While studying psychology by myself in Shanghai as a high school student, I discovered something strange, which was the huge difference between psychologists as scientists and psychologists as therapists, counselors, or practitioners. The difference was so fundamental that I started to question whether these psychologists were “psychologists” at all.
For instance, while most scientists have already been viewing Freud’s theories as historical facts and learning them generally for remembering the insights they provided us, considerable amount of practitioners are still frequently discussing about concepts such as childhood trauma, unconsciousness, repression, or defense mechanisms, applying a psychoanalytical model in treating patients. I admit this analysis might be a little bit biased, since there exist many research showing the efficacy of psychodynamic treatments. Nevertheless, I believe there still exist the problem of definition or classification: what counts as a psychodynamic treatment? Since psychodynamic model has varied a lot in the history — from the original psychoanalysis created by Freud to the ones based on, or influenced by the Neo-Freudians, and then to the current psychodynamic model that actually is a lot different from the original one — it is very crucial for us to distinguish the really effective ones from the maybe out-dated, ineffective ones. And I believe, at least based on what I have observed and heard of in Shanghai, there might not be such a systematic classification and regulation.
Well, if there is still some controversies around the effectiveness of psychodynamic therapies, let us put them aside and pay attention to something even more interesting. In the television shows, on the internet, on the psychology bookshelves of bookstores, I have frequently found “new,” “amazing,” “eye-catching” therapies or theories that I have not ever heard of or read about in scientific papers or books. Some therapists, instead of following the scientific criteria or procedures to conduct the therapy, to treat the patients, simply form their “own styles of treatment.” This would definitely be a nice progress for clinical psychology if these “new styles” were tested with randomized placebo controlled clinical trials. Nevertheless, most of the time, they just remain unsubstantiated. The main support will come from the practitioners themselves, saying that they were developed based on clinical experiences, which is, as discussed in the later part of the article, not very tenable.
Above is just some random observations or thoughts that came to my mind while writing. Now, I would like to summarize for you some of the most important points in the book Science and Pseudoscience in Clinical Psychology:
We need more evidence-based therapies and treatments.
We need to have a balance between excessive open-mindedness and excessive skepticism.
Training for practitioners are useful. Experiences are not. It is difficult for practitioners to learn from experience because of the nature of feedback and the bias existing within every human being.
Most psychological tests based on the theory of projection — including HTP, Rorschach Inkblot Test, TAT, and so on — are problematic. We cannot find enough evidence to support their validity and reliability.MBTI is also not supported by evidence.
There are basically two major etiological models for DID, one is the post traumatic model (PTM) and the other one is the sociocognitive model (SCM). Later one is supported by more evidence. DID might be therapist-induced. DID is influenced by culture.
We need both efficacy research and effectiveness research for therapies.
All psychological assessments, treatments, therapies need to receive regulation, examination, and evaluation.
There is little support for the use of memory recovery techniques to uncover memories of abuse in psychotherapy.
Cognitive-Behavioral Theory is relatively evidence-supported for the treatment for trauma disorders, including PTSD.
Antidepressants might not be that useful. Placebo effect might receive more credit for the real positive effect in patients. We should pay more attention to placebo as it may itself become a reliable and easy treating method.
For treating ADHD, medications and behavior modifications are generally effective. New therapies including EEG biofeedback, etc., might need further research.
Generally, Self-Help Therapies are not effective. Find a reliable therapist is important. However, the mess of Self-Help books and therapies were partially created by psychologists in the 1970s and 80s with great intentions.
Commercializing mental health issues is almost always a problem. “When psychological expertise and services enter the mass market, they become beholden to marketplace values and strategies.” “As commercialized forms of professional expertise succeed in the mass market, they not only degrade, but ultimately displace, the original on which they are based.”
Suggestions from authors
All clinical psychology training programs must require formal training in critical thinking skills, particularly those needed to distinguish scientific from pseudoscientific methods of inquiry.
The field of clinical psychology must focus on identifying not only empirically supported treatments, but also treatments that are clearly devoid of empirical support.
The American Psychological Association and other psychological organizations must play a more active role in ensuring that the continuing education of practitioners is grounded in solid scientific evidence.
The American Psychological Association and other psychological organizations must play a more visible public role in combating erroneous claims in the popular press and elsewhere (e.g., the Internet) regarding psychotherapeutic and assessment techniques.
The American Psychological Association and other psychological organizations must be willing to impose stiff sanctions on practitioners who engage in assessment and therapeutic practices that are not grounded in adequate science or that have been shown to be potentially harmful.
On a more positive note, the field of clinical psychology must actively address the continued sources of resistance to evidence-based practice among many mental health professionals.
Bibliography
Lilienfeld, S. O., Lohr, J. M., & Lynn, S. J. (2015). Science and Pseudoscience in Clinical Psychology. New York, NY: Guilford Press.