The Great Psychotherapy Debate Continues
Tarrant, Dr. Jeff, Skeptic (Altadena, CA)
IN DEFENSE OF PSYCHOTHERAPY
In "Psychotherapy: The Snake Oil of the 90s?" (Vol. 6, #3, (SKEPTIC), Dr. Tana Dineen makes the following broad-based claims: 1) psychotherapy is no more effective than talking to a friend; 2) short term therapy is just as effective as long term therapy; 3) psychologists and the "psychology industry" ignore information which might discredit their profession and promote misinformation to create a market for their services. Her arguments sound a bit like a conspiracy orchestrated by Martin Seligman, past-president of the American Psychological Association (APA) and "the psychology industry" in an effort to make more money and create increasing markets for their phony services (hence the snake oil analogy). This response to Dr. Dineen's article will address both the process and content of her arguments as there are serious flaws in both.
The majority of Dr. Dineen's "evidence" for her claims comes from two sources: a Consumer Reports Survey (CR) on mental health effectiveness (1995) and the Fort Bragg Demonstration Effectiveness Project (FBEP; Bickman, et al., 1995). Briefly, the CR study was the result of "a supplementary survey about psychotherapy and drugs in one version of its 1994 annual questionnaire, along with its customary inquiries about appliances and services" (Seligman, 1995, p. 967). The survey contained 26 questions about mental health professionals, for those to whom the questions applied. The FBEP was a very large and expensive project which compared a comprehensive, integrated system of mental health care versus "usual care," in the form of disconnected and diverse services (Sechrest & Walsh, 1997).
The first argument offered is that psychotherapy is no more effective than talking to a friend. Dr. Dineen states "for reasons that they will not make public, CR chose to ignore the experiences" (p. 57) of the 3,000 respondents who had talked to a friend, relative, or clergy, but not a mental health professional. Dr. Dineen seems to think that this information is being withheld as it would prove her theory that talking to a friend is as effective as seeing a mental health professional.
Dr. Seligman dearly addresses this concern when he explains "because there are no control groups, the CR study cannot tell us directly whether talking to sympathetic friends or merely letting time pass would have produced as much improvement as treatment by a mental health professional. The CR Survey unfortunately, did not ask those who just talked to friends and clergy to fill out detailed questionnaires about the results" (1995, p. 972). Data from the 3,000 "Bermuda Triangle" respondents were not included because there was no corresponding data to compare! While Dr. Seligman considers this a "serious objection" (1995, p.972) he goes on to discuss some of the internal controls which performed many of the functions of the control groups and support the notion that psychotherapy is superior to talking to a friend.
First, marriage counselors do significantly worse than psychologists, psychiatrists, and social workers, in spite of no significant differences in kind of problem, severity of problem, or duration of treatment. Marriage counselors control for many of the nonspecifics, such as therapeutic alliance, rapport, attention, as well as for the passage of time. Second, there is a dose-response curve, with more therapy yielding more improvement The first point is the dose-response curve approximates no treatment: people who have less than a month of treatment have on average an improvement score of 201, whereas people who have over two years of treatment have an average score of 241. Third, psychotherapy does just as well as psychotherapy plus drugs for all disorders, and there is such a long history of placebo controls inferior to these drugs that one can infer that psychotherapy likely would have outperformed such controls had they been run (Seligman, 1995, p. …