The Most Discredited Therapies—2007
The Networker has always offered critical perspectives on clinicians’ excesses and blind-spots. In a profession where therapeutic fads have long exerted a disproportionate influence on practice without any relationship to demonstrated results, it’s seemed crucial to regularly look at not only psychotherapy’s successes, but our failures. The following represented an unusually systematic attempt to attach warning labels to a wide variety of treatment methods, some still commonly used.
With the increasing focus on evidence-based therapies, psychologist John Norcross decided it would be worthwhile to identify some of the most discredited therapies. Along with current American Psychological Association President Gerald Koocher and doctoral student Ariele Garofalo, he combed the literature and asked hundreds of mental health professionals to nominate what they considered “discredited treatments and tests that have been used professionally within the last 100 years for mental health purposes.”
After the list was compiled, a panel of 101 researchers, journal editors, and therapists were asked to rate each method on a 5-point scale from “not at all discredited” to “certainly discredited” (raters could also choose “not familiar with”). Using the Delphi survey method, his team then sent the panel members the results of the survey, minus those techniques that less than 25 percent of the members had rated, and asked them to rate them again. In the end, the expert panel rated 89 treatments and assessment methods.
Part of the list of discredited methods, presented in the October Professional Psychology: Research and Practice, reads like an amalgamation of medical horrors and New Age ideas: prefrontal lobotomies, crystals, and pyramids. Other treatments listed comprise a historical tour of psychotherapy: Freudian dream analysis, Jungian sand trays, past lives, future lives, primal scream, Erhard Seminar Training, Bettelheim’s model for treating childhood autism, family therapy for schizophrenia based on the double-bind theory, marathon encounter groups, and holding therapy for attachment disorders.
More recent controversial treatments on the list that garnered highly discredited ratings were reparative therapy for homosexuality, rebirthing, and Thought Field Therapy. Other recent therapies, like EMDR for trauma, psychosocial therapies for AD/HD, thought-stopping for excessive rumination or worry, and laughter or humor therapy for depression, were deemed credible. Several older methods, including J. L. Moreno’s psychodrama and Wilfred Bion’s psychoanalytically oriented group analysis, also garnered respectable ratings.
Norcross stresses that a discredited ranking of any treatment should primarily be construed as a call for more research on it, not as a condemnation, that experts “can and have been wrong,” and that therapists shouldn’t be afraid to be innovative and trust their intuition. Nevertheless, he says, the study has generated considerable controversy, including protests from many psychotherapists who pointed out that they themselves have successfully used some of the most “discredited” treatments like the Lüscher Color Test for personality assessment. “I don’t know how to answer them,” he says. “If something’s helped them, I want to be respectful of their experience. At the same time, we know from research that placebos work about a third of the time.”
We’re always on the lookout for intriguing findings that may not initially get much public attention, but suggest unrecognized changes in people’s attitudes and beliefs. One of the most interesting that we came across recently was a phenomenon that’s made the job of researchers looking for significant treatment effects harder than ever.
What are they putting into placebos, those supposedly inert pills with no medicinal effect that have long been the benchmark against which the effectiveness of new medications are measured? Something’s going on, because placebos are getting stronger. An intriguing metanalysis in the November 2009 Journal of Affective Disorders, for example, found that the potency of placebos has nearly doubled between 1985 and 2005. How can that be? . . .
As brain-imaging technology has revealed that people’s expectations produce actual brain reactions, the key to understanding placebos has shifted from the notion that their effect is purely imaginary to a new appreciation of their real psychological impact. Silberman speculates that the pharmaceutical companies may be victims of their own multimillion-dollar advertising successes. Press reports and mass advertising have led us to believe increasingly in the power of medications, so critical trial subjects and raters (whose unconscious biases often influence results) may have developed higher expectations that pills will work.
The End of the Psychotropic Era—2010
The pharmaceutical industry—“Big Pharma”—has long been a bugaboo of our profession. We like to see ourselves as idealistic Davids pitted against soulless corporate Goliaths that dispense pills instead of expanding awareness. For those of us long grown accustomed to the idea that the continued triumph of these Goliaths goes without question, the very idea that their business might experience a downturn was an invitation to gloat that many of us couldn’t resist.
By now, we’ve gotten accustomed to expecting successive new waves of psychotropic medications to make their much ballyhooed appearance on the market, each set of drugs accompanied by claims that they’re far more effective than their predecessors, with fewer side effects.
Antidepressant tricyclics gave way to SSRIs, which have more recently led to SSNRIs (which affect norepinephrine levels as well as serotonin); the first generation of antipsychotics was followed by the atypical antipsychotics. But beginning last winter, a series of surprising announcements indicated that even the mighty psychopharmaceutical industry has hit hard times. Claiming that researching and developing psychotropics has becomes too expensive and unprofitable, both GlaxoSmithKline and AstraZenica said they were suspending or curtailing research on drugs targeting depression, anxiety, and other psychiatric conditions.