History of Psychotherapy in a Nutshell—2000
While Clinician’s Digest largely focused on weighty matters like the important trends shaping the field and studies with interesting clinical implications, it still occasionally included items that encouraged therapists not to take themselves too seriously.
In May, we asked readers to condense the history of psychotherapy (from the cave to the new millennium) into 75 words or less, promising an award of a one-year gift subscription to the Family Therapy Networker to the top entry. First place, for her precise, accurate tracking of the profession’s progress from ascription of blame to acceptance goes to Sykesville, Maryland, social worker Wendy Smith:
B.C-1945 A.D.: It’s God.
1950: It’s your parents.
1960: It’s you.
1980: It’s them.
1990: It’s us.
2000: It is.
Unmasking Big Pharma—2001
Under the direction of contributing editor Garry Cooper, a repeated subject of Clinician’s Digest was exposing the pharmaceutical companies’ control and manipulation of research findings on psychotropic drugs to highlight positive studies and obscure negative findings. Here’s just one example of the critical examinations of the data supporting medications’ effectiveness that Garry wrote over the years.
According to an article in the November 14, 2000, issue of Newsday, during the 1990s, pharmaceutically funded research increased six times faster than government funded research. At the Duke University Medical Center alone, for example, corporate-sponsored biomedical research increased nearly 70 percent in two years, jumping from $63 million in 1997 to $107 million in 1999. Richard Horton, editor of the British medical journal The Lancet, says that his peer reviews reject 9 out of 10 studies of new drugs submitted to the journal because the research has been designed to produce results favorable to the medication. In a September 9 article, the Canadian newswire service Canadian Press reports that companies have also withheld data necessary to answer peer reviewers’ questions and, in some instances, withheld negative data, even from the researchers who reported the results.
Companies have also required researchers to sign agreements that prohibit the scientists from publishing negative findings or discussing such findings with the press. A series of articles in the April 10-15 Hartford Courant reveals that academic researchers are even paid to put their names on articles actually written by ghostwriters working for pharmaceutical companies.
It Ain’t Necessarily So—2002
Another important role this department has played is as a regular debunker of the field’s certainties, alerting readers to studies challenging the conventional wisdom and reporting on emerging debates. In 1996, a task force in the American Psychological Association’s Division of Clinical Psychology began the effort to distinguish between treatment approaches founded in scientific evidence and the unregulated range of methods being applied in the name of “psychological healing.” The result was a list of approved treatments, consisting almost entirely of behavioral treatments, which sought to bring more of a sense of discipline, coherence, and professionalism to psychotherapy. But many critics remained unconvinced that the collection of supposed empirically supported treatments really worked.
Many therapeutic regimens for treating depression, panic disorder, and generalized anxiety disorder (GAD) have earned the imprimatur of an American Psychological Association task force charged with identifying “empirically supported” treatments. These therapies must be scrutinized in carefully controlled, replicable studies that demonstrate their effectiveness. But a new metanalysis of many of the studies says that these treatments may not work so well in everyday clinical practice.
In December’s Journal of Clinical and Consulting Psychology, Boston University researchers Drew Westen and Kate Morrison say many of the studies that purportedly demonstrate the efficacy of a treatment are based on samples so pure as to bear little resemblance to real-world treatment populations. For example, they found that many studies excluded subjects diagnosed with more than one disorder. . . .
When Westen and Morrison factored in the subjects who had been excluded from the samples, the success rates of the treatments declined significantly—from 54 percent to 37 percent for the depression treatments, 52 percent to 44 percent for GAD, and 63 percent to 54 percent for panic disorders.
Westen and Morrison found that empirically supported treatments may not work so well in the long term, even for the samples on which the studies are based. . . . Putting the best face on the findings, Westen and Morrison conclude that about half the people who complete the empirically supported treatments will benefit from them, primarily in the immediate reduction of symptoms. However, they caution that the average person who completes these treatments will remain clinically depressed or anxious.