Benefits of psychotherapy lack ‘reliable scientific proof’

Professor Bruce W. Davidson outlines the deficiencies of psychotherapy, including this scathing criticism.

Psychotherapism is mostly fraudulent. For more than 80 years, considerable research has been done looking into its effectiveness, and the weight of the evidence indicates that it is ineffectual at best and harmful at worst.

This is not to say that psychotherapists are con artists with evil intentions. No doubt many are well-meaning people who genuinely want to alleviate human suffering, and certainly many people have felt encouraged by their therapists. However, much of this may be simply the relief that comes from unburdening one’s concerns to a sympathetic ear. Indeed, amateur therapists such as teachers have done as well as trained, credentialed therapists in some research studies.

The big problem is that there is little or no reliable scientific proof for believing that talking about one’s problems really leads to solving those problems, or to improved well-being. Long ago the philosopher Karl Popper pointed out that Freudian psychology, like Marxism, was a pseudo-science, since it claimed to explain everything and could not be experimentally proven to be false. That reality has not changed, as many writers like Dawes in his book House of Cards have pointed out.

More ominously, much evidence exists that psychotherapy can sometimes do great harm. For example, counseling the victims of traumatic events like plane crashes often aggravates their suffering and prolongs the time it takes for them to recover emotionally.

If this is true, then we should applaud the “trend of less talk and more medication for patients with mental disorders”.

… The benefits of psychotherapy seem fuzzy to many potential patients, but pharmacological treatment enjoys “clearer, better marketed evidence” of its efficacy. Some of this comes from the failure of psychotherapists to take a scientific approach to patient treatment.

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 Bruce W. Davidson, “The Sins of Psychotherapism”, American Thinker, August 2, 2014.

The trend of less talk and more medication for patients with mental disorders

Clinical psychologist Brandon A. Gaudiano wrote in the New York Times that psychotherapy is in decline while the use of medication is on the rise for the treatment of mental disorders.

…  In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent. This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.

Yet psychotherapy for the most common conditions is considered the best treatment “of first choice”.  What is going on? The benefits of psychotherapy seem fuzzy to many potential patients, but pharmacological treatment enjoys “clearer, better marketed evidence” of its efficacy.  Some of this comes from the failure of psychotherapists to take a scientific approach to patient treatment.

But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.

Psychologists need better, well-defined treatment guidelines.

There is a lot of organizational catching up to do. Groups like the American Psychiatric Association, which typically promote medications as treatments of first choice, have been publishing practice guidelines for more than two decades, providing recommendations for which treatments to use under what circumstances. The American Psychological Association, which promotes psychotherapeutic approaches, only recently formed a committee to begin developing treatment guidelines.

Lack of clarity is also a problem in diagnosis. Gary Greenberg, a practicing psychotherapist and author of of The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry, argues that another problem is the method used to diagnose mental disorders, which “is not scientific, but political and bureaucratic”.

Psychiatry and psychology just seems fuzzy all around, more art than science.

Related:  ‘Every 20-something I know is in therapy for something’ (Cost of College)

Quick Links – College students seek mental health assistance; students not prepared for college writing; we need to ‘create education better’

Almost 40% of Harvard students seek mental health treatment.

45.1% of females and 30.1% of males have sought mental health assistance while at Harvard, according to the Harvard Class of 2013 Senior Survey

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Graduates from low performing D.C high schools:  ‘Students almost universally said writing is a significant challenge when they get to college.’

… Darryl Robinson, a Georgetown student and 2011 graduate of Cesar Chavez, a D.C. charter school, said it was his first college writing assignment that taught him how much he had to learn.

Asked to analyze a memoir, Robinson wrote a simple plot summary. He hadn’t known how to develop an argument and back it up. His paper received a D-minus, as he recalled in an opinion piece he wrote for The Washington Post last year.

“Other Georgetown freshmen from better schools had been trained to form original, concise thoughts within a breath, to focus less on remembering every piece of information,” Robinson wrote. “My former teachers simply did not push me to think past a basic level, to apply concepts, to move beyond memorizing facts and figures.”

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America needs to “create education better“, according to the response Miss Utah gave to a question during the Miss USA pageant.

Of course this flub went viral.  Here’s the question Miss Utah was asked.

“A recent report shows that in 40% of American families with children, women are the primary earners, yet they continue to earn less than men,  What does this say about society?”

I agree with Linda Holmes of NPR that this was a “simultaneously (1) dumb and (2) impossible to answer question”.  And it may have had another purpose.

That type of question is meant to weed out the un-PC.

Here’s Miss Utah’s complete answer:

“I think we can relate this back to education and how we are continuing to try to strive to figure out how to create jobs right now,’’ she replied at the pageant. “That’s the biggest problem and I think, especially the men are, um, seen as the leaders of this and so we need to try to figure out how to create education better so that we can solve this problem. Thank you.”

In her second try during an appearance on the Today Show, Miss Utah gave a revised answer.

“This is not OK,’’ she said. “It needs to be equal pay for equal work. It’s hard enough already to earn a living, and it shouldn’t be harder just because you’re a woman.”

Given my views on this touchy subject, I don’t care for either response.  But her second try was certainly a politically correct answer.

Quick Links – The ‘science’ of psychiatry

Up to 20% of American children suffer from mental disorders, but the accuracy of reporting is questionable.

Scientists at the U.S. Centers for Disease Control and Prevention found that 13% to 20% of American children age 3 to 17 experience mental disorders each year, and that rates have been increasing.

A ‘hodgepodge’ of counting methods

The study also showed there are no standard ways of counting afflictions, but a hodgepodge including parental reports or reports directly from children. Some disorders, such as bipolar disease and anxiety disorders, weren’t included in the overall rates for lack of data. The disorders that were included span a wide range, including hyperactivity and severe autism.

Statistical experts are skeptical of the reported numbers.  Data collection is inconsistent, with random phone surveys of parents yielding higher results than other methods.  Families with health insurance report higher rates, and regional differences raise suspicion about different approaches in diagnosis.  Double counting children with multiple disorders leads to inflated rates.

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French children have much lower rates of diagnosed ADHD.

In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

Different approaches to diagnosis and treatment

 In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological–psycho stimulant medications such as Ritalin and Adderall….

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children’s focusing and behavioral problems withdrugs, French doctors prefer . . . to treat the underlying social context problem with psychotherapy or family counseling…

Different parenting styles

And then, of course, there are the vastly different philosophies of child-rearing in the United States and France. These divergent philosophies could account for why French children are generally better-behaved than their American counterparts….

From the time their children are born, French parents provide them with a firm cadre—the word means “frame” or “structure.” Children are not allowed, for example, to snack whenever they want. …

… French parents have a different philosophy of discipline. Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier and safer … French parents believe that hearing the word “no” rescues children from the “tyranny of their own desires.” And spanking, when used judiciously, is not considered child abuse in France.

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Psychiatry:  diagnosis is not scientific, but political and bureaucratic

In an interview with The Atlantic, Gary Greenberg, a practicing psychotherapist and author of The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry, says no one can define “mental illness”.

What is the difference between a disorder and distress that is a normal occurrence in our lives?

That distinction is made by a clinician, whether it’s a family doctor or a psychiatrist or whoever. But nobody knows exactly how to make that determination. There are no established thresholds. Even if you could imagine how that would work, it would have to be a subjective analysis of the extent to which the person’s functioning is impaired. How are you going to measure that? Doctors are supposed to measure “clinical significance.” What’s that? For many people, the fact that someone shows up in their office is clinical significance. I’m not going to say that’s wrong, but it’s not scientific. And there’s a conflict of interest — if I don’t determine clinical significance, I don’t get paid.

Is a child autistic or just awkward?  Special education services and insurance coverage are controlled by committee decisions on what is to be included in the DSM.

… You can’t just ask for special services for a student who is awkward. You have to get special services for a student with autism. In court, mental illnesses come from the DSM. If you want insurance to pay for your therapy, you have to be diagnosed with a mental illness….

Arbitrary?
Homosexuality was declassified as a DSM disorder in 1973.  And I’m sure I’m not the only one who has considered that Oppositional Defiant Disorder (ODD), characterized by “negativistic, defiant, disobedient, and hostile behavior toward authority figures that persist for at least six months“, is a particularly arbitrary disorder.

‘What Families Can Do When a Child May Have a Mental Illness’

From the National Alliance on Mental Illness (NAMI):

If you are worried about your child’s mental health, follow your instincts. Unexplained changes in a child’s behavior and/or mood may be the early warning signs of a mental health condition and should never be ignored.

There are many different types of mental illness, and it isn’t easy to simplify the range of challenges children face. One way to begin to get a handle on this question is to get an evaluation of your child or teen by a licensed mental health professional.  Because all children and youth are unique and the local mental health services, insurance coverage and school services vary a great deal from community to community, it is a challenge to find the right kind of help for your child.

Like many others, my family has had to deal with this issue.  You can read more about different types of mental illness and what steps parents can take to help their children at the NAMI website.

Have a joyful and peaceful Christmas.

 

Related:

• Parents Worry Their Child Could Be ‘Next Adam Lanza’ (CBS Detroit)
• ‘Every 20-something I know is in therapy for something’ (Cost of College)

‘Every 20-something I know is in therapy for something’

A 20-something college graduate looks around and finds her peers need counseling to help them handle their unemployment blues.

Being depressed prolongs the unemployment process, and I believe a lot of kids my age were/are depressed. One of the ways to pull out of depression is to be productive. If you need medical attention, get it. If you need therapy, get therapy. Every 20-something I know is in therapy for something. I take anti-depressants and anxiety medication. My anxiety medication is the butt of a lot of jokes, but it helps me. A part of being an adult is knowing when you need help and seeking it.

…
Is this hyperbole?  Let’s look at the numbers.

Young adults do seem to suffer from mental illness at higher rates, with the 18-25 age group the highest at almost 30%.  I could not find data for how many are undergoing therapy, but apparently there has been a shift from “talk therapy” to drugs as the dominant mode of treatment.

…
Who is taking medication?

This graph shows that members of my demographic group, females aged 40-59, use the most antidepressants.  This is consistent with my personal observation.  But other reasons may explain why the numbers are so high.

The survey captured how many patients are on antidepressants, not necessarily how many patients are being treated for depression with antidepressants. Because antidepressants are also prescribed for anxiety, neurological pain, fibromyalgia, sleep problems, and menopausal hot flashes, some of those reporting being on antidepressants may have been medicated for those reasons, not for depression, says Dr. John Messmer, associate professor of Family and Community Medicine at Penn State College of Medicine.

Well.  I’ll just reiterate the advice given above, applicable both to unemployed* 20-somethings and menopausal women.

If you need medical attention, get it. If you need therapy, get therapy.

* Unfortunately, with health insurance so closely tied to employment, paying for medical needs can be the biggest challenge for this group.

Are college students with psychological problems over-indulged?

Increased incidents of  psychological problems among college students have caused colleges to become more accommodating, but some wonder if all this is just another sign of  a coddled generation.

Colleges say they’re seeing more students on campus with psychiatric illnesses. About 11.6% of college students were diagnosed or treated for anxiety in the last year, and 10.7% were diagnosed or treated for depression, according to a survey of more than 100,000 students at 129 schools conducted by the American College Health Association. Many mental illnesses, particularly depression, bipolar disorder and schizophrenia, emerge during late adolescence.

Psychiatric disorders like depression and anxiety can have serious academic consequences because they affect concentration, sleep and cognitive processing, say mental health professionals.

Institutions are required to comply with the American for Disabilities Act, but it can get complicated.

Schools say they can’t require faculty to adjust deadlines or attendance policies. And in some courses, like science labs and speech classes, participation is critical, but schools can push instructors to compromise with students.

Even with increased accommodations, psychological conditions are often not viewed as charitably as physical ones.  Is it really an anxiety disorder, or simply a frail temperament overwhelmed by hard work and tough deadlines?  And does a school’s forgiving attitude adequately prepare graduates for a competitive work environment?

“There’s the danger that we take too much care and when they hit the real world that same kind of support isn’t there,” says David Cozzens, dean of students and associate vice president of student affairs at the University of Wyoming in Laramie.

This harsh tone was typical among the 250 comments to this story:

I am so sickened by this article I don’t even know where to begin…….what a bunch of coddled whiners this generation is…….if these students cannot make deadlines because their “karma” is upset ot they are having a bad day caused by the pressure of deadlines and exams…then they should be allowed to fail…as they will in the real world whjere they will not be coddled or catered to….there will be nobody to ‘understand’ just somebody in line to take their job and they will be fired…deservedly…this is not high school…you are in college to perform…under all sorts of pressures….performance requires that you deliver the goods when asked to do so…not on your own timetable…those who can will advance…those who do not will fail…and oh by the way…when allowed an extra 10 days to complete her report where is the fairness to the other students who busted their you know what to be on time? If she is that mentally oppressed and cannot play by the rules then she should simply not be there.

Ouch!  It’s a tough world, even if official attitudes seem more humane  than before.  Parents and students dealing with psychological problems should become fully informed about individual school policies.

Some formal accommodations, like additional test time, are fairly standard across universities and apply to students with physical and learning disabilities, too. But, schools diverge widely on formal accommodations for flexibility with assignment deadlines, class attendance and participation. Some schools leave it up to individual instructors. Others intervene more directly on students’ behalf.

Some more tough talk from college professors over at College Misery

Related articles

• Mental Illness in Kids: The Surprising Warning Signs (everydayhealth.com)