Terence Hines - Pseudoscience and the Paranormal

If psychotherapies in general are more effective than doing nothing because the therapist is providing advice to patients, one would expect that professional advice givers (i.e., trained professional psychotherapists) would not be much more effective than individuals lacking formal therapeutic training. This issue has been the focus of considerable research. Two reviews of the literature on this issue (Durlak 1979; Hattie, Sharpley, and Rogers 1984) have actually found that patients treated by trained professionals do worse than those treated by untrained “paraprofessionals.” Berman and Norton (1985) have criticized the Hattie, Sharpley, and Rogers review on statistical grounds and reanalyzed the literature that the original study reviewed. In their reanalysis Berman and Norton find no difference in therapeutic effectiveness between trained professionals and untrained paraprofessionals. Dawes (1994) has penned an especially trenchant critique of the practice of psychotherapy that exposes the many empirical and logical failings of claims that underlie many psychotherapeutic beliefs and techniques.

Returning to the specific issue of the effectiveness of psychoanalytic therapies, what is true for psychotherapies in general is true for psychoanalytic therapies in particular. Repeated reviews of the literature have failed to show any solid evidence that psychoanalytic therapy is superior to placebo therapy (Eysenck 1952; Rachman 1971; Rachman and Wilson 1980; Erwin 1980, 1986).

Does any type of psychotherapy provide a better result than placebo therapy? The answer is yes, and the type of therapy is behavior therapy and its close relative, cognitive behavior therapy (Erwin 1986). Developed as an alternative to the ineffective psychoanalytic treatments in the early 1960s, early behavior therapies concentrated on classical and instrumental conditioning as the explanation of disordered behavior. The idea was that such behavior was learned and could be eliminated using the techniques of reinforcement, punishment, and extinction drawn from work on conditioning animals. As the field of behavioral therapies has matured, it has become much more cognitive, admitting that patients’ cognitions play an important role in disordered behavior and must be addressed by any therapy. Thus, Lazarus (1986) notes that “terms such as ‘expectancies,’ ‘encoding,’ ‘plans,’ ‘values,’ and ‘self-regulatory systems,’ all operationally defined, have crept into the behavior literature” (p. 251). More recently, it has shown that versions of behavior modification are effective in treating major depression (Whooley and Simon 2000; Hollon, Thase, and Markowitz 2002). However, pharmacological treatment is superior in patients with more severe depression (Schulberg et al. 1998).

In the last decades of the twentieth century, research on psychotherapy has focused on which forms of therapy are effective and just what specific disorders they are effective for. Chambless et al. (1998) have reviewed this research and publish in their paper a listing of therapies that have been shown to be either “well established” or “probably efficacious” based on empirical research. Therapies in both these categories are almost exclusively of the behavioral or cognitive behavior type.

The early behavior modifiers made the unfounded claim that all disordered behaviors were the result of learning or conditioning of one type or another. While this rather grandiose claim was wrong—for example, many behavioral disorders are biochemically caused—other disorders were properly thought to be due to learning factors. Behavior therapies were quite effective at treating these. Examples include phobias (Paul 1969a, 1969b), certain specific types of depression (Rehm 1981), and other disorders ranging from obsessive-compulsive disorders to some sexual disorders (Bandura 1969).

Interestingly, the advent of behavioral modification techniques that focus on the disordered behavior itself, rather than on hypothetical psychological causes such as unresolved Oedipal complexes and the like, provided an opportunity to test one strong prediction made by psychoanalytic theory. According to psychoanalytic theory, the overt disordered behavior a patient displays is merely a symptom of some hidden, deep psychological cause According to psychoanalytic theory, it would not be sufficient to simply eliminate the symptom (i.e., the behavior), because the underlying cause of the disorder would still be there and would only cause some other problem behavior (i.e., symptom) in the future. This is known as the symptom substitution hypothesis . Studies of patients who have been treated behaviorally have shown no evidence of symptom substitution (Bandura 1969; Franks 1969).

The evidence indicates that the belief that psychotherapies other than behaviorally oriented ones actually work is a myth. Another myth held dear by psychologists is what Dawes (1994) terms the “myth of expertise.” This is the deeply held belief that clinical judgments based on interviews and personal interaction with patients or clients results in better judgments about such variables as dangerousness, psychopathology, neuropsychological status, and so on than do judgments based only on the results of valid and reliable empirical tests. It has been known since the early 1950s that this belief is simply wrong. Not only are judgments based on what is often termed “clinical experience” no better than those based purely on statistical calculations, they are almost always worse (Meehl 1954; Faust and Ziskin 1988; Dawes, Faust, and Meehl 1989; Dawes 1994; Ziskin 1995). Clinicians continue to believe that their experience-based judgments are superior because of effects such as selective memory: They are much more likely to remember the instances in which their judgments happened to be correct than those in which they were not. This is precisely the sort of cognitive illusion that supports beliefs in other invalid belief systems such as ESP (see chapter 2) and astrology, moon madness, and biorhythm theory (see chapter 6). The realization of the “myth of expertise” has led some (e.g., Dawes 1994; Hagen 1997) to question whether testimony by psychologists and psychiatrists based on interviews, projective tests, and other invalid techniques is anything other than junk science.

Although Freud believed that the constructs in psychoanalytic theory were biologically real, he also believed that the causes of psychological disorders, serious and minor, could be traced to patients’ experiences while growing up. The early years, during which psychosexual development was said to take place, were especially important. If the child was exposed to aberrant situations during this period, disorders of psychosexual development could occur that would appear in adulthood. Thus, for example, overt male homosexuality was thought to be due to the boy’s failure to form a normal identification with his father, due to either a cold, unloving father or a domineering mother. Mothers, in psychoanalytic thought, are often responsible for the psychological disturbances of their children. Depression is said to be caused when a loss during adulthood reactivates the represssed feelings of the traumatic loss during childhood of the mother’s affection. Psychoanalytic psychologist Bruno Bettelheim (1967) argued that the childhood disorder autism is caused by inept, unloving, and cold mothers, a now totally discredited view.

Within the past decade great strides have been made in understanding the nature of many disorders. In a host of such disorders that were previously thought to be “psychological”—that is, caused by some abnormality in the interactions the individual had with his parents or peers, usually as a child—the actual causes have been determined to be physiological, usually involving abnormalities in the chemistry of the brain. Considerable evidence now exists to show that human homosexuality is caused, at least in large part, by hormonal influences that take place while the brain is developing in utero (Ellis and Ames 1987; Goy and McEwen 1980), although specific cultural influences are also at work (Green 1987; Money 1987). There is also evidence that there are anatomical differences between the brains of straight and gay human males (LeVay 1993).The important fact here is that modern research on the etiology of homosexuality fails to support the psychoanalytic view.