Greegor
November 15th 06, 01:17 AM
http://chronicle.com/free/v49/i25/25b00701.htm
>From the issue dated February 28, 2003
Mind Games: Psychological Warfare Between Therapists and Scientists
By CAROL TAVRIS
Recently, while lecturing to a large group of lawyers, judges,
mediators, and others involved in the family-court system in Los
Angeles, I asked how many knew what a "social psychologist" was. Three
people shyly raised their hands. That response was typical, and it's
the reason I don't tell people anymore that I'm a social psychologist:
They think I'm a therapist who gives lots of parties. If I tell them
I'm a psychological scientist, they think I'm a pompous therapist,
because everyone knows that "psychological science" is an oxymoron.
In fact, in many states, I cannot call myself a psychologist at all --
the word is reserved for someone who has an advanced degree in clinical
psychology and a license to practice psychotherapy. That immediately
rules out the many other kinds of psychologists who conduct scientific
research in their respective specialties, including child development,
gerontology, neurobiology, emotions, sleep, behavioral genetics, memory
and cognition, sexual behavior and attitudes, trauma, learning,
language, . . . and social psychology, the study of how social
situations and other people affect every human activity from love to
war.
For the public, however, the word "psychologist" has only one meaning:
psychotherapist. It is true that clinical psychologists practice
therapy, but many psychologists are not clinicians, and most therapists
are not clinical psychologists. The word "psychotherapist" is
completely unregulated. It includes people who have advanced training
in psychology, along with those who get a "certification" in some
therapeutic specialty; clinical social workers; marriage, family, and
child counselors; psychoanalysts and psychiatrists; and countless
others who have no training in anything. Starting tomorrow, I could
package and market my own highly effective approach, Chocolate
Immersion Therapy, and offer a weekend workshop to train neophytes
($395, chocolate included). I could carry out any kind of unvalidated,
cockamamie therapy I wanted, and I would not be guilty of a single
crime. Unless I described myself as a psychologist.
As a result of such proliferation of psychotherapists, the work of
psychological scientists who do research and teach at colleges and
universities tends to be invisible outside the academy. It is the
psychotherapists who get public attention, because they turn up on talk
shows, offer advice in books and newspaper columns, and are interviewed
in the aftermath of every disaster or horrible crime -- for example,
speculating on the motives and childhoods of the Washington snipers.
Our society runs on the advice of mental-health professionals, who are
often called upon in legal settings to determine whether a child has
been molested, a prisoner up for parole is still dangerous, a defendant
is lying or insane, a mother is fit to have custody of her children,
and on and on. Yet while the public assumes, vaguely, that therapists
must be "scientists" of some sort, many of the widely accepted claims
promulgated by therapists are based on subjective clinical opinions and
have been resoundingly disproved by empirical research conducted by
psychological scientists. Here are a few examples that have been shown
to be false:
Low self-esteem causes aggressiveness, drug use, prejudice, and low
achievement.
Abused children almost inevitably become abusive parents, causing a
"cycle of abuse."
Therapy is beneficial for most survivors of disasters, especially if
intervention is rapid.
Memory works like a tape recorder, clicking on at the moment of birth;
memories can be accurately retrieved through hypnosis, dream analysis,
or other therapeutic methods.
Traumatic experiences, particularly of a sexual nature, are typically
"repressed" from memory, or split off from consciousness through
"dissociation."
The way that parents treat a child in the first five years (three
years) (one year) (five minutes) of life is crucial to the child's
later intellectual and emotional success.
Indeed, the split between the research and practice wings of psychology
has grown so wide that many psychologists now speak glumly of the
"scientist-practitioner gap," although that is like saying there is an
"Arab-Israeli gap" in the Middle East. It is a war, involving deeply
held beliefs, political passions, views of human nature and the nature
of knowledge, and -- as all wars ultimately do -- money and
livelihoods. The war spilled out of academic labs and therapists'
offices and into the public arena in the 1980s and '90s, when three
epidemics of hysteria caught fire across the country: the rise of
claims of "repressed memories" of childhood sexual abuse; the growing
number of cases of "multiple-personality disorder" (MPD), from a
handful before 1980 to tens of thousands by 1995; and the proliferation
of day-care sex-abuse scandals, which put hundreds of nursery-school
teachers in prison on the "testimony" of 3and 4-year-old children.
All three epidemics were fomented and perpetuated by the mistaken
beliefs of psychotherapists: that "children never lie about sexual
abuse"; that childhood trauma causes the personality to "split" into
several or even thousands of identities; that if you don't remember
being sexually abused in childhood, that's evidence that you were; that
it is possible to be raped by your father every day for 16 years and to
"repress" the memory until it is "uncovered" in therapy; that hypnosis,
dream analysis, and free association of fantasies are reliable methods
of "uncovering" accurate memories. (On the contrary, such techniques
have been shown to increase confabulation, imagination, and memory
errors, while inflating the belief that the retrieved memories are
accurate.) The epidemics began to subside as a result of the
painstaking research of psychological scientists.
But psychotherapeutic nonsense is a Hydra: Slay one set of mistaken
ideas, and others take their place. Recovered-memory therapy may be on
the wane, but "rebirthing" techniques and forms of "restraint therapy"
-- physically abusive practices that supposedly help adopted or
troubled children form attachments to their parents -- are on the rise.
In Colorado, 10-year-old Candace Newmaker was smothered to death during
rebirthing, a procedure in which she was expected to fight her way
through a "birth canal" of suffocating blankets and pillows. The two
therapists convicted in Candace's death are now serving time in prison,
but efforts in Colorado to prohibit all forms of "restraint therapy"
were defeated by protests from "attachment therapists" in the state and
throughout the country. After Candace's death, one member of the
Colorado Mental Health Grievance Board noted with dismay that her
hairdresser's training took 1,500 hours, whereas anyone could take a
two-week course and become "certified" in rebirthing. Yet the basic
premise -- that children can recover from trauma, insecure attachment,
or other psychological problems by "reliving" their births or being
subjected to punitive and coercive restraints -- has no scientific
validity whatsoever.
To understand how the gap between psychological scientists and
clinicians grew, it is necessary to understand a little about therapy
and a little about science, and how their goals and methods diverged.
For many years, the training of most clinical psychologists was based
on a "scientist practitioner" model. Ideally, clinicians would study
the research on human behavior and apply relevant findings to their
clinical practice. Clinical psychologists who are educated at major
universities are still trained in this model. They study, for example,
the origins of various mental disorders and the most effective ways to
treat them, such as cognitive-behavior therapy for anxiety, depression,
eating disorders, anger, and obsessive-compulsive disorder.
They have also identified which interventions are unhelpful or
potentially harmful. For example, independent assessments of a popular
post-trauma intervention called Critical Incident Stress Debriefing
have found that most survivors benefit just as much by talking with
friends and other survivors as with debriefers. Sometimes CISD even
slows recovery, by preventing victims from drawing on their own
wellsprings of resilience. And, sometimes, it harms people -- for
example, by having survivors ventilate their emotions without also
learning good methods of coping with them.
Unfortunately, the numbers of scientifically trained clinicians have
been shrinking. More and more therapists are getting their degrees from
"free-standing" schools, so called because they are independent of
research institutions or academic psychology departments. In these
schools, students are trained only to do therapy, and they do not
necessarily even learn which kinds of therapy have been shown to be
most effective for particular problems. Many of the schools are
accredited by the American Psychological Association, and their
graduates learn what they need to know to pass state licensing
examinations. But that does not mean that the graduates are
scientifically knowledgeable. For example, the Rorschach Inkblot Test
has been resoundingly discredited as a reliable means of diagnosing
most mental disorders or emotional problems; it usually reveals more
about the clinician administering it than about the individual taking
it. I call it the Dracula of psychological tests, because no one has
been able to drive a stake through the cursed thing's heart. Many
clinicians love it; it is still widely used; and it still turns up on
licensing exams.
Of course, tensions exist between researchers and practitioners in any
field -- medicine, engineering, education. Whenever one group is doing
research and the other is working in an applied domain, their interests
and training will differ. The goal of the clinician, in psychology or
medicine, is to help the suffering individual; the goal of the
psychological or medical researcher is to explain and predict the
behavior or course of illness in people in general. That is why many
clinicians argue that empirical research cannot possibly capture the
complex human beings who come to their offices. Professional training,
they believe, should teach students empathy and appropriate therapeutic
skills. Good therapy depends on the therapist's insight and experience,
not on knowledge of statistics, the importance of control groups, and
the scientific method.
I agree that therapy often deals with issues on which science is
silent: finding courage under adversity, accepting loss, making moral
choices. My clinician friends constantly impress me with their deep
understanding of the human condition, which is based on seeing the
human condition sobbing in their offices many times a week. Nor am I
arguing that psychological scientists, or any other kind, are white
knights with a special claim to intellectual virtue. They, too, wrangle
over data, dispute each other furiously in print and public, and have
plenty of vested interests and biases. (For example, many scientists
and consumer advocates are concerned about the growing co-optation of
scientific investigators by the pharmaceutical industry -- which now
finances the majority of studies of treatments for mental disorders and
sexual problems -- because the result has been a pro-drug bias in
research.)
It is not that I believe that science gives us ultimate truths about
human behavior, while clinical insight is always foolish and wrong.
Rather, I worry that when psychotherapists fail to keep up with basic
research on matters on which they are advising their clients; when they
fail to learn which methods are most appropriate for which disorders,
and which might be harmful; when they fail to understand their own
biases of perception and do not learn how to correct them; when they
fail to test their own ideas empirically before running off to promote
new therapies or wild claims -- then their clients and the larger
public pay the price of their ignorance.
For present purposes, I am going to do an end run around the
centuries-old debate about defining science, and focus on two core
elements of the scientific method. These elements are central to the
training of all scientists, but they are almost entirely lacking in the
training of most psychotherapists, including clinical psychologists.
The first is skepticism: a willingness to question received wisdom. The
second is a reliance on gathering empirical evidence to determine
whether a prediction or belief is valid. You don't get to sit in your
chair and decide that autism is caused by cold, rejecting,
"refrigerator" mothers, as Bruno Bettelheim did. But legions of
clinicians (and mothers) accepted his cruel and unsubstantiated theory
because he was, well, Bruno Bettelheim. It took skeptical scientists to
compare the mothers of autistic children with those of healthy
children, and to find that autism is not caused by anything parents do;
it is a neurological disorder.
The scientific method is designed to help investigators overcome the
most entrenched human cognitive habit: the confirmation bias, the
tendency to notice and remember evidence that confirms our beliefs or
decisions, and to ignore, dismiss, or forget evidence that is
discrepant. That's why we are all inclined to stick to a hypothesis we
believe in. Science is one way of forcing us, kicking and screaming if
necessary, to modify our views. Most scientists regard a central, if
not defining, characteristic of the scientific method to be what Karl
Popper called "the principle of falsifiability": For a theory to be
scientific, it must be falsifiable -- you can't show me just those
observations that confirm it, but also those that might show it to be
wrong, false. If you can twist any result of your research into a
confirmation of your hypothesis, you aren't thinking scientifically.
For that reason, many of Freud's notions were unfalsifiable. If
analysts saw evidence of "castration anxiety" in their male patients,
that confirmed Freud's theory of its universality; if analysts didn't
see it, Freud wrote, they lacked observational skills and were just too
blind or stubborn to see it. With that way of thinking, there is no way
to disconfirm the belief in castration anxiety.
Yet many psychotherapists perpetuate ideas based only on confirming
cases -- the people they see in therapy -- and do not consider the
disconfirming cases. The popular belief in "the cycle of abuse" rests
on cases of abusive parents who turn up in jail or therapy and who
report that they were themselves victims of abuse as children. But
scientists would want to know also about the disconfirming cases:
children who were beaten but did not grow up to mistreat their children
(and, therefore, did not end up in therapy or jail), and people who
were not beaten and then did grow up to be abusive parents. When the
researchers Joan Kaufman and Edward Zigler reviewed longitudinal
studies of the outcomes of child abuse, they found that although being
abused does considerably increase the risk of becoming an abusive
parent, more than 70 percent of all abused children do not mistreat
their offspring -- hardly an inevitable "cycle."
Practitioners who do not learn about the confirmation bias and ways to
counteract it can make devastating judgments in court cases. For
example, if they are convinced that a child has been sexually molested,
they are often unpersuaded by the child's repeated denials; such
denials, they say, are evidence of the depth of the trauma. Sometimes,
of course, that is true. But what if it isn't? In the Little Rascals
day-care-abuse case in North Carolina, one mother told reporters that
it took 10 months before her child was able to "reveal" the
molestation. No one at the time considered the idea that the child
might have been remarkably courageous to persist in telling the truth
for so long.
Because many therapists tend not to be as deeply imbued with the spirit
of skepticism as scientists are (or are supposed to be), it is common
for many of them to place their faith in the leader of a particular
approach, and to set about trying to do what the school's founder did
-- rather than to raise too many questions about the founder's methods
or the validity of the founder's theories. If you go off to become
certified in Eye Movement Desensitization and Reprocessing (EMDR),
invented by Francine Shapiro while she was walking in the woods one
day, you are unlikely to ask, "Why, exactly, does waving your finger in
front of someone's eyes realign the halves of the brain and reduce
anxiety?" Scientific studies of this method show that the successful
ingredient in EMDR is an old, tried-and-true technique from behavior
therapy: exposing people to a thought or situation that makes them
anxious, until the feeling subsides. The eye movements that are
supposedly essential, the clinical scientist Scott O. Lilienfeld
concluded, do not constitute "anything more than pseudoscientific
window dressing."
Similarly, most clinicians are not trained to be skeptical of what a
client says or to demand corroborating evidence. Why would they be? A
client comes to see you complaining that he has a terrible mother; are
you going to argue? Ask to meet the mother? Some clinicians, notably
those who practice cognitive-behavior therapy, would, indeed, ask you
for the evidence that your mother is terrible and also invite you to
consider other explanations of her behavior; but most do not. As the
psychiatrist Judith Herman explained in a PBS Frontline special on
recovered memory: "As a therapist, your job is not to be a detective;
your job is not to be a fact-finder; your job is not to be a judge or a
jury; and your job is also not to make the family feel better. Your job
is to help the patient make sense out of her life, make sense out of
her symptoms . . . and make meaning out of her experience."
That remark perfectly summarizes the differing goals of most clinicians
and scientists. Clinicians are certainly correct that most of the time
it is not possible to corroborate a client's memory anyway, and that it
isn't their job to find out what "really" happened in the client's
past. Scientists, though, have shown that memories are subject to
distortion. So, if the client is going to end up suing a parent for
sexual abuse, or if the therapist's intervention ends up causing a
devastating family rift, a little detective work seems called for.
Detective work is the province of scientists, who are trained not to
automatically believe what someone says or what someone claims to
remember, but to ask, "Where's the evidence?"
For psychological scientists, clinical insight is simply not sufficient
evidence. For one thing, the clinician's observations of clients will
be inherently limited if they overlook comparison groups of people who
are not in therapy. For example, many clinicians invent "checklists" of
"indicators" of some problem or disorder -- say, that "excessive"
masturbation or bed-wetting are signs of sexual abuse or, my favorite,
that losing track of time or becoming engrossed in a book is a sign of
multiple-personality disorder. But, before you can say that bed-wetting
or masturbation is an indicator that a child has been sexually abused,
what must you know? Many psychotherapists cannot give you the simple
answer: You must know the rates of bed-wetting and masturbation among
all children, including nonabused ones. In fact, many abused children
have no symptoms, and many nonabused children wet their beds,
masturbate, and are fearful in new situations.
Throughout the 1980s and '90s, many therapists routinely testified in
court that they could magically tell, with complete certainly, that a
child had been sexually abused because of how the child played with
anatomically correct dolls, or because of what the child revealed in
drawings. The plausible assumption is that very young children may
reveal feelings in their play or drawings that they cannot express
verbally. But while such tests may have a therapeutic use, again the
scientific evidence is overwhelming that they are worthless for
assessment or diagnostic purposes. How do we know that? Because when
scientists compared the doll play of abused children to that of control
groups of nonabused children, they found that such play is not a valid
way of determining whether a child has been sexually abused. The doll's
genitals are pretty interesting to all kids.
Likewise, psychological scientists who study children's cognitive
development empirically have examined the belief held by many
psychotherapists that "children never lie" about sexual abuse.
Scientists have shown in dozens of experiments that children often do
tell the truth, but that they also lie, misremember, and can be
influenced to make false allegations -- just as adults do. Researchers
have shown, too, that adults often misunderstand and misinterpret what
children say, and they have identified the conditions that increase a
child's suggestibility and the interviewing methods virtually
guaranteed to elicit false reports. Those conditions and methods were
present in the interrogations of children by social workers,
therapists, and police officers in all of the sensational cases of
day-care hysteria of the 1980s and '90s. And those coercive practices
continue in many jurisdictions today where child-protection workers
have not been trained in the latest research.
I fear that the scientist-therapist gap is a done deal. There are too
many economic and institutional supports for it, in spite of yearly
exhortations by every president of the American Psychological
Association for "unity" and "cooperation." That's why, in the late
1980s, a group of psychological scientists formed their own
organization, the American Psychological Society, to represent their
own scientific interests. Every year, the APA does something else to
rile its scientific members while placating its therapist members --
like supporting prescription-writing privileges for Ph.D. psychologists
and approving continuing-education programs for unvalidated methods or
tests -- and so, every year, more psychological scientists leave the
APA for the APS.
But to the public, all this remains an internecine battle that seems to
have no direct relevance. That's the danger. Much has been written
about America's scientific illiteracy, but social-scientific illiteracy
is just as widespread and in some ways even more pernicious. People can
deny evolution or fail to learn basic physics, but such ignorance
rarely affects their personal lives. The scientific illiteracy of
psychotherapists has torn up families, sent innocent defendants to
prison, cost people their jobs and custody of their children, and
promoted worthless, even harmful, therapies. A public unable to
critically assess psychotherapists' claims and methods for scientific
credibility will be vulnerable to whatever hysterical epidemic comes
along next. And in our psychologically oriented culture, there will be
many nexts. Some will be benign; some will merely cost money; and some
will cost lives.
Carol Tavris, a social psychologist, is on the board of the Council for
Scientific Clinical Psychology and Psychiatry, a consulting editor of
The Scientific Review of Mental Health Practice, and a member of the
editorial board of Psychological Science in the Public Interest.
http://chronicle.com
Section: The Chronicle Review
Volume 49, Issue 25, Page B7
--------------------------------------------------------------------------------
Copyright © 2006 by The Chronicle of Higher Education
>From the issue dated February 28, 2003
Mind Games: Psychological Warfare Between Therapists and Scientists
By CAROL TAVRIS
Recently, while lecturing to a large group of lawyers, judges,
mediators, and others involved in the family-court system in Los
Angeles, I asked how many knew what a "social psychologist" was. Three
people shyly raised their hands. That response was typical, and it's
the reason I don't tell people anymore that I'm a social psychologist:
They think I'm a therapist who gives lots of parties. If I tell them
I'm a psychological scientist, they think I'm a pompous therapist,
because everyone knows that "psychological science" is an oxymoron.
In fact, in many states, I cannot call myself a psychologist at all --
the word is reserved for someone who has an advanced degree in clinical
psychology and a license to practice psychotherapy. That immediately
rules out the many other kinds of psychologists who conduct scientific
research in their respective specialties, including child development,
gerontology, neurobiology, emotions, sleep, behavioral genetics, memory
and cognition, sexual behavior and attitudes, trauma, learning,
language, . . . and social psychology, the study of how social
situations and other people affect every human activity from love to
war.
For the public, however, the word "psychologist" has only one meaning:
psychotherapist. It is true that clinical psychologists practice
therapy, but many psychologists are not clinicians, and most therapists
are not clinical psychologists. The word "psychotherapist" is
completely unregulated. It includes people who have advanced training
in psychology, along with those who get a "certification" in some
therapeutic specialty; clinical social workers; marriage, family, and
child counselors; psychoanalysts and psychiatrists; and countless
others who have no training in anything. Starting tomorrow, I could
package and market my own highly effective approach, Chocolate
Immersion Therapy, and offer a weekend workshop to train neophytes
($395, chocolate included). I could carry out any kind of unvalidated,
cockamamie therapy I wanted, and I would not be guilty of a single
crime. Unless I described myself as a psychologist.
As a result of such proliferation of psychotherapists, the work of
psychological scientists who do research and teach at colleges and
universities tends to be invisible outside the academy. It is the
psychotherapists who get public attention, because they turn up on talk
shows, offer advice in books and newspaper columns, and are interviewed
in the aftermath of every disaster or horrible crime -- for example,
speculating on the motives and childhoods of the Washington snipers.
Our society runs on the advice of mental-health professionals, who are
often called upon in legal settings to determine whether a child has
been molested, a prisoner up for parole is still dangerous, a defendant
is lying or insane, a mother is fit to have custody of her children,
and on and on. Yet while the public assumes, vaguely, that therapists
must be "scientists" of some sort, many of the widely accepted claims
promulgated by therapists are based on subjective clinical opinions and
have been resoundingly disproved by empirical research conducted by
psychological scientists. Here are a few examples that have been shown
to be false:
Low self-esteem causes aggressiveness, drug use, prejudice, and low
achievement.
Abused children almost inevitably become abusive parents, causing a
"cycle of abuse."
Therapy is beneficial for most survivors of disasters, especially if
intervention is rapid.
Memory works like a tape recorder, clicking on at the moment of birth;
memories can be accurately retrieved through hypnosis, dream analysis,
or other therapeutic methods.
Traumatic experiences, particularly of a sexual nature, are typically
"repressed" from memory, or split off from consciousness through
"dissociation."
The way that parents treat a child in the first five years (three
years) (one year) (five minutes) of life is crucial to the child's
later intellectual and emotional success.
Indeed, the split between the research and practice wings of psychology
has grown so wide that many psychologists now speak glumly of the
"scientist-practitioner gap," although that is like saying there is an
"Arab-Israeli gap" in the Middle East. It is a war, involving deeply
held beliefs, political passions, views of human nature and the nature
of knowledge, and -- as all wars ultimately do -- money and
livelihoods. The war spilled out of academic labs and therapists'
offices and into the public arena in the 1980s and '90s, when three
epidemics of hysteria caught fire across the country: the rise of
claims of "repressed memories" of childhood sexual abuse; the growing
number of cases of "multiple-personality disorder" (MPD), from a
handful before 1980 to tens of thousands by 1995; and the proliferation
of day-care sex-abuse scandals, which put hundreds of nursery-school
teachers in prison on the "testimony" of 3and 4-year-old children.
All three epidemics were fomented and perpetuated by the mistaken
beliefs of psychotherapists: that "children never lie about sexual
abuse"; that childhood trauma causes the personality to "split" into
several or even thousands of identities; that if you don't remember
being sexually abused in childhood, that's evidence that you were; that
it is possible to be raped by your father every day for 16 years and to
"repress" the memory until it is "uncovered" in therapy; that hypnosis,
dream analysis, and free association of fantasies are reliable methods
of "uncovering" accurate memories. (On the contrary, such techniques
have been shown to increase confabulation, imagination, and memory
errors, while inflating the belief that the retrieved memories are
accurate.) The epidemics began to subside as a result of the
painstaking research of psychological scientists.
But psychotherapeutic nonsense is a Hydra: Slay one set of mistaken
ideas, and others take their place. Recovered-memory therapy may be on
the wane, but "rebirthing" techniques and forms of "restraint therapy"
-- physically abusive practices that supposedly help adopted or
troubled children form attachments to their parents -- are on the rise.
In Colorado, 10-year-old Candace Newmaker was smothered to death during
rebirthing, a procedure in which she was expected to fight her way
through a "birth canal" of suffocating blankets and pillows. The two
therapists convicted in Candace's death are now serving time in prison,
but efforts in Colorado to prohibit all forms of "restraint therapy"
were defeated by protests from "attachment therapists" in the state and
throughout the country. After Candace's death, one member of the
Colorado Mental Health Grievance Board noted with dismay that her
hairdresser's training took 1,500 hours, whereas anyone could take a
two-week course and become "certified" in rebirthing. Yet the basic
premise -- that children can recover from trauma, insecure attachment,
or other psychological problems by "reliving" their births or being
subjected to punitive and coercive restraints -- has no scientific
validity whatsoever.
To understand how the gap between psychological scientists and
clinicians grew, it is necessary to understand a little about therapy
and a little about science, and how their goals and methods diverged.
For many years, the training of most clinical psychologists was based
on a "scientist practitioner" model. Ideally, clinicians would study
the research on human behavior and apply relevant findings to their
clinical practice. Clinical psychologists who are educated at major
universities are still trained in this model. They study, for example,
the origins of various mental disorders and the most effective ways to
treat them, such as cognitive-behavior therapy for anxiety, depression,
eating disorders, anger, and obsessive-compulsive disorder.
They have also identified which interventions are unhelpful or
potentially harmful. For example, independent assessments of a popular
post-trauma intervention called Critical Incident Stress Debriefing
have found that most survivors benefit just as much by talking with
friends and other survivors as with debriefers. Sometimes CISD even
slows recovery, by preventing victims from drawing on their own
wellsprings of resilience. And, sometimes, it harms people -- for
example, by having survivors ventilate their emotions without also
learning good methods of coping with them.
Unfortunately, the numbers of scientifically trained clinicians have
been shrinking. More and more therapists are getting their degrees from
"free-standing" schools, so called because they are independent of
research institutions or academic psychology departments. In these
schools, students are trained only to do therapy, and they do not
necessarily even learn which kinds of therapy have been shown to be
most effective for particular problems. Many of the schools are
accredited by the American Psychological Association, and their
graduates learn what they need to know to pass state licensing
examinations. But that does not mean that the graduates are
scientifically knowledgeable. For example, the Rorschach Inkblot Test
has been resoundingly discredited as a reliable means of diagnosing
most mental disorders or emotional problems; it usually reveals more
about the clinician administering it than about the individual taking
it. I call it the Dracula of psychological tests, because no one has
been able to drive a stake through the cursed thing's heart. Many
clinicians love it; it is still widely used; and it still turns up on
licensing exams.
Of course, tensions exist between researchers and practitioners in any
field -- medicine, engineering, education. Whenever one group is doing
research and the other is working in an applied domain, their interests
and training will differ. The goal of the clinician, in psychology or
medicine, is to help the suffering individual; the goal of the
psychological or medical researcher is to explain and predict the
behavior or course of illness in people in general. That is why many
clinicians argue that empirical research cannot possibly capture the
complex human beings who come to their offices. Professional training,
they believe, should teach students empathy and appropriate therapeutic
skills. Good therapy depends on the therapist's insight and experience,
not on knowledge of statistics, the importance of control groups, and
the scientific method.
I agree that therapy often deals with issues on which science is
silent: finding courage under adversity, accepting loss, making moral
choices. My clinician friends constantly impress me with their deep
understanding of the human condition, which is based on seeing the
human condition sobbing in their offices many times a week. Nor am I
arguing that psychological scientists, or any other kind, are white
knights with a special claim to intellectual virtue. They, too, wrangle
over data, dispute each other furiously in print and public, and have
plenty of vested interests and biases. (For example, many scientists
and consumer advocates are concerned about the growing co-optation of
scientific investigators by the pharmaceutical industry -- which now
finances the majority of studies of treatments for mental disorders and
sexual problems -- because the result has been a pro-drug bias in
research.)
It is not that I believe that science gives us ultimate truths about
human behavior, while clinical insight is always foolish and wrong.
Rather, I worry that when psychotherapists fail to keep up with basic
research on matters on which they are advising their clients; when they
fail to learn which methods are most appropriate for which disorders,
and which might be harmful; when they fail to understand their own
biases of perception and do not learn how to correct them; when they
fail to test their own ideas empirically before running off to promote
new therapies or wild claims -- then their clients and the larger
public pay the price of their ignorance.
For present purposes, I am going to do an end run around the
centuries-old debate about defining science, and focus on two core
elements of the scientific method. These elements are central to the
training of all scientists, but they are almost entirely lacking in the
training of most psychotherapists, including clinical psychologists.
The first is skepticism: a willingness to question received wisdom. The
second is a reliance on gathering empirical evidence to determine
whether a prediction or belief is valid. You don't get to sit in your
chair and decide that autism is caused by cold, rejecting,
"refrigerator" mothers, as Bruno Bettelheim did. But legions of
clinicians (and mothers) accepted his cruel and unsubstantiated theory
because he was, well, Bruno Bettelheim. It took skeptical scientists to
compare the mothers of autistic children with those of healthy
children, and to find that autism is not caused by anything parents do;
it is a neurological disorder.
The scientific method is designed to help investigators overcome the
most entrenched human cognitive habit: the confirmation bias, the
tendency to notice and remember evidence that confirms our beliefs or
decisions, and to ignore, dismiss, or forget evidence that is
discrepant. That's why we are all inclined to stick to a hypothesis we
believe in. Science is one way of forcing us, kicking and screaming if
necessary, to modify our views. Most scientists regard a central, if
not defining, characteristic of the scientific method to be what Karl
Popper called "the principle of falsifiability": For a theory to be
scientific, it must be falsifiable -- you can't show me just those
observations that confirm it, but also those that might show it to be
wrong, false. If you can twist any result of your research into a
confirmation of your hypothesis, you aren't thinking scientifically.
For that reason, many of Freud's notions were unfalsifiable. If
analysts saw evidence of "castration anxiety" in their male patients,
that confirmed Freud's theory of its universality; if analysts didn't
see it, Freud wrote, they lacked observational skills and were just too
blind or stubborn to see it. With that way of thinking, there is no way
to disconfirm the belief in castration anxiety.
Yet many psychotherapists perpetuate ideas based only on confirming
cases -- the people they see in therapy -- and do not consider the
disconfirming cases. The popular belief in "the cycle of abuse" rests
on cases of abusive parents who turn up in jail or therapy and who
report that they were themselves victims of abuse as children. But
scientists would want to know also about the disconfirming cases:
children who were beaten but did not grow up to mistreat their children
(and, therefore, did not end up in therapy or jail), and people who
were not beaten and then did grow up to be abusive parents. When the
researchers Joan Kaufman and Edward Zigler reviewed longitudinal
studies of the outcomes of child abuse, they found that although being
abused does considerably increase the risk of becoming an abusive
parent, more than 70 percent of all abused children do not mistreat
their offspring -- hardly an inevitable "cycle."
Practitioners who do not learn about the confirmation bias and ways to
counteract it can make devastating judgments in court cases. For
example, if they are convinced that a child has been sexually molested,
they are often unpersuaded by the child's repeated denials; such
denials, they say, are evidence of the depth of the trauma. Sometimes,
of course, that is true. But what if it isn't? In the Little Rascals
day-care-abuse case in North Carolina, one mother told reporters that
it took 10 months before her child was able to "reveal" the
molestation. No one at the time considered the idea that the child
might have been remarkably courageous to persist in telling the truth
for so long.
Because many therapists tend not to be as deeply imbued with the spirit
of skepticism as scientists are (or are supposed to be), it is common
for many of them to place their faith in the leader of a particular
approach, and to set about trying to do what the school's founder did
-- rather than to raise too many questions about the founder's methods
or the validity of the founder's theories. If you go off to become
certified in Eye Movement Desensitization and Reprocessing (EMDR),
invented by Francine Shapiro while she was walking in the woods one
day, you are unlikely to ask, "Why, exactly, does waving your finger in
front of someone's eyes realign the halves of the brain and reduce
anxiety?" Scientific studies of this method show that the successful
ingredient in EMDR is an old, tried-and-true technique from behavior
therapy: exposing people to a thought or situation that makes them
anxious, until the feeling subsides. The eye movements that are
supposedly essential, the clinical scientist Scott O. Lilienfeld
concluded, do not constitute "anything more than pseudoscientific
window dressing."
Similarly, most clinicians are not trained to be skeptical of what a
client says or to demand corroborating evidence. Why would they be? A
client comes to see you complaining that he has a terrible mother; are
you going to argue? Ask to meet the mother? Some clinicians, notably
those who practice cognitive-behavior therapy, would, indeed, ask you
for the evidence that your mother is terrible and also invite you to
consider other explanations of her behavior; but most do not. As the
psychiatrist Judith Herman explained in a PBS Frontline special on
recovered memory: "As a therapist, your job is not to be a detective;
your job is not to be a fact-finder; your job is not to be a judge or a
jury; and your job is also not to make the family feel better. Your job
is to help the patient make sense out of her life, make sense out of
her symptoms . . . and make meaning out of her experience."
That remark perfectly summarizes the differing goals of most clinicians
and scientists. Clinicians are certainly correct that most of the time
it is not possible to corroborate a client's memory anyway, and that it
isn't their job to find out what "really" happened in the client's
past. Scientists, though, have shown that memories are subject to
distortion. So, if the client is going to end up suing a parent for
sexual abuse, or if the therapist's intervention ends up causing a
devastating family rift, a little detective work seems called for.
Detective work is the province of scientists, who are trained not to
automatically believe what someone says or what someone claims to
remember, but to ask, "Where's the evidence?"
For psychological scientists, clinical insight is simply not sufficient
evidence. For one thing, the clinician's observations of clients will
be inherently limited if they overlook comparison groups of people who
are not in therapy. For example, many clinicians invent "checklists" of
"indicators" of some problem or disorder -- say, that "excessive"
masturbation or bed-wetting are signs of sexual abuse or, my favorite,
that losing track of time or becoming engrossed in a book is a sign of
multiple-personality disorder. But, before you can say that bed-wetting
or masturbation is an indicator that a child has been sexually abused,
what must you know? Many psychotherapists cannot give you the simple
answer: You must know the rates of bed-wetting and masturbation among
all children, including nonabused ones. In fact, many abused children
have no symptoms, and many nonabused children wet their beds,
masturbate, and are fearful in new situations.
Throughout the 1980s and '90s, many therapists routinely testified in
court that they could magically tell, with complete certainly, that a
child had been sexually abused because of how the child played with
anatomically correct dolls, or because of what the child revealed in
drawings. The plausible assumption is that very young children may
reveal feelings in their play or drawings that they cannot express
verbally. But while such tests may have a therapeutic use, again the
scientific evidence is overwhelming that they are worthless for
assessment or diagnostic purposes. How do we know that? Because when
scientists compared the doll play of abused children to that of control
groups of nonabused children, they found that such play is not a valid
way of determining whether a child has been sexually abused. The doll's
genitals are pretty interesting to all kids.
Likewise, psychological scientists who study children's cognitive
development empirically have examined the belief held by many
psychotherapists that "children never lie" about sexual abuse.
Scientists have shown in dozens of experiments that children often do
tell the truth, but that they also lie, misremember, and can be
influenced to make false allegations -- just as adults do. Researchers
have shown, too, that adults often misunderstand and misinterpret what
children say, and they have identified the conditions that increase a
child's suggestibility and the interviewing methods virtually
guaranteed to elicit false reports. Those conditions and methods were
present in the interrogations of children by social workers,
therapists, and police officers in all of the sensational cases of
day-care hysteria of the 1980s and '90s. And those coercive practices
continue in many jurisdictions today where child-protection workers
have not been trained in the latest research.
I fear that the scientist-therapist gap is a done deal. There are too
many economic and institutional supports for it, in spite of yearly
exhortations by every president of the American Psychological
Association for "unity" and "cooperation." That's why, in the late
1980s, a group of psychological scientists formed their own
organization, the American Psychological Society, to represent their
own scientific interests. Every year, the APA does something else to
rile its scientific members while placating its therapist members --
like supporting prescription-writing privileges for Ph.D. psychologists
and approving continuing-education programs for unvalidated methods or
tests -- and so, every year, more psychological scientists leave the
APA for the APS.
But to the public, all this remains an internecine battle that seems to
have no direct relevance. That's the danger. Much has been written
about America's scientific illiteracy, but social-scientific illiteracy
is just as widespread and in some ways even more pernicious. People can
deny evolution or fail to learn basic physics, but such ignorance
rarely affects their personal lives. The scientific illiteracy of
psychotherapists has torn up families, sent innocent defendants to
prison, cost people their jobs and custody of their children, and
promoted worthless, even harmful, therapies. A public unable to
critically assess psychotherapists' claims and methods for scientific
credibility will be vulnerable to whatever hysterical epidemic comes
along next. And in our psychologically oriented culture, there will be
many nexts. Some will be benign; some will merely cost money; and some
will cost lives.
Carol Tavris, a social psychologist, is on the board of the Council for
Scientific Clinical Psychology and Psychiatry, a consulting editor of
The Scientific Review of Mental Health Practice, and a member of the
editorial board of Psychological Science in the Public Interest.
http://chronicle.com
Section: The Chronicle Review
Volume 49, Issue 25, Page B7
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Copyright © 2006 by The Chronicle of Higher Education