There has always been a gap between psychological science and practice. In many ways, it is no different from the natural tensions that exist between researchers and practitioners in any field-medicine, engineering, education, psychiatry, physics-when one side is doing research and the other is working in an applied domain: their goals and training are inherently quite different. The goal of psychotherapy, for example, is to help the suffering individual who is sitting there; the goal of psychological research is to explain and predict the behavior of people in general. That is why many therapists maintain that research methods and findings capture only a small, shriveled image of the real person. Therapy, they note, was helping people long before science or psychology were invented. Professional training, therefore, should teach students how to do therapy, not how to do science.
In psychology, this divergence in goals and training was present at the conception. Empirical psychology and psychoanalysis were born of different fathers in the late 19th century, and never got along. Throughout the 20th century, they quarreled endlessly over fundamental assumptions about the meaning of science and truth. How do we know what is true? What kind of evidence is required to support a hypothesis? To early psychoanalysts, "science" had nothing to do with controlled experiments, interviews, or statistics. In constructing what they saw as a "science of the mind," psychoanalysts relied solely on their own interpretations of cases they saw in therapy, of myths and literature, and of people.
The field of psychology has traditionally been reluctant to subject novel and controversial methods to careful scientific evaluation. This reluctance has left a major gap.
Therefore widely held beliefs, promoted by many psychotherapists, that have been discredited by empirical evidence are for example:
• Almost all abused children become abusive parents.
• Almost all children of alcoholics become alcoholic.
• Children never lie about sexual abuse.
• Childhood trauma invariably produces emotional symptoms that carry on into adulthood.
• Memory works like a tape recorder, clicking on at the moment of birth.Hypnosis can reliably uncover buried memories.
• Traumatic experiences are usually repressed.
• Hypnosis reliably uncovers accurate memories.
• Subliminal messages strongly influence behavior.
• Children who masturbate or "play doctor" have probably been sexually molested.
• If left unexpressed, anger builds up like steam in a teapot until it explodes.
• Projective tests like the Rorschach validly diagnose personality disorders, most forms of psychopathology, and sexual abuse.Other unvalidated psychological treatments, include Thought Field Therapy and Imago Relationship Therapy, for which essentially no published controlled research exists.
Yet among the workshops providing continuing education (CE) credits to therapists are courses in calligraphy therapy, neurofeedback, Jungian sandplay therapy, and the use of psychological theater to "catalyze critical consciousness" Credits for critical incident stress debriefing, a technique that has been shown to be harmful in several controlled studies.
One can wonder whether individual differences exist among psychotherapists in their attraction to pseudoscientific methods. For example, if a therapist is attracted to one pseudoscientific method, will the therapist also be attracted to others?
But many today can receive a PhD in psychology without having acquired a core understanding of the basic principles of critical and scientific thinking.
What kinds of evidence are needed before we can draw strong conclusions?
Are there alternative hypotheses that I have not considered?The importance of testing clinical assumptions empirically, let alone of operationally defining terms.
About confirmation bias or the principle of falsifiability, and how these might affect diagnosis.About the social psychology of diagnosis: for example, how a rare problem, such as "dissociative identity disorder" (see my article yesterday) or "Munchausen by proxy" syndrome, becomes overreported when clinicians start looking for it everywhere and are rewarded with fame, acclaim, and income when they find it.
Why are so many diagnoses of mental illness based on consensus-a group vote-rather than on empirical evidence, and what does this process reveal about problems of reliability and validity in diagnosis?
An ethnographic study of the training of psychiatrists showed that psychiatric residents learn how to make quick diagnoses, prescribe medication, and, in a dwindling number of locations, do psychodynamic talk therapy, but rarely do they learn to be skeptical, ask questions, analyze research, or consider alternative explanations or treatments.
It is surprisingly difficult for clinicians to learn from clinical experience. This is not to say that clinical experience is never valuable. For example, experience may help clinicians structure judgment tasks. That is, it may help clinicians decide what judgments and decisions need to be made. Similarly, more experienced clinicians may be better at knowing what information to collect in an interview. However, experience does not seem to be useful for helping clinicians evaluate the validity of an assessment instrument. Nor does experience seem to help clinicians make more valid judgments when the task is structured for them (e.g., when they are all given the same information).
Psychotherapists who use pseudoscientific assessment and treatment methods continue to use them in part because they have not learned from clinical experience that they do not work. Empirical studies may raise questions about the validity and utility of pseudoscientific methods, but clinical experience is less likely to do so. A great deal of research has been conducted on cognitive processes, the nature of feedback, and the reasons why it is difficult to learn from experience. However, empirical studies have not focused on studying clinicians who use pseudoscientific methods. That is, studies have not focused on understanding why clinicians who use pseudoscientific methods have trouble learning from experience. Put another way, no study has looked at the cognitive processes, personality traits, and belief structures (cognitive schemas) of clinicians who use pseudoscientific methods. Nor has any study looked at social factors that may reinforce clinicians for using pseudoscientific methods.
But there is also scant support for the Rorschach test, some promising avenues no support for the Thematic Apperception Test( TAT) measure as it is currently used in clinical practice, only very limited promise for holistic scoring of some projective drawings, no support for anatomically detailed dolls (ADDs) as a screening instrument for evidence of sexual abuse, and evidence that the Myers-Briggs Type Indicator (MBTI) is a potentially reliable measure that lacks convincing validity data. A lack of standardization in the use of many of these techniques and an overreliance on unsubstantiated beliefs that certain people possess special interpretive powers has thwarted the possibility of advancing these techniques into the realm of scientifically supported assessment strategies.
It is also clear that self-help has not advanced substantially over the past three decades and it is unlikely to advance over the next 30 years if prevailing models are maintained. Unless a new direction is taken, there is no reason to expect that the next Don't Be Afraid, published perhaps in the year 2010, will be any more effective than the Don't Be Afraid of 1976 and 1941, or that the next Mind-Power will be anymore effective than the -Wind Powers of 1987, 1912, or 1903.
Case Example 1: Possession
Following an illustration of how reading material and psychological symptom interpretation can increase the plausibility of an initially implausible memory of witnessing a demonic possession. in an initial testing session, all of the participants indicated that demonic possession was not only implausible, but that it was very unlikely that they had personally witnessed an occurrence of possession as children.
A month after the first session, participants in one group first read three short articles (in a packet of 12), which indicated that demonic possession is more common than is generally believed and that many children have witnessed such an event. These participants were compared with (1) individuals who read three short articles about choking and (2) individuals who received no manipulation. Individuals who received one of the manipulations returned to the laboratory the following week and, based on their responses to a fear questionnaire they completed, were informed (regardless of their actual responses) that their fear profile indicated that they had probably either witnessed a possession or had almost choked during early childhood.
When the students returned to the laboratory for a final session and completed the original questionnaires, they indicated that the two suggested events-witnessed possession and choking-were more real than before. Additionally, 18% of the participants indicated that they had probably witnessed possession. No changes in memories were evident in the control condition. These findings provide evidence that events that were not experienced during childhood and are initially thought to be highly implausible can, with sufficient credibility-enhancing information, come to be viewed as having plausibly occurred in real life. (1)
2. Space Aliens
Myra was referred to a psychologist for relaxation training by her treating physician. The referral was to a psychologist who specialized in pain relief. During Myra's initial visits, the psychologist took virtually no history. Nevertheless, after hypnosis, the psychologist informed Myra that her back problems were a result of her having been molested by her father. The psychologist further informed Myra that she mentioned visiting her favorite uncle while she was hypnotized. The psychologist shifted to saying that her uncle had molested her. While in a normal waking state, Myra had no memories of abuse, either by her father or her uncle and took issue with the therapist's claims of such abuse. At her next session, the therapist indicated that, during another hypnotically induced state, Myra had remembered being abducted by a UFO while at her uncle's home. The UFO descended into her uncle's backyard and had taken her onboard a spacecraft that looked like the white "Inside of an eggshell." There, she was reported to have been sexually examined by aliens. This examination and subsequent examinations, performed while she was lying on an table, were the cause of her back problems. The psychologist hypnotized Myra in each of her sessions, maintaining that hypnosis was necessary with clients abducted by space aliens because the aliens hypnotized humans to force them to forget their alien encounters. Over the next 3 years, the psychotherapist focused on uncovering, all of Myra's alleged encounters with aliens. Myra felt that the therapist only seemed interested when she cooperated by producing information concerning these purported encounters. She reported that she began "to feel foggy, tired all the time, and out of touch with my feelings about anything." The psychologist significantly enlarged the boundaries of the therapy, eventually seeing her in 3-4 hour sessions held 3 days a week. The psychologist also forbade her from taking medications prescribed by her physician because the medications would interfere with her "recalling all the experiences on the UFOs which were central to the therapy." When Myra's savings were depleted, she was forced to terminate therapy.
On the other hand the "cognitive interview", which incorporates a variety of basic techniques derived from experimental research on memory, appears to hold promise as a method of enhancing memory in eyewitness contexts. (2)
(1) Mazzoni, G. A., Loftus, E. E, & Kirsch, 1. (2001). Changing beliefs about implausible autobiographical events: A little plausibility goes a long way. Journal of Experimental Psychology: Applied, 7, 51-59.
(2) Fisher, R. P., & Geiselman, R. E. (1992). Memory enbancement techniques for investigative interviewing.
