At a time when Complementary and Alternative Therapies have (again) been under fire from some university scientists for falsely claiming scientific status, and in an era of evidence-based psychotherapy, this book is a key text. It should have a place on all postgraduate counselling and psychotherapy courses, but I suspect it will not be so readily accommodated.
Science and Pseudoscience in Clinical Psychology
Edited by Scott O. Lilienfeld, Steven Jay Lynn and Jeffrey M. Lohr, 2003. ISBN 1572308281. The Guilford Press. xxii + 474 pages.
Divided into five parts — Controversies in Assessment and Diagnosis, General Controversies in Psychotherapy, Controversies in the Treatment of Specific Adult Disorders, Controversies in the Treatment of Specific Child Disorders, and Controversies Regarding Self-Help and the Media — this book is, if not comprehensive, far-reaching. Its focus is on the scientist-practitioner, the balance between extremes of scepticism and open-mindedness, harmful pseudoscientific techniques and serious ways of tackling these problems. It is well organised and each chapter is thoroughly referenced and has its own glossary.
As an American text, certain topics and the related legal and professional language don’t always match UK needs and style. However, assessment and diagnosis are in my view shamefully neglected areas in much British counselling and psychotherapy. (Johnstone and Dallos’s recent Formulation in Psychology and Psychotherapy is a welcome exception to this complaint.) The authors look for subtleties of systemic and personal errors of judgement and caution against attraction to charismatic figures and recommend a balance of scientific and relational factors in training. Rorschach and inkblot tests are examined for reliability and validity (the authors are dubious); the Thematic Apperception Test (TAT) wins some praise but ultimately “falls woefully short of professional and scientific test standards” (p.53); projective drawings are likewise found wanting; anatomically detailed dolls (used in some child sexual abuse therapy) likewise; the Myers-Briggs Type Indicator is found ‘suspect’. Quite a lot of scepticism is expended on expert testimony subjects, e.g. predicting violent behaviour, eyewitness testimony, sexual addiction, road rage, codependency, factitious disorder by proxy, and child sexual abuse accommodation syndrome. A balanced view on these is given. As might be expected, dissociative identity disorder is picked apart sceptically but the authors here include a fair balance of nuanced arguments for and against.
The section on the science of psychotherapy research begins with a chapter that overviews known existing problems and offers an intelligent and wide-ranging discussion. This is followed by a chapter on New Age Therapies (copious references to abduction by space aliens, satanists, past lives, recovered memory therapy, evil entities, rebirthing, re-experiencing past traumas, spirit guides, angels, archetypes, crystals, etc.). These are rather non-rigorously grouped together as ‘idiosyncratic belief systems’, but an interesting argument is offered for the authors’ general scepticism, and legal accountability is dangled over the subject, warning that all such practitioners must be held to account alongside their more conventional professional peers. Some vivid case examples are given. At this point in the book one cannot help realising that rather less critical attention is given to traditional and academically-approved forms of psychotherapy (nothing on psychoanalysis, relatively little on CBT). However, as myself a survivor of Janov’s primal therapy in the late 1970s, I think extra caution does need to be voiced about expensive, extremist and charismatic-male-driven, cult-like therapies (see also debunkingprimaltherapy.com on this). Problematic early memory recovery techniques are examined in some detail. Eye movement desensitisation and reprocessing (EMDR) comes in for a hefty critical analysis, in some cases thought to be inferior to CBT and lacking theoretical cogency. Likewise thought field therapy and critical incident stress debriefing seem full of holes.
Certain treatments for alcoholism, herbal treatments and antidepressant medication are critically reviewed and the positive value of placebos acknowledged. (Recently published UK doubts about the actual potency of antedepressants might bear this out.) A variety of treatments for attention-deficit/hyperactivity disorder (ADHD) are analysed, as are touted treatments for autism (including dolphin-assisted therapy, DAT). Applied Behaviour Analysis (ABA) is commended for autism on the basis of 500 published, largely favourable reports, while many treatments such as sensory integration, drug, vitamin and diet regimes are found lacking in empirical evidence. Predictably but none the less entertainingly, self-help therapies (largely in book and tape form) for child-rearing, fear reduction, happiness seeking and so on, are panned. There are methodological problems in seriously evaluating planned bibliotherapy as against cheaply available, unaccountable self-help books. The authors do make some sound suggestions, however, for the psychology profession to evaluate self-help programmes. Finally, attention is paid to the commercialisation of mental health issues in entertainment, advertising and psychological advice in television shows, for example. Perhaps those of our own UK psychologists who appear quite readily on TV shows might consider their impact more carefully.
In their conclusions, the editors suggest that all training should include critical thinking skills (yes — but please, not the simplistic, packaged kind already being pushed at AS level; let’s have a real, in-depth commitment to thinking critically about a field that is too often brimming with faith-smitten acolytes). Awareness of ‘pseudoscience’ should be a key feature of training, professional bodies must play a larger watchdog role, and — perhaps more contentiously — sanctions must be tightened. On this last point, professional bodies will be all too ready to display their seriousness about individual errant practitioners but will be constrained by their wish to remain as liberal as possible towards the majority of their members, not all of whom are committed to scientific principles or a pseudoscience-exposing agenda.
This book is a veritable critfest for those considering working in the field, availing themselves of its services or indeed attempting to evaluate evidence as stacked up against faith and enthusiasm. It should have a place in every training course in clinical and counselling psychology. It should probably also have a similar place on all postgraduate counselling and psychotherapy courses but I suspect it will not be so readily accommodated. Its American and somewhat uncritical psychology-privileging nature, and its relative weakness in any appeal to philosophy of science will be seized on by those occupying the farther shores of the faith-oriented psychotherapy world. It is not a fun read, nor at all easy for the general public, but my final word on it would not be negative, but a plea for an even more comprehensive version that applies similar stringent analyses to all aspects of the field.
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