How to Spot Hype in the Field of Psychotherapy: A 19-Item Checklist, Meichenbaum & Lilienfeld, 2018

[rvallee]

And, in my opinion, we see this exact thing happening in things like the Lightning Process, where it is claimed that change can only happen if the patients 'buy' into the process presented to them. And obviously this relieves the 'therapist' of any responsibility for whether it actually works or not, as it's all down to the patient.

Exact same energy, spoon-bending edition:

In the documentary, James Randi says that "Johnny had been a magician himself and was skeptical" of Geller's claimed paranormal powers, so prior to the date of taping, Randi was asked "to help prevent any trickery". Per Randi's advice, the show prepared their own props without informing Geller, and did not let Geller or his staff "anywhere near them". When Geller joined Carson on stage, he appeared surprised that he was not going to be interviewed, but instead was expected to display his abilities using the provided articles. Geller said, "This scares me", and, "As you know, I told your people what to bring", and "I'm surprised because before this program your producer came and he read me at least 40 questions you were going to ask me". Geller was unable to display any paranormal abilities, saying, "I don't feel strong", and expressed his displeasure at feeling like he was being "pressed" to perform by Carson.

Also too much same energy, when evidence doesn't even matter and everything is about belief and illusion:

This appearance on The Tonight Show, which Carson and Randi had orchestrated to debunk Geller's claimed abilities, backfired. According to Higginbotham,

To Geller's astonishment, he was immediately booked on The Merv Griffin Show. He was on his way to becoming a paranormal superstar. 'That Johnny Carson show made Uri Geller,' Geller said. To an enthusiastically trusting public, his failure only made his gifts seem more real: If he were performing magic tricks, they would surely work every time.

 

[DokaGirl]

Especially as you can no longer rely so much on the solution they had in the 70s: handing out a prescription for extremely addictive tranquillisers, which kept people quiet beautifully, some of them for decades.

Ah, the 70s. When I had a terrible, and very painful infection for which I was given a tranquilizer, and told my pain was real. The tranqs of course did nothing to help the pain or infection. Eventual biomedical treatment fixed the problem.

How many millions have gone through this same type of thing, decade after decade?
I'm too tired to count them.

 

[Arnie Pye]

This reminds me of my dislike of having to answer questions about English literature at school, especially poetry (it was all long dead male English poets, largely incomprehensible to a science oriented Australian schoolgirl like me). I thought the task was to get the 'right' answer to please the teacher. I had no idea it was OK to give my own interpretation.

I have heard and read multiple anecdotes, not just from people of school age, but from university students too, that expressing an opinion on a subject that was different from the teachers / lecturers would get marked down and/or failed. So I think your interpretation of the rules was most probably right in many cases.

I remember being a teenager in an English class and we were discussing the poem Pot Pourri from a Surrey Garden by John Betjeman.

It has this verse :

Pam, I adore you, Pam, you great big mountainous sports girl,
Whizzing them over the net, full of the strength of five:
That old Malvernian brother, you zephyr and khaki shorts girl,
Although he's playing for Woking,
Can't stand up
To your wonderful backhand drive.

I had forgotten after the early discussion what "zephyr" meant so I looked it up in a dictionary at home. This is an internet definition :

zeph·yr
(zĕf′ər)
n.
1. The west wind.
2. A gentle breeze.
3. Any of various soft light fabrics, yarns, or garments, especially a lightweight, checked gingham fabric.
4. Something that is airy, insubstantial, or passing.

The teacher had told us about the wind/breeze meaning, but I discovered it could also be an item of clothing. When discussion continued during the next class I mentioned this meaning in class and got laughed at in a patronising way and told that No, it was a wind and Betjeman must have meant this because, it was implied, Betjeman was cleverer than me and so he wouldn't use a meaning that was so pedestrian. And my thought was that, Yes, he was cleverer than me which is why he could have used a word with more than one meaning, and meant all of them. I tried to explain that, but got more patronising responses so I just gave up.

And here we are, nearly 50 years later, and it still rankles.

 

[DokaGirl]

It is interesting to see the open acknowledgement of the likely main source of bias in studies, and the fact that they even have a word for it - 'therapeutic alliance'. How far away is that from therapeutic connivance or conspiracy? In the 1989 Chalder paper it is overt connivance. The patient has to say what they are supposed to say in order to be doing the treatment right.

My worry is that this is not so much David against Goliath as 'mind your 'ps and qs'.

They seem to be saying:
Mind out for these cowboys - they are not doing things right.

Maybe they are saying:
Here's how to put down these cowboys when they threaten to take away your business.

I was told off by a psychologist referee for possibly implying that maybe all psychotherapy trials are rubbish. This neatly dodges that by focusing on treatments that are 'hyped' - implying that what psychotherapists do all day long normally is fine.

It seems uncomfortably close to the response to PACE criticism that 'oh we don't do it like that anyway, we do person-centred treatments'.

Yes, clever, to put an iron ring around "hyped therapies". Segment these "unproven therapies" off from the rest of the..."unproven therapies".

 

[Graham]

I'm almost afraid to agree with any of you.

I never really understood why so many teachers were unhappy when students disagreed with them: year after year of teaching similar things made me yearn for some argument, some controversy.

 

[Woolie]

I think this desire to give the correct answer on questionnaires is particularly problematic with therapy with children who spend their school lives being tested where marks are gained for getting the 'right' answer.

There's a term for this, its called "demand characteristics", which is the inclination to affirm the researchers expectations, or to respond in a way that's socially desirable or acceptable. But there are a whole lot of other biases.

There is some really nice work by Norbert Schwarz on this. He viewed the questionnaire as a sort of offline social interaction, in which the respondent considers what the questioner's purpose is in asking you the question and uses the information provided in the range of response alternatives to decide on where their answer best fits.

Schwarz, N. (1999). Self-reports: How the questions shape the answers. American Psychologist, 54(2), 93–105. https://doi.org/10.1037/0003-066X.54.2.93

The nature of the response alternatives:

Suppose that respondents are asked how frequently they felt "really irritated" recently. To provide an informative answer, respondents have to determine what the researcher means with "really irritated." Does this term refer to major or to minor annoyances? To identify the intended meaning of the question, they may consult the response alternatives provided by the researcher. If the response alternatives present low-frequency categories, for example, ranging from "less than once a year" to "more than once a month,"respondents may conclude that the researcher has relatively rare events in mind.

The length of the reference period:

Empirically, individuals report more intense emotions ... and more severe marital disagreements ... in retrospective than in concurrent re-ports. Whereas findings of this type are typically attributed to the higher memorability of intense experiences, ... (they)... may in part be due to differential question interpretation: Concurrent reports necessarily pertain to a short reference period, with one day typically being the upper limit, whereas retrospective reports cover more extended periods.... Accordingly, participants who provide a concurrent report may infer from the short reference period used that the researcher is interested in frequent events, whereas the long reference period used under retrospective conditions may suggest an interest in infrequent events. Hence, respondents may deliberately report on different experiences, rendering their reports incomparable

Retrospective estimates of behaviour frequency and why they are influenced by the alternatives offered:

Unless the behavior is rare and of considerable importance, respondents are unlikely to have detailed episodic representations available in memory. Instead, the individual instances of frequent behaviors blend into generic, knowledge-like representations that lack the time and space markers that allow for episodic recall... (the participant)...constructs a meaningful scale, based on his or her knowledge of, or expectations about, the distribution of the behavior in the "real world." Accordingly, respondents assume that the values in the middle range of the scale reflect the "average" or "usual" behavioral frequency, whereas the extremes of the scale correspond to the extremes of the distribution.

 

[Woolie]

But the term 'alliance' seems to me very specifically used to imply commitment on both sides, with the patient's commitment being under scrutiny and the therapist merely being scrutinised for whether or not they can engender commitment in the patient!

No, its considered a therapist-related factor, and its not seen as the responsibility of the client, but there is recognition that some therapists might "click" more with some people than others.

I see no problem with the idea that if you go to therapy, you'll have a much better experience if the therapist actually builds a relationship with you than if they don't. In fact, if anything helps people at all, its probably this. The opposite of the therapeutic alliance is by-the-book therapy - that would be the IAPT like approach of working thorough a workbook or checklist or set of procedures without bothering to give much consideration to the client as a fellow person.

We all implicitly endorse the view that the client-therapist alliance is important when we complain about by-the-book therapy approaches.

Of course, a good client-therapist alliance can falsely increase trust if the therapist is peddling woo. But the answer is not to become robots, its to stop peddling woo!

 

[alex3619]

I was told off by a psychologist referee for possibly implying that maybe all psychotherapy trials are rubbish. This neatly dodges that by focusing on treatments that are 'hyped' - implying that what psychotherapists do all day long normally is fine.

The first problem in psychotherapeutic trials is lack of objective diagnostic criteria. Potentially all large cohorts are tainted.

 

[alex3619]

I think that's the part most people struggle with about the crisis of replicability/validity: none of this is accidental, it is done entirely on purpose, because otherwise the work is too hard, too demanding, almost nothing comes out positive.

Yes, with one caveat ... I suspect many are taught this stuff so thoroughly, and supervised accordingly, that they are at best dimly aware of the biases.

 

[alex3619]

But the answer is not to become robots, its to stop peddling woo!

This is an absolute requirement if psychiatric therapy, including psychotherapy, is to advance the science. Woo-science is not science as we expect it.

 

[Peter T]

I see no problem with the idea that if you go to therapy, you'll have a much better experience if the therapist actually builds a relationship with you than if they don't. In fact, if anything helps people at all, its probably this.

I read over forty years ago, a research paper that attempted to compare different types of psychotherapy. It was dated then and I can’t remember if it was any good as science, but I rather liked the conclusion, which I am now probably grossly misrepresenting, but basically it was that there were no good or bad therapies, just good and bad therapists.