Vol. 4, No. 2, 2005

Science and Pseudoscience in Clinical Psychology

Scott O. Lilienfeld, Steven Jay Lynn, Jeffrey M. Lohr (Editors)

New York: Guilford Press, 2004. ISBN: 1572308281 (hardcover) $48 ISBN: 1593850700 (paperback) $25. 474 pages

Reviewed by Arthur A. Dole, Ph.D., ABPP

 

Those who attended the 2004 AFF Conference in Atlanta might remember vividly Dr. Lilienfeld keynote PowerPoint presentation. Dr. Lilienfeld was scholarly and scientific, yet energetic and funny. In contrast, this 474-page book to which 37 authors contributed 16 chapters also succeeds in distinguishing a variety of defensible mental-health practices from the merely fashionable, but without the cartoons and amusing asides. In their concluding comments, the editors state, “...the preceding chapters make clear that the scientific underpinnings of the field of clinical psychology are threatened by the increasing proliferation of unsubstantiated and untested psychotherapies, assessment, and diagnostic techniques.”

The three editors are established academics. Scott O. Lilienfeld, Ph.D., whose work on pseudoscience in clinical psychology has come to the attention of the popular press, is Associate Professor of Psychology at Emory University. Steven Jay Lynn, Ph.D., is Professor of Psychology at the State University of New York at Binghamton. Jeffrey M. Lohr, Ph.D., is Professor of Psychology at the University of Arkansas—Fayetteville. In my unofficial analysis of the 37 contributors, 19 with doctorates are housed in departments of psychology; 11 with masters degrees, also housed in psychology departments, are probably advanced graduate students; 5 are psychologist practitioners, 1 is in a department of counselor education, and 1 is a lawyer. Carol Tavris, Ph.D., who wrote the Foreword, has a doctorate in social psychology and is an independent writer. It is safe to say then that in style, perspective, and orientation this book (like this reviewer) is weighted toward academic psychology. And academic psychologists emphasize science, experimental design, statistics, evidence, and data. It follows that within the diverse ICSA (formerly AFF) community, the academics, especially in psychology, will appreciate this fact-filled book. However, those to whom terms such as “double blind” and “meta analysis” or “DSM” and “ADHD” are unfamiliar will prefer chapter 1 for an overview, and part V (chapters 14, 15, and 16), “Controversies Regarding Self-Help and the Media.” Mental-health practitioners might be informed by the evaluations of Alcoholics Anonymous, age regression, memory recovery, Myers Briggs Type Indicator, neurolinguistic programming, rebirthing, and dozens of other controversial interventions for assessment and diagnosis, psychotherapy, and the treatment of adult and child disorders. A glossary of technical terms and extensive references at the end of each chapter, and an Index that covers the entire volume, are helpful, especially to graduate students and scholars.

Before I consider Science and Pseudoscience in Clinical Psychology‘s possible value to ICSA and the possible value of ICSA to clinical psychology, I want to comment on the “widening gap” between “scientists” and “practitioners” alleged by Carol Tavris. Most of the contributors to this book, as I have noted, are the “scientists”—psychologists who teach aspiring doctoral-student clinical psychologists. But who are “the practitioners?” What proportion are clinical psychologists trained in programs approved by the American Psychological Association and state-licensed or board-certified, as compared to the proportions of professional practitioners in social work, psychiatry, mental-health counseling, and the like, and to those with no credentials? What proportions use unsubstantiated interventions? No contributor reports such data.

I recognize not one but several “gaps.” The gap between academics such as the editors and practicing clinical psychologists I attribute to two distinct cultures—the former demanding, within a timeframe of years, publications, research, grants, and critical inquiry; the latter stressing immediate ethical, responsible services to clients who often present serious, complex crises. This gap between the campus and “the real world” also is found within law, social work, psychiatry, and other professions.

Here is another gap: Well outside both these cultures are the quacks, frauds, hustlers, popularizers, and cult leaders who feed on the gullible and often are motivated by money, power, and sex. Both in her chapter (written with Abraham Nievod) in this book and elsewhere, Margaret Singer and collaborators have discussed the New Age and crazy therapies purveyed by the unqualified. Nona Wilson in her chapter on commercializing mental-health issues describes how John Gray, Steven Covey, Tony Robbins, and Philip McGraw profitably combine entertainment, advertising, and psychological advice. Of these four, only “Dr. Phil” has a legitimate degree in clinical psychology.

Except for the Singer-Nievod and Nona Wilson chapters, the contributors focus largely on treatments rather than on clinicians or their patients. They stress the medical model of research in which hypothesized cures for a specific disease are systematically controlled in a laboratory, and sophisticated statistics are applied to precise measures. For the most part, they ignore controversies with proponents of qualitative and longitudinal designs, and studies that consider who does what to whom in real situations. For instance, the October 2004 Consumer Reports reported a survey of 3,079 readers who described themselves as either depressed, anxious, or both. The article was supplemented by three, brief case studies. “Overall, adding talk therapy to medication produced more improvement” whether the respondents saw a psychiatrist, psychologist, or social worker. According to Consumer Reports, some of the many findings captured information that smaller, placebo-controlled clinical trials cannot.

As I read Science and Pseudoscience... with its compact summaries of the hundreds of controversial psychological tests, psychotherapies, and treatments for child and adult problems, I realized that there are excellent opportunities for ICSA to collaborate with psychologists such as the three editors. For example, we in the cult research area might encourage more academic psychologists to join us in studying how destructive groups apply psychological principles in harmful ways. Thus, a group that promotes a pseudopsychotherapy might use personality tests in recruiting. Several cultic groups use covert hypnosis and intensive persuasion. Some of Dr. Lilienfeld’s contributors, for example, might be invited to future ICSA conferences to craft a multidisciplinary study of Al Qaeda that could contribute to the prevention of terrorism.

Deprogrammers have morphed into exit counselors and thought-reform consultants, developed interventions by trial and error, and policed themselves with a code of ethics. Scientific psychologists might work with them to answer such questions as 1) what specific interventions are most effective, 2) what personal characteristics of thought-reform consultants make a difference, and 3) over a period of months, how well do clients cope, compared to untreated controls?

In  their concluding chapter, Drs. Lilienfeld, Lynn, and Lohr, commendably, present a five-point prescription for the field of clinical psychology: Formal training in critical-thinking skills, identification of empirically supported and unsupported treatments, continuing education of practitioners in solid scientific evidence by the American Psychological Association, combat against erroneous claims in the popular press, and sanctions on practitioners who engage in potentially harmful assessment and therapeutic practices. In the next edition, I recommend that the authors justify these sensible prescriptions by additional chapters. One chapter might document the current characteristics and practices of professional psychologists in comparison with other mental-health specialists and unqualified persons. Another would summarize major activities of the American Psychological Association, such as its publications, enforcement of its code of ethics, approval of doctoral programs, and specialty standards of the American Board of Professional Psychologists. Furthermore, readers should be informed of the licensing standards for psychologists and for other mental-health specialists in the 50 states. For instance, in the state of Pennsylvania, anyone can collect a fee for advice, however unscientific, but to practice psychology without an advanced degree from an approved graduate school is illegal. Finally, I predict sales will increase if the editors include some of the wonderful cartoons Dr. Lilienfeld presented at AFF Atlanta.

Reference

Drugs vs. talk therapy. 3,079 readers rate their care for depression and anxiety. (2004, October). Consumer Reports, p. 23-29.