From December 2000 through to December 2001 a debate was conducted in the Australian Psychological Society’s mainstay periodical publication, InPsych.
The debate was initiated by columnist Dr Jeff Patrick in his December 2000 piece “Why has nobody heard of IPT?” in his Satirical Psych column.
Having quoted Herbert et al (2001) commenting on EMDR thus:
“. . . everyone here [in Australia] knows what EMDR is and hundreds still religiously use it, despite definitive evidence that its only value is that it ‘provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques’ (Herbert, et al., [2001]).
Patrick went on to say:
“Anyway, this article is not about EMDR or any other pseudoscientific treatment (e.g . . . or thought field therapy [TFT]), it is about how some efficacious treatments are not being taken up.”
Subsequent to the appearance of this article I engaged Jeff Patrick in an email debate which ended with him encouraging me to submit a letter to the editor of the InPsych. This first letter was published in February 2001. Following this there were a number of letters published which are reproduced below with minor corrections and additions.
‘Cheap shot’ misfires
EDITOR: I write with regard to a comment made in Jeff Patrick’s Satirical Psych article "Why has nobody heard of IPT?" (InPsych, December 2000). His referring to thought field therapy (TFT) as a pseudoscientific treatment is a cheap shot fired from a crowded runaway bandwagon.
TFT is being, on the one hand, shamelessly copied and imitated from outside the discipline of clinical psychology. On the other hand, it is being righteously debunked and maligned from within the profession by the zealots of scientism who show no interest in conducting the simplest and most elegant of relevant scientific experiment: do it and see what happens.
While perfection is not claimed (as it is certainly not possible), neither is it demanded nor expected in other approaches to resolving clients’ disturbances. However what is likely to be found if such an experiment [do it and see what happens] were to be conducted is that specific phobias will be resolved (i.e., gone) in eight or so minutes instead of eight or so sessions. The emotional disturbance associated with recollections of an isolated traumatic experience and associated clinical sequelae are likely to be abolished in 15 or so minutes instead of 15 or so sessions. For the purposes of this scientific experiment I recommend skeptical (but not subversive) therapists and dubious clients (but not non-compliant as in the recent BBC Phobias documentary).
What I found when I conducted such an experiment – including the skeptical and dubious components – more than three years ago [1997] was that the hypothesis that the client would report no difference was not supported because the client’s anxiety SUDS (subjective units of distress/disturbance) reduced to the minimum level. Further replications of this elementary scientific experiment [do it and see what happens] have yielded such encouraging outcomes that to withhold this form of treatment in favour of an approach that I feel will take longer – and be more expensive – has become an issue of ethics.
I have now conducted more than 2,000 such experiments [as at February 2001] since training with Dr. Roger Callahan in January 1998. TFT is a scientific development in clinical psychology. When there are not long latencies between therapy applications and clinically significant outcomes, when the differences being dealt with are not small and the causal relationships are self-evident (like Florey’s penicillin effect), there is not the need to impose the requirements of standardisation, controls, randomisation and sophisticated statistical tests as a condition for the recognition of a scientific enterprise. The absence of such traditional psychological research tools certainly should not be seen as sufficient reason to brand the treatment as pseudoscientific.
Christopher G Semmens
Clinical Psychologist
Mr Garry Bakker replied to this letter in a piece published in the InPsych letters to the editor in April 2001 titled:
Are therapists hiding a God-given ‘cure-all’?
EDITOR: I was embarrassed when I read Christopher Semmens' defence of Thought Field Therapy (InPsych, February 2001) - embarrassed for my profession and embarrassed for Christopher's past lecturers who allowed him to gradulate without knowing what a "scientific experiment" is.
His claim that 2000 unpublished, uncontrolled subjective self-reported, non randomised, unreplicated single case study "experiments" by one unsupervised devotee compromises objective scientific support for a therapy is ludicrous.
The same claims have been made for flotation tanks, subliminal tapes, magnet therapy, astrology, phrenology and thousands of other (profitable) 'therapies' that have been found, when someone has finally bothered to check scientifically, to be totally useless. In fact, as psychologists we should, above all others, know about placebos, expectancy, bias, misperception, suggestion and faith healing.
My embarrassment turned to anger when I realised that these people, who are sitting on a treatment that they presumably genuinely believe is the next God-given cure-all, and who know that two or three replicated, randomised, controlled trials will convince enough of us to revolutionise clinical psychology (and often the Laws of Physics), still refuse to conduct such research. This seems selfish and irresponsible, especially as a recent advertisement in a professional publication claimed that Thought Field Therapy "could be used for almost any psychological problem ... includes stimulation of acupressure points by tapping them in specific sequence ... (helps) within minutes ... is ... rapid and lasting ... Most people respond ... can be customised ... is suitable for children or adults and effective in treating traditionally resistant psychological problems."
If any of this were true it surely would turn clinical psychology upside down, ease the suffering of millions of people worldwide, be worth billions and threaten several accepted laws of nature.
Keep up the good work, Jeff Patrick.
Gary Bakker MAPS
Launceston, TAS
I responded to this letter with a submission which was published in the InPsych letters to the editor in June 2001:
Critics the losers in ‘pseudoscience’ therapies
EDITOR: Gary Bakker (InPsych, April 2001) touches on a number of issues that are currently being keenly debated in our profession – quite apart from that of thought field therapy (Thought Field Therapy – TFT.)
Firstly I wish to say that I don’t believe that ad hominem attacks enhance any scientific argument and I am convinced that the use of emotive language is more likely to cloud the issues than to advance a debate towards a better understanding of the way the world – and the human beings in it – work.
Secondly, let me respond to Mr Bakker’s venomous attack regarding the “embarrassment for Christopher’s past lecturers who allowed him to graduate without knowing what a ‘scientific experiment’ is”. The Chair of the Department of Psychology at the University of Western Australia at the time of my undergraduate studies [early 1970s], including my BSc, was Professor Aubrey Yates. He very much advocated “the experimental investigation of the single case”. For those not educated in his department, a perusal of Chapter 1 of his well respected 1970 book Behavior Therapy will make it very clear that the “scientific experiment” within treatment sessions that I discussed earlier (InPsych, February 2001) is actually derived from his teaching. He concludes this chapter with the statement: “It is here that behavior therapy [italics in the original] is defined as the application of the experimental method to the presenting problem” (p. 19).
My great mentor Dr Albert Ellis (1996) concurs:
"With 'average' or 'regular' clients, I usually (not always) try my main tested and 'proven' REBT methods – tentatively and experimentally. If they work – as they often do – I continue with them; later, I include several other methods. I go along with Aubrey Yates [1970] in this regard and consider each session an experiment [italics in the original]. On the basis of a few such experiments, I then may downplay my favorite A, B, C methods and add to them or replace them with other 'better' ones." (p.3)
Mr Bakker appears to have either misperceived the purpose of my letter (InPsych, February 2001) or set up a straw man. I was defending TFT against unfair accusations of it being “pseudoscientific.” In so doing I suggested that critics are vulnerable to the accusation of being uninformed if they in fact have not attempted to apply the therapy in order to at least present themselves with the potential opportunity to refute the claims that I and other practitioners make for it’s clinical effectiveness as measured by the client’s subjective report at the time of treatment and again at follow up. There are basically two possibilities – 1) the client reports no change to their presenting complaint, and this provides some evidence to refute the claims that have been made, or 2) the client reports positive change that, subject to positive reports at follow-up, suggests that the approach warrants further investigation – like, try it again with another client! I maintain that this represents a scientific experiment at the fundamental level. I am not saying that it is conclusive research, but if I can be convinced that this is not a scientific undertaking then I will be willing to burn my science degree.
Reliance upon counter intuitiveness is neither a scientific nor reliable basis on which to condemn proposed advances in understanding (e.g. heliocentricism; the germ theory; quantum mechanics). TFT more than adequately satisfies criteria for falsifiability in a Popperian sense and so I again urge critics towards that undertaking. I made no statement about refusing to conduct any sort of research – I am currently in discussion with a university about a Ph.D project. The form that this research takes, however, is not set in concrete.
It seems that Mr Bakker would have us believe that the only legitimate tactic in a therapeutic engagement is that which has been shown to be effective by way of randomised controlled trials (RCT’s). That would mean that hundreds of strategies in common clinical use would be out. We are left with very little, then, in the way of clinical responses to a client’s disturbance – and it will be delivered by a psychologist whose role has been paralysed to that of a technician rather than a responsive clinician.
Again, while I am not claiming to be engaged in a formal research project with my work, I do maintain that I am operating as a scientist-practitioner with the objective of finding the most efficient and effective way of assisting my clients towards a resolution of their presenting complaints. At the end of the day what it is all about is getting to the point where the client says “thank you, you’ve helped me immensely, I don’t think I need to come back” with them having to write out as few $158 cheques as possible.
Christopher G Semmens MAPS
Wembley, WA
References:
Ellis, A. (1996). Better, deeper, and more enduring brief therapy: The rational emotive behavior therapy approach. New York: Brunner/Mazel.
Popper, K. R. (1959). The logic of scientific discovery. London: Hutchinson.
Yates, A. (1970). Behavior therapy. New York: John Wiley & Sons.
Also published in the June 2001 InPsych was a letter from Mr George Wills:
Scorn and snake oil a scathing mix
EDITOR: In a somewhat hysterical follow-up by Gary Bakker (InPsych April 2001) to Semmens' letter (InPsych February 2001), Bakker seems to be trying to stifle all comments about therapy other than that sanctioned by extreme proponents of scientism. I'm not impressed.
Does Bakker mean that comments about percieved efficacy have no place even in a journal devoted to discussion among peers? How else does he imagine that discource can occur? Does he mean that unless that perfect experiments are performed and reported on, there is no place for indeterminate comments? Does he think that scorn will shut people up so he can continue to entertain his water tight conceptions of what constitutes theraputic practice?
If you were so certain of your virtue, Gary Bakker, why the heat? Do you really think it would be better if people who tried something they found useful were shamed into saying nothing about it to their peers? I haven't seen Christopher Semmens' snake-oil caravan. Perhaps you have.
George Wills MAPS
Mt Dandenong, VIC
I responded to Wills with this, published in the InPsych in August 2001:
‘Blinkers’ support scientism debate
EDITOR: While there has been a good deal written in this forum advocating and supporting the adoption of a view towards certain practices in clinical psychology that characterises them as pseudoscientific (Patrick, InPsych, Dec 2000, Feb 2001; Bakker, InPsych, April 2001), Wills (InPsych, June 2001) adds balance to the debate by pointing out that much of this denigration could qualify as examples of “scientism”.
The kind of blinkered attitude that has dominated these attributions of pseudoscientific - that a treatment strategy is not an appropriate intervention in therapy if there are not randomised controlled trials (RCTs) to support its efficacy - is what Hayek (1952) has described as “scientism”. Ronald Fox (1996) in his 1995 APA presidential address asserts: “rigid definitions of science that mimic those of the mature physical sciences lead to a rejection of precisely those ideographic approaches that clinicians are forced to pursue by the very nature of their work”(p.780). He warns us to be vigilant regarding those who would substitute scientism for science. Fox sees a threat to our discipline arising from those who casually dismiss any clinical experience that cannot be verified by the use of methodologies and assumptions that were developed for disciplines that have little or no relevance to the problems found in the social sciences.
Peterson (1994) is referred to by Fox as warning that if our only response to society’s pleas for help is that we haven’t yet done enough research, society is likely to find a way to get along without us.
Allied to these comments has been an active debate in the literature in recent years, most recently represented by Krueger (2001) and Morgan & Morgan (2001), regarding the inadequacies of and alternatives to the Fisherian dogma of large-N group designs with null hypothesis significance testing (NHST) driven by statistical inference. Among the limitations exposed with regard to these group designs have been issues such as; the distinction between statistical reliability and clinical significance; the group mean as a quantitative abstraction; and the idea that the proper direction of inference is from sample means to population means, not sample means to individuals.
An alternative is increasingly discussed as more relevant to the clinical situation: single-participant research designs. These approaches have a long history in psychology – Ebbinghaus, Pavlov, Piaget and Skinner all approached their research along these lines. It seems to me that a greater recognition of what can be demonstrated as effective in the non-selected-in, not subject-to-exclusion-criteria, non-standardised, “contaminated” real life individuals who are our clients, and for these data to be seen as legitimately contributing to the scientific body of knowledge in our profession, can only contribute to us being better able to assist the clients that come to us for help.
Christopher G Semmens MAPS
Wembley, WA
References:
Fox, R. E. (1996). Charlatanism, scientism, and psychology’s social contract. American Psychologist, 51, 777-784.
Hayek, F. A. (1952). The counter-revolution of science: Studies on the abuse of reason. Glencoe: The Free Press.
Krueger, J. (2001). Null hypothesis significance testing: On the survival of a flawed method. American Psychologist, 56, 16-26.
Morgan, D. L. & Morgan, R. K. (2001). Single-participant research design: Bringing science to managed care. American Psychologist, 56, 119-127.
Peterson, D. R. (1994, February). Making psychology indispensable. Paper presented the conference for Standards for Education in Professional Psychology, Cancun, Mexico.
Mr Bakker responded to this letter in the October 2001 Letters to the Editor section of the InPsych:
Claims can’t justify client experiments
[To be added]
To this I responded in the December 2001 InPsych:
Things are just dandy, thanks … or are they?
EDITOR:
A consideration of Gary Bakker’s contributions to ‘Letters to the Editor’ (InPsych, April 2001; October 2001) leaves me with the distinct impression that he does not value cogency nearly as much as he claims to esteem scientific endeavour.
His latest effort essentially takes the form: Things are just dandy in clinical psychology in terms of our ability to effectively assist our clients and in researching these interventions. If someone wants to do things differently (empirically and/or therapeutically) they (i.e., me) are unscientific and have a vested interest.
He then, once again, uses the straw man fallacy to attribute to me many views about our profession that are not mine and some of which are issues I myself have defended/argued for. Nowhere does he take up the challenge to argue the points I have actually made (In Psych, Feb 2001, June 2001 and Aug 2001).
He makes no attempt to dispute Popper’s (1959) condition of falsifiability; no apology for the group mean; no exposing the inadequacies of the single-subject design; no support for the nomothetic approach over the ideographic; no discussion of how the logical difficulties inherent in the inductive inference can be accommodated.
Mr Bakker concedes not a single point to me. I concede that at this point in time [December 2001] there are no RCT’s supporting TFT’s efficacy. This does not constitute a sufficient condition for designating the approach “pseudoscientific”, nor does it have anything to do with whether the technique actually achieves its clinical objectives. There is, however, a complete issue of a reputable journal devoted to thought field therapy (Journal of Clinical Psychology, 2001, 57, 1149-1260) [a non peer reviewed edition], which is more than can be said for Mr Bakker’s ‘Custard Therapy’. TFT is not an “arbitrarily-proposed treatment”. It is the outgrowth of classical scientific enterprise: an informed curious mind; hypothesis formation; experimentation; observation; hypothesis adjustment, and refinement.
There is more to Mr Bakker’s “given that…” than he is prepared to concede. Yes, we have evidence-based models of treatment for a number of psychological disturbances. But does this mean that it is right for us to be smugly conceited and self-congratulatory? Should Ignaz Semmelweis (Loudan, 2000) have been satisfied that as many as 83% of 19th century women survived childbirth without contracting septicaemia, and so not have risked the ridicule and harassment that eventually unbalanced him? Should Albert Ellis (1957) have been contented with being able to significantly help 50% of his clients with an average of 100 sessions of classical psychoanalysis?
Should we be contented that an evidence-based 15-session treatment costs nearly $2,500.00 [in December 2001] or else a wait of up to six months for a publicly funded intervention? And, incidentally, where are the vital RCT’s that are seen as imperative precursors by Mr Bakker and others to any approach that we might offer our clients, especially the highly sensitive fee-paying one’s that Mr Bakker acts as protector to, that control for subjects paying $161 per session as opposed to being induced into participation by the promise of free therapy?
Mr Bakker accuses me, by way of his foggy form of implication, of advocating an “inclusive and populist” approach to clinical psychology. No, I advocate a scientific approach – but not one that is fundamentalist. TFT is a genuine scientific development within clinical psychology. Roger Callahan is acknowledged by Ellis as a primary associate in Reason and Emotion in Psychotherapy (1962), the first textbook on cognitive-behavioural therapy. Callahan continued Ellis’ pursuit of increased efficiency and effectiveness in psychotherapy and this led him to his important discoveries.
I see Mr Bakker as painting himself into a lonely corner with his rabid insistence on the elimination of scientific decision-making in the consulting room. It flies in the face of the intention of the Boulder model that, at one level, he argues for so passionately.
Finally, I must say that I see Mr Bakker’s attribution of the term “courageous” to be entirely misplaced.
Christopher G. Semmens, MAPS
Wembley, W.A.
References:
Ellis, A. (1957). Outcome of employing three techniques of psychotherapy. Journal of Clinical Psychology, 3, 344-350.
Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus: Citadel.
Loudan, I. (2000). The tragedy of childbed fever. Oxford: OUP.
Popper, K. R. (1959). The logic of scientific discovery. London: Hutchinson.
There was no response to this December 2001 letter.
Nearly eight years later Mr Bakker returns to the Letters to the Editor pages of the InPsych (April 2009) on the topic of Thought Field Therapy (TFT):
Concerns regarding PD endorsement
EDITOR:
I have great sympathy for those members of the APS College of Counselling Psychologists who have been seeking sufficient recognition of their specialist skills so as to argue for parity with Clinical College members in terms of Medicare rebates or more public health employment opportunities, when their College is undermining these very aims. Despite the Chair of the Counselling College assuring us that"specialists in this discipline are scientist-practitioners . . . [who] draw on evidence-based practice" (InPsych, October, 2008), it was the only College to agree to endorse a September 2008 Thought Field Therapy workshop for 13 PD points. The other Colleges presumably had greater qualms about endorsing an unproven, fringe, 'power' therapy.
When I asked the Counselling College about their decision I received a one-line dismissive reply. More recently, the response of the College has been: "That process has been completed, and I can't say any more about it."
It is no wonder that members of the College who seek recognition and parity for their evidence-based practice and their accountability are frustrated.
Gary Bakker MAPS, Launceston, TAS
I submitted a response for the June 2009 InPsych Letters to the Editor:
'Scientistically' prejudiced view of method
EDITOR:
Mr Bakker’s (InPsych, April 2009) attitude towards science is reminiscent of the 19th century surgeons who, in mocking defiance of Pasteur’s emerging “germ theory”, ritualistically scraped their scalpels on their boots prior to making the initial incision of surgical procedures.
The dangers of “scientism” – the uncritical transplanting of methods of the physical (hard) sciences, with comparatively few variables, to the complex phenomena of the social (soft) sciences – were discussed in F A Hayek’s 1974 Nobel Prize lecture “The Pretence of Knowledge.” Hayek highlights “scientistic prejudice” as an imitation of the “form rather than the substance of scientific procedure.” (See also Semmens, InPsych, August 2001.)
I see Mr Bakker’s continued attack on Thought Field Therapy (TFT) and his failure to revise his position in the face of cumulative evidence and reasoned debate (Semmens, InPsych, Feb; June; August and December 2001) as a display of scientism and scientific bigotry on three levels: (i) method; (ii) theory and (iii) discourse.
A scientistically prejudiced view of method is that nothing is worth trying in clinical psychology without supporting RCTs, together with a scathing disregard of precursor (to RCTs) anecdotal reports and case studies.
When the RCTs do begin to appear, an obtuse attitude to theory can inhibit any credence attached - this derived from the view that all possible experience has to be consistent with that with which we are already familiar, and so explanation must be thus confined.
It may be that because his views are not too distant from these that Mr Bakker takes license to trample on the usual conventions of cogent scientific discourse. To pop up in these pages (InPsych April 2009), brandishing the pejorative terms “unproven” and “fringe”, 8 years after having withdrawn from the 2001 InPsych debate can be seen as bordering on intellectual thuggary.
Christopher Semmens MAPS
Nedlands, WA
In the December 2009 InPsych Letters to the Editor Jennifer Flatt drawing inspiration from Mr Bakker's letter (InPsych, April 2009) sought to righteously put the boot into thought field therapy (TFT).
Important distinctions from counsellors
EDITOR:
Ronit Joel's letter in the October 2009 edition of InPsych prompted me to write about a quite recent insight of my own. I have a friend who has recently completed a Bachelor of Counselling degree at a non-university college. He has learned lots of stuff, all oriented toward treatment of clients. Just the kind of stuff that undergraduate psychology students are crying out for: lots of specific techniques, lots of 'how to'. He has not had to endure statistics of any kind, or a detailed training in experimental methodology or anything remotely scientific.
He's a smart guy who could easily have handled these challenges in a university course, but he chose his Counselling degree because he wanted to be out there treating people. And, talking to him, I fully understood for the very first time (after four years undergraduate, two years clinical masters and a PhD) exactly why the scientific components of our undergraduate psychology training are so important.
My friend has no ability to critically evaluate anything. He does not know how to read results and statistics in journal articles and make sense of them. He sees his training in Thought Field Therapy as just as useful as his training in CBT. He does not see why asking people about their star sign is not useful.
Maybe we should redesign our undergraduate courses to include more skills that are necessary to being a psychologist - I'd be happy to leave this decision to the academics. But what we should be careful not to do is eliminate giving students a thorough understanding of statistics and research methods and all the tools we need to be effective scientist practitioners. These kills are what make us good at what we do, and different from many 'counsellors'.
Jennifer Flatt MAPS, Lilyfield, NSW
I engaged Dr Flatt in a backchannel discussion asking her to inform me as to what she was relying upon to essentially characterise TFT as unscientific.
She responded by saying that there was very little good systematic research about the efficacy of TFT and that what there was is strongly suggestive of there being no effect beyond a placebo one and she asked me to provide her with references showing otherwise.
I responded saying that I would be happy to supply those references. However, the immediate focus was regarding her claim that the available evidence strongly suggested nothing but a placebo effect. I asked her to point me to the research upon which she was relying upon as the basis for this claim.
She refused and again asked me to supply the research that counteracts the claim. I wrote to her again pointing out that it was a very different discussion to be considering the issue of "lack or otherwise of supporting evidence" to one that has its focus on the claim that she was putting forth - that the research that is available strongly suggests that TFT has no effect beyond placebo.
I said that I did not want to switch to the first of these until we have the opportunity to fully explore the issue that she has gone into print with - the claim that available research strongly suggests nothing but a placebo response.
She was asked again to point me to the research upon which she was basing this claim. She did not respond. I wrote to the Editor of the InPsych along the lines of our backchannel discussion with the view of making her publicly accountable for her claim - such accountability being the point of her letter to the editor.
The APS refused to publish my letter. I viewed this as a clear case of suppression. I wrote to the APS Board of Directors complaining of the suppression. I received a letter back from the Chairman of the Board saying that the Board supported the right of the Editor to "close the topic under discussion." I appealed the decision of the board and received a stonewalled reiteration of the initial response.
If that is not suppression - I don't know what is!
|
