Debates

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 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 experiments: 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 is likely to be abolished in 15 or so minutes instead of 15 or so sessions. For the purposes of this scientific experiment, I recommend sceptical (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 sceptical 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 of February 2001] since training with Dr Roger Callahan in January 1998. TFT is a scientific development in clinical psychology. When there are no 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 no 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 a 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 graduate 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 compromise 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 that was published in the InPsych letters to the editor in June 2001:

Critics are 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 toward 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 B.Sc., 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 behaviour therapy 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. On the basis of a few such experiments, I then may downplay my favourite 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 its 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 a 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. heliocentrism, germ theory, quantum mechanics). TFT more than adequately satisfies the criteria for falsifiability in a Popperian sense, and so I again urge critics toward that undertaking. I made no statement about refusing to conduct any sort of research – I am currently in discussion with a university about a PhD 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 (RCTs). 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 toward 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 behaviour 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 perceived efficacy have no place, even in a journal devoted to discussion among peers? How else does he imagine that discourse can occur? Does he mean that unless 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 watertight conceptions of what constitutes therapeutic 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 toward 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 no 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 a 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 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.