What is therapy?
Whatever it is, it seems fair to say that a therapy is a good one if it cures people of what the therapy treats. In short, if a type of therapy says it will treat people with X, then it is assumed that advocates of that therapy lead their patients to believe that the therapy will effect either a cure or a control of X in a significant percentage of cases.
What counts as a significant number of cases? There is a general statistic that has been floating around for years that from 40-60% of patients on waiting lists to get therapy are cured by the time they are admitted to therapy. If about half your patients are cured with no treatment, then a 50% success rate would not be too impressive. Anything less would indicate that the therapy is harming more patients than it is helping. Anything close to 50% would indicate that the therapy isn't much of a causal factor in effecting cures or controls of X.[note]
Is there any evidence that any of the dozens of psychological therapies now being practiced by psychologists and other "social scientists" are effective at a greater than chance rate? Can any therapist be sure that any patient's cure is due to the therapist's intervention? Unless a patient is in contact only with the therapist, how could one be sure it was not some other factor or set of factors that effected the cure? For example, Jay Haley had a patient he was treating for obsessive/compulsive behavior (she was wringing her hands all the time or something like that). He asked her what would happen if her condition got worse. She said that she would lose her job. He asked what would happen if she lost her job. She said her husband would have to go to work and couldn't finish school. He asked what would happen if her husband had to go to work. Etc. Anyway, he finds out that the girl's parents don't think much of their son-in-law. The mother calls the daughter every day and asks her when she's going to leave the worthless no-count and come home to mama. Then one day, the girl is cured. Everyone congratulates Haley on a job well done with a tough case. But he concludes that he had little if anything to do with the girl's cure. She got pregnant and had to quit work and her husband had to go to work. The mother stopped calling and pestering the daughter to come home, apparently because she didn't want a baby in the house. In any case, the girl's abnormal behavior stopped.
What therapy occurs in a controlled situation where the validity of the therapy could be scientifically tested? I don't know. The evidence for successful therapies and therapists seems to be mostly anecdotal and unverifiable. Do people ever get better after seeing a therapist. Sure. But just as many people get better who don't see a therapist. Why is there such strong belief among psychologists and patients in therapy? Communal reinforcement in the psychological community has a lot to do with it. Wishful thinking and old fashioned hope have a lot to do with it. Post hoc reasoning has a lot to do with it.
Another question which should interest us as much as the question of success rates in therapy is the question of harm rates. What percentage of patients are harmed by therapy? Is there a way to tell which patients have increased the quantity and quality of their problems thanks to the intervention of the therapist? How many patients, their families, friends, employers, co-workers, etc., have been damaged by the intervention of therapists?
To see some of the latest therapies in action, one should view Ofra Bikel's Divided Memories, first aired on Frontline on April 4, 1994, and available on video tape for purchase for $133.50 ($155 abroad) from:
Bikel's documentary of therapists lets the practitioners themselves confidently show you their absurdity and incompetence. The therapists are oblivious to the fact that they are being used to demonstrate the monstrosity of their stupid and evil work. Therapist after therapist talks freely about how uninterested they are in the truth, how indifferent they are to the families they help destroy, how cavalier they are about categorizing all who would question their methods as being "in denial." Patient after patient is paraded forth by the therapists as evidence of their good work, yet none of the patients seems the better for the therapy and many seem much worse.
Trying to find a meaningful common thread in the therapies is not too difficult, but its meaningfulness does not enhance the position of those who think psychological therapy is a science. One common thread is the belief that a person having "problems" today is not responsible for those problems. Another thread is the belief that the cause of a problem is some traumatic past event, such as being stabbed in the stomach in a previous lifetime or being sexually abused, the latter being the favorite cause of most of the therapists depicted. Childhood sexual abuse is not only the cause of most problems, according to the therapists, childhood sexual abuse seems to be the cause around which their lives revolve. Several therapists claim to have been abused themselves; one discovers her abuse while treating a patient who is remembering her abuse. Why a therapist's problems or past life is relevant to therapy is obvious to those who recognize that much of this New Age therapy is more like a cult than a science.
Another common thread is the belief that the patient must discover the cause of his or her problem in order to be helped, but there does not seem to be any clear idea on what it means to be helped by therapy. The only common thread regarding cure seems to be that the patient believes she (or he, though the he's seem to be rarer than the she's) knows what caused her problems. Believing you know who or what harmed you in the past is the cure. The quality of the patient's life, the interaction of the patient in significant social settings such as with one's family, friends, co-workers, etc. is irrelevant. Having the patient trust the therapist is all-important. To gain this trust, one of the common tactics of the therapists is to turn the patient against the patient's family. This is done by leading the patient to believe that the cause of the patient's problems is a family member or several family members. The family can't help the patient because the family is the cause of the patient's problems. One or more family members abused the patient and is now either a liar or in denial; the other family members are deluded or in conspiracy to protect the evil family member. Of course, this demand that the therapist be trusted by the patient has its corollary: the patient puts all her faith in the therapist in return. The patient has been persecuted; the therapist is her savior.
The final thread holding these therapies together is a lack of interest in truth. Neither patient nor therapist is to be concerned with facts or tangible evidence that the "believed cause" actually happened. In fact, whether the "believed cause" is the real cause is irrelevant to the therapy. The patient creates truth and it is as real to the patient as facts are to the skeptic. That's all that matters. We all live in a delusion, proclaims one therapist. So, it is of no concern to him that his patient's "believed cause" is pure delusion. Any first-year psych student recognizes the projection in that claim. The viewer, however, needs no training to see that this therapist is clearly deluded when he claims that he did not induce his patient's bizarre tale of ritual abuse by her satanic cult parents and grandparents. His total lack of interest in corroborating evidence to his patient's story, his lack of concern for the family he was helping to destroy, his disingenuous claims about needing to accept on faith everything his patient tells him, his apparent obliviousness to the absurdity and cruelty of inducing his patient to file a $20 million lawsuit against the woman's family, his deluded claim that he can tell in the first session with a patient whether or not they have been abused as a child, all add up to a self-labelled therapeutic package: delusion.
If only it were a crime, such people should be arrested for practicing religion with a license.
See related entry on trauma-search therapy
reader comment:
25 Apr 1996 22:41:33 -0700
I have only recently discovered your dictionary while browsing the volumes of skeptic-related material on the internet. I found many of the entries entertaining and informative.
However, as a psychologist and a therapist, I must take exception to your blithe dismissal of psychotherapy. I will acknowledge a shameful level of quackery in my field, and I regret the harm that has likely been done through recovered memory therapy, age regression therapy and other similar foolishness. However, over 30 years of psychotherapy research has established beyond the shadow of a doubt that, on the whole, psychotherapy is more effective than no treatment (I refer you to the meta-analyses of Orlinsky and Howard <1986> and Smith and Glass <1980>, among others). Some research even suggests that the average effect size of psychotherapy is comparable to most established medical treatments. These meta-analyses have been based on literally hundreds of studies which have incorporated double-blind designs and/or placebo controls.
Sincerely,
Jonathan Krejci
further reading
Dawes, Robyn M. House of Cards - Psychology and Psychotherapy Built on Myth, (New York: The Free Press, 1994).
See "Therapy--A New Phenomenon" by Jay Haley, in The Power Tactics of Jesus Christ and Other Essays, (Rockville, Md.: The Triangle Press, 1986.) Haley's little book is full of wry humor and insight. One of his more memorable lines is : "It is possible that the most important decision in the history of therapy was the idea that it should be paid for by the hour." (p. 150)