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., A.B.P.P.
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.
