Domestic Diversions

Challenging the science of psychology

The New York Times turns up the volume on mental health debates.

Erica Goode writes (excerpt):
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.
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.”

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