggestion

that abuse, in fact, occurred in “ real life.”

 

-.- dream interpretation.

 

The “ thought field” is posited to be both the locus of psychopatholo­

gy and the vehicle for therapeutic change. It has been described thus (I.

Callahan, 1998):

A “ field,” in scientific terms, is defined as “ an invisible sphere of influ­

ence” ; magnetic fields and gravitational fields being familiar examples. In

this case, when we think about a situation a Thought Field (a manifestation

of the body’s energy system) becomes active. Effectively, the Thought Field

has been “ tuned in” to that specific thought. The body responds to its in­

fluence by reproducing, to a greater or lesser extent, the nervous, hor­

monal, and cognitive activity that occurs when we are in the real situation.

If that Thought Field contains perturbations then the body response is in­

appropriate.” (p. 2)

derp, fucking technobabble.

The discrepancy between the meager research support and the exten­

sive promotion of EMDR, TFT, and CISD may be due in part to improper

allocation of the burden of proof. McFall (1991) argued that the burden of

proof of positive effects should rest squarely on those who implement and

promote novel therapies (see also Chapter 1). Thus, it is reasonable to ex­

pect proponents of new treatments to answer clearly and convincingly such

questions as:

• “Does your treatment work better than no treatment?”

• “Does your treatment work better than a placebo?”

• “Does your treatment work better than standard treatments?”

• “Does your treatment work through the processes you claim it

does?”

decent overview of the perhaps four most important questions to ask and answer about any proposed treatment.

For both antidepressants and herbal remedies, the relatively small dif­

ferences between placebo and active substances do not necessarily mean

that these treatments are of little value. If we define the usefulness of a

treatment only in terms of (1) the difference between this treatment and

placebo and (2) the direct and indirect costs of the treatment versus the

costs of the untreated disease, as is implied by the conventional definitions

of efficacy and utility, then some could conclude that both antidepressants

and phytotherapeutic substances are only of relatively modest value. How­

ever, what matters is not only the relative size of the effect, but also the ab­

solute size compared with baseline, or, in other words, the magnitude of

specific and nonspecific effects combined. The provision of a good explan­

atory myth and a convincing therapeutic ritual are among the common fac­

tors of all efficacious therapies (Frank, 1987). Hence we can hypothesize

that for certain people, the potential for nonspecific effects is greater in

herbal treatments than in standard treatments. This is particularly true of

people who have a worldview compatible with the application of “ natu­

ral” products and who have a belief system favoring complementary and

alternative treatments. For others, who subscribe to a more rational and

mechanistic approach to diseases, conventional medical treatments are

likely to be more effective. For still others, psychotherapy might elicit the

greatest expectancy effects, and thereby the greatest therapeutic benefit.

It would be intriguing to determine whether patients requesting an

herbal treatment experience greater benefits than do those who are either

opposed or indifferent to this treatment. Our prediction is that the differ­

ence would be statistically and clinically significant, precisely because the

nonspecific effects can be better harnessed in believers. Indeed, this effect

has been demonstrated in a comparison of the use of hypnosis versus

nonhypnotic treatment with clients who either did or did not request hyp­

notic treatment (Lazarus, 1973).

this is an interesting idea. surely one shud check for correlations between g, five factor factors, and varius stated beliefs, and these outcomes. perhaps beliefs do play a mor activ role in placebo effects. perhaps it is just personality. who knows. lets find out! :)

Whereas the Feingold Diet implicates an entire class of food sub­

stances in the occurrence of ADHD, refined sugar is a specific substance

presumed to cause hyperactivity and other child behavior problems (Smith,

1975). Despite the popular support for this proposition among parents,

teachers, and some mental health professionals, well-controlled studies

have not demonstrated an effect of sugar on children’s behavior.

Milich, Wolraich, and Lindgren (1986) reviewed studies and found no

consistent, significant effects of sugar on a variety of behavioral measures

across studies, even among subjects who were thought to be “ sugar sensi­

tive.” Similar conclusions have been reported in controlled studies of

aspartame on behavior. As one example, Wolraich and colleagues (Wol­

raich, 1988; Wolraich et al., 1994) compared three controlled diets (high

sucrose-low sweetener, low sucrose-high sweetener, and placebo) in two

groups of children presumed to be especially vulnerable to the effects of

sugar ingestion (i.e., preschool and school-age children nominated by par­

ents as highly adverse to sugar). The diets were presented in 3-week blocks

using a counterbalanced, double-blind, crossover design. Results showed

no differences among the three diets on any of almost 40 behavioral and

cognitive measures. Shaywitz and colleagues (1994) also found no effect

on cognitive or behavioral measures with children with ADHD who con­

sumed unusually high amounts of aspartame over a 4-week period. There

is little evidence, then, that either sugar or aspartame ingestion have appre­

ciable effects on children’s behavior.

see also: en.wikipedia.org/wiki/Hyperactivity#Sugar_consumption

Proponents of FC claim that the experimental studies conducted are

inappropriately designed and do not accurately measure performance.

Silliman (1995) asserted that the studies were conducted out of the sub­

jects’ normal social context, creating an unfamiliar environment that hin­

ders performance. Duchan (1995) states that, “The context of interaction

is not a naturally occurring one, but one that is tampered with in a variety

of ways” (p. 208).

yes… thats what an experiment IS.

Dolphin-Assisted Therapy

Dolphin-assisted therapy (DAT) has attracted many parents of children

with autism. DAT received significant attention after it was presented on

Cable News Network (CNN, March 28, 1998; www.cnn.com/

HEALTH/9803/28/dolphin.therapy/index.html#op). The basic procedure

of DAT was depicted, with the child completing a one-to-one teaching ses­

sion with a therapist and then being given the opportunity to swim with a

dolphin. The child’s interaction with the dolphins was described as moti

vating the child to participate in therapy sessions (www.nextstep.com).

Dolphins are currently the only nondomesticated animals used regularly as

treatment partners with children with autism.

The website of the Human Dolphin Therapy Center in Miami reports

a success rate of 97%, which is not defined with respect to the assessment

instruments and measurements utilized (www.cnn.com/HEALTH/

9803/28/dolphin.therapy/index.html#op). The average cost for dolphin

therapy is $2,600 per week (www.nextstep.com/stepback/cycle9/

109/dolphin_therapy.btml). Families have reported raising over $10,000

for the small number of sessions. This cost excludes airfare and lodging

(www.cnn.eom/HEALTH/9803/28/dolphin.therapy/index.html#op).

The time and cost of this treatment may foster an expectation of positive

results.

According to Christopher Peknic, founder and executive director of

the Dolphin Institute, the use of dolphins as treatment partners for autism

and other childhood disorders is a natural and positive therapeutic tech­

nique (www.dolpbininstitute.org/text/cp.htm). He believes that “ dol­

phins have a very special bond,” and are “ attracted to young children”

(.www.dolphininstititute.org/text.cp.htm). In addition, supporters of

DAT suggest that dolphins possess an uncanny ability to “ understand and

respond to the needs of special people” (www.dolphininstitute.org/

iscltextle_smith.htm).

what the fuck

If the 1970s represented a decade during which psychologists tried to “ give

psychology away,” unencumbered by concerns over the therapeutic value

of their gifts, then the following two decades represented a time when mar­

keting strategies were refined, programs proliferated, and data remained

sparse (Rosen, 1987, 1993). We found support for this appraisal by log­

ging on to the Web, at www.amazon.com, where 137 self-help books were

listed for just the letter “A.” Among the titles listed by www.amazon.com

were A.D.D. and Success, Access Your Brain’s Joy Center: The Free Soul

Method, Amazing Results o f Positive Thinking, and The Anxiety Cure: An

Eight-Step Program for Getting Well. There also were many titles with the

word “Art,” as in The Art o f Letting Go, The Art o f Making Sex Sacred,

and The Art o f Midlife. Findings were similar for the letters B through Z.

i really hate this use of punctuation INSIDE quotes! it makes no sense.

There also were many titles with the word “Art,”

shud be:

 

There also were many titles with the word “Art”,

 

Unlike the self-help advisors who came on the market in the early and

mid-1990s, Gray is less scolding, more “ supportive,” and he found his

niche by smoothing out gender conflicts. His bromide is that conflicts be­

tween men and women arise from their inherent differences, which should

be honored. This more acceptance-based doctrine links him to earlier,

more “ therapeutic” incarnations of the self-help movement. This therapeu­

tic slant (along with its remarkable simplicity and spiffed-up sexism) is the

source of much of the controversy surrounding his popularity. In Mars and

Venus in the Bedroom (1995), for example, Gray gave advice about what

he believes to be effective communication skills: To “ give feedback in sex,

it is best for women to make little noises and not use complete sentences”

because “when a woman uses complete sentences, it can be a turn off” (p.

57). Additionally, he instructed readers about the meaning of women’s un­

derwear. He explained that when “ she wears silky pink or lace, she is ready

to surrender to sex as a romantic expression of loving vulnerability” (p.

106) and that a “ cotton T-shirt with matching panties . . . may mean she

doesn’t need a lot of foreplay” (p. 107). Moreover, according to Gray such

clothing indicates that the woman wearing it “may not be in the mood for

an orgasm” but rather might be “happy and satisfied” by feeling her part­

ner’s “ orgasm inside her” (p. 107). Offering such opinions is part of what

Gray states he does “ best,” which he believes is to “ save marriages, create

romance and passions and relationships” (Adler, 1995, p. 96).

 

seems legit lol

 

 

 

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