Psychoquackery?

 I wrote an article recently “The Psychotherapy Mess”, entailing my ‘mess’ with the whole psychotherapy process.  Thinking it was just perhaps me negatively affected by this form of therapy, I discovered this amazing article written in Newsweek.

 I am back in therapy, just for the short term, to help me deal with work issues.  For me, and for my PTSD issue, it was a complete disaster and a descent into hell, and to this day I ask, what was the point of it all?  

A tame written article; stay-tuned to a powerful, re-write of “The Psychotherapy Mess”.

~~~~~~~~~

“Get Shrunk at Your Own Risk”,  By Sharon Begley,  Newsweek

June 18, 2007 issue – No one bats an eye when a drug for a severe mental illness such as schizophrenia or depression causes serious side effects such as nausea, weight gain, blurred vision or a vanishing libido. But what few patients seeking psychotherapy know is that talking can be dangerous, too—and therapists have not exactly rushed to tell them so.

For treatments that come in a bottle, the Food and Drug Administration requires proof of safety and efficacy. For treatments that come from the lips of psychologists and psychiatrists, there’s no such requirement. But while therapists fight over whether they should use only treatments for which there is rigorous scientific evidence for efficacy, they have largely ignored something more fundamental. “The profession hasn’t shown much interest in the problem of treatments that can be harmful,” says psychology professor Scott Lilienfeld of Emory University. “Of the few psychotherapies that have been tested for safety, too many cause harm to at least some patients.”

The failure to heed Hippocrates reflects the assumption that psychotherapy is, at worst, innocuous. That naive trust should have been blown out of the water when “recovered memory” therapy actually created false memories, often of childhood sexual abuse, tearing families apart. But the “Handbook of Psychotherapy and Behavior Therapy,” the clinicians’ bible, devotes only 2.5 pages out of 821 to adverse effects, even though documented risks of therapies could fill a small book.

“Stress debriefing,” for instance, is designed to prevent symptoms of posttraumatic stress disorder in those who have suffered or witnessed a trauma. In a three- to four-hour group session, a therapist pushes patients to discuss and “process” their feelings and to describe in detail what they experienced or witnessed. Many of those who undergo stress debriefing develop worse PTSD symptoms than those who deal with the trauma on their own, controlled studies show, probably because the intense reliving of the trauma impedes natural recovery. Burn victims who underwent stress debriefing, for instance, had worse PTSD 13 months later than victims who had no psychotherapy; people who went through it after being in a car crash had greater anxiety about travel three years later than those who did not.

Psychotherapy for dissociative-identity disorder (formerly called multiple-personality disorder) can pose even greater risks. Some therapists believe that the best treatment for these fractured souls is to bring out the hidden identities, called “alters,” through hypnosis or helping alters leave messages for one another. Unfortunately, many alters cause “self-injurious behavior, suicide attempts, and verbal and physical aggression,” notes Lilienfeld in a paper in the journal Perspectives on Psychological Science. In addition, the “let’s meet the alters!” techniques can actually create alters in suggestible patients. “As more alters come out, it gets harder to get the patient back to having one identity,” Lilienfeld says. The longer someone stays in therapy, the more alters show up, evidence that “many and perhaps most alters are products of inadvertent therapist suggestion.” So much for “First, do no harm.”

Few of us will need therapy for multiple-personality disorder. But everyone will experience grief—and counseling for normal bereavement may not always be benign. A 2000 study found that four in 10 people who lost a loved one would have been better off without grief counseling (based on a comparison with people who were randomly assigned to a no-therapy group). That was especially so for those who experienced normal grief. In that case, counseling sometimes prolonged and deepened grief, leaving more depression and anxiety than in those who worked through their loss on their own.

That 40 percent figure is likely inflated, argues psychologist Dale Larson of Santa Clara University. But he agrees with Lilienfeld’s estimate that 10 to 20 percent of people who receive psychotherapy are harmed by it. Even the American Psychological Association acknowledges that too many clinicians practice “psychoquackery,” as psychologist John Norcross of Scranton University puts it. If we had FDA-style regulation of psychotherapies—difficult though that would be to do, especially since the effects of psychotherapy depend on the therapist—”fringe therapies would not be on the market.”

How fringe is “fringe”? In percentage terms, very. But the number of people undergoing potentially risky therapies reaches into the tens of thousands. Vioxx was yanked from the market for less. To be sure, even risky psychotherapies don’t harm everyone, just as most people who took Vioxx will never have a heart attack. What is remarkable about psychotherapies, though, is that few patients have any idea that “just talking” can be dangerous to their mental health.

© 2007 Newsweek, Inc.

http://www.msnbc.msn.com/id/19121639/site/newsweek/page/0/

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18 thoughts on “Psychoquackery?

  1. Anything to help anybody with the therapy choice.

    When I went for THAT inital interview for therapy (geez if I could step back in time), I really did not understand the implications. Nothing was explained, and I was so needy for answers that I was willing to do anything. The bumbling therapist was so inept, she didn’t even clue in to my apprehentions.

    I know we are not buying a car here, but this is your life, so BUYER BEWARE. Put more effort in making sure what’s under your hood than your new car’s hood.

  2. (cherished i won’t be offended if this comment isn’t moderated for dropping links)

    in repsonse to Helena comment:
    how to look at a therapy choice.
    first resource is the internet
    eg:
    http://psychcentral.com/therapy.htm

    a page like this does a decent job at describing the philosophy, understandably behind these therapies

    than search therapies that interests you.

    they are not great examples, but my blog has links to therapies that i was interested in.

    there is a great deal of explanation of each therapy on the web. it can be a resource in investigating a choice in therapy.

  3. Helena: Before I started with psychotherapy, I never heard of this therapy or didn’t even know what therapy was all about.

    Depression and bad memories go hand in hand. Sometimes I find it even difficult to even describe how low and black I felt. I don’t have bars on my living room windows, but in actual fact, during my horrid black moments I could actually see that they were there. They were cold and grey, and I knew it was daylight out, but when I peered outside it was pitch dark. Amazing how the mind works – amazing how depression destroys the mind.

  4. Robyn: You were so lucky to have friends to share feelings with. I basically had no one. I had friends, but who wants to share detailed sexual memories; at least I didn’t. Also, the two closest to me were work friends, and did not want this to leak into the office (around the water cooler stuff).

    These flashbacks are killers, but in hindsight, I allowed this hocus-pocus therapy method to create a source for the memories to keep appearing. The obvious incompetent therapist should have recognized this, but didn’t. How does she sleep at night – maybe she has flashbacks of me sitting in the hospital all of those years, praying for death? Probably not. I often wonder how many other victims have gone through her same dangerous therapy regimen.

    I’m glad you dealt with your issues on your own and won.

  5. Victorya: On a note about insurance. When I decided to enter back into this short therapy stint (work issues) and approached my work’s ins. benefits, they said that psychotherapy is not covered. It was stated that “anyone can say they are a psychotherapist”, so would have to go to a licensed doctor (psychologist/psychiatrist), otherwise fees wouldn’t be covered.

  6. I agree.

    Another problem is that there are so many different “therapies” out there, and who actually sits down with us and explains the difference between them? Certainly my doc just referred me on to the local “mental health team”. I have no idea if they call themselves pyschotherapists, pyschologists, pyschoanalysts, psychiatrists… I really wouldn’t know what the differences between these are.

    One thing they all seem to believe in right now is cognitive behaviour therapy. Whenever I get my 4-a-year half hour session (with another new psycho-something, as they never stick around in the dept. long enough for me to see the same person twice!!!) I have to make it clear all over again that I will not do CBT. They act as though I am 4 yrs old and don’t know what I’m talking about. Even try to sneak some of it in, as if a test to see if I do.

    The crux they try to sell me every time is “Bad thought patterns cause the depression. Stop thinking about the bad memories. If you switch off the bad thoughts you won’t be depressed any more. It’s up to you.”

    Er… not so. Not in my case, anyway, and I can’t believe I’m unique:

    It’s when I’m depressed that the bad memories close in. The depression comes first, not the “bad thoughts”. And when I’m that low, I can’t fight them off. It takes a mental energy I just don’t have then.

    So you see, they have it “all arse about face” as we say here. Back to front. Having a head full of sh*t is a symptom, not the cause.

    But what do I know? I’m only a patient. GOing through it for 26 years means nothing up against someone who has been *trained*.

    Ohhhhhh it gets me riled! Enough to make you want to chew your own foot off!

    Sorry for such a long comment, btw!

    :^)

  7. I’ve long thought therapy could be as harmful in some circumstances, as it could be helpful in others, depending on the type of therapy, timing, and the therapist. And considering my many years of experience with therapy and therapists on an off, I think I probably have a good feel for it by now. No one therapy or therapist is necessarily good for any one person with a problem. It’s good to see that what has seemed obvious to me for many years is coming to light in public.

    Hearing about your experience with therapy re childhood sexual abuse, I’m so glad I didn’t have therapy for dealing with it! At the time all the flashbacks happened for me, I was so disgusted with therapy and therapists, I dealt with it on my own, in practical ways, with a couple of friends to call on when I needed someone. The flashbacks happened, life went on, and after about two years of it, I was pretty ok in regards to it, as far as it affecting my daily life. The flashbacks themselves were more than enough to deal with. Adding planned sessions of trying to dig through it verbally would have been far more than I could have dealt with. I’m glad you survived the therapy-induced chaos!

  8. Glad you liked my blog! yeah, I linkified you so I don’t forget to check in :)

    It’s just so tough, the whole thing. And so insanely unfair, if fairness exists, that we have to go through such bullshit. At least people are starting to recognize mental health is as important as physical. That’s Timothy’s Law, right? I have to look that up one day myself and see what happened that now insurance companies have to provide the same care for mental as well as physical.

  9. Yes, the sessions took such a toll, and then I would have to carry on daily life. Everything went down the toilet. Relieved it’s behind me.

  10. I would be emotionally ok entering the appointment, however, exiting after only one hour, I would be in my car driving home, praying it would crash and I would be dead. The sessions were exhausting, filled with self-blame and guilt – I really just wanted death.

    man! it sounds awful. so sorry. i am not myself sure about the value of unearthing or revisiting memories. there’s a lot of theory on this, oceans of ink spilled, but at the end of the day, maaaan, if you come out of there feeling you wanna crash, yeah, definitely not for you, cherished.

  11. Victorya: Your comment made some excellent points, one being the ‘experts’. That hit home. Just because one is an expert, whether it be pdoc/therapist/surgeon doesn’t mean he’s a good one. In hindsight, easy to do, I wished I done a little more asking and not just sitting with my down instead of up. Sometimes we are intimidated by professions.

    And that’s right with therapy – if it’s working…stay….if it ‘aint….hit the road. Plain and simple. Please people – beware.

    Excellent comment.

  12. Wow, good article. I’ve long been wary of therapists but do find mine helping for the time being. Mainly, it forces me to recognize patterns I ignores previously (self-destructive ones) and not ones planted. It’s a tough call for sure. The bottom line is if you feel it is helping, it is. If you think it’s harming, it is. The same goes with everything though. the other thing is some people just follow everything the doctor says because they are the ‘experts’ but you have to be able to question things.

    I also have PTSD, and have to cruise through your blog more.

  13. You just don’t know. Maybe if a more responsible therapist had taken me as a patient things may have turned out differently. But, I still have a dim view of “getting in touch with your feelings” therapy. Living, and re-living them week in and week out is not be beneficial; at least not for me.

    In the case of my PTSD (childhood sexual abuse), I would be emotionally ok entering the appointment, however, exiting after only one hour, I would be in my car driving home, praying it would crash and I would be dead. The sessions were exhausting, filled with self-blame and guilt – I really just wanted death.

    So, for me, therapy definatly proved way more harm than good. Life changing into a life of pure hell.

  14. no need to slam you at all! why? i’m sure most of us can personally testify to therapy that was bad and painful and harmful. in my blog, i talk about a therapist that literally led me to a very dangerous suicide attempt and did nothing to help me during, immediataly after, or ever afterwards. it was really traumatic. i was badly shellshocked for years. i was horrified of coming across her and could barely leave the house, even though i lived in one of the largest cities in america!

    i had three therapists in my life who helped so much i think i wouldn’t be alive without them. but maybe i would be: who knows? one thing i know: therapy is no longer for me. i think i have maxed out on therapy. i don’t believe that the interaction with a mental health professional would benefit me now, not at all. it did in the past, as i said, but it’s as if i had outgrown it, or outlasted it, or whatever. it’s hard to explain. just today i was thinking about writing about it in my blog. it’s a complicated issue for me, and maybe a little painful. we shall see.

    but no, no slamming, cherished!

  15. Thank you for sharing that, as most people completely shut off what I have to say on this subject, and feel as if I am attacking them. They insist they were ‘saved’, and that is fine and I am happy for them – but what about those who are not ‘fine’.

    I am exposing this and I will be slammed – but as you stated; it needs to be discussed. Pro or con.

  16. I like that you brought up the idea therapy can be a bad thing, if this is medicine ( I hope it is), the science (success/failure) of various treatments have to be discussed/exposed.

  17. I agree, and I know I am going to get hit hard on this issue. I truly hope that some people have indeed been helped/saved or whatever by psychotherapy – but I’d also like to warn others who are perhaps drowning out there. Others who are in the middle of a muddle…..afraid to leave…afraid to stay in therapy. As you said “use the present as a fixed point”.

  18. I am not a PTS survivor.
    But i fail to see how these stress debreifing and recovery therapies can do any good!
    We live in the present.
    all our thoughts, feelings,perceptions of the past….
    are actually in the present. that is: the feelings are happening now towards the past.(an the future)
    All this uncovering the past, as sited in the NW article
    I just don’t get. Hope to hear from those who say these techniques are effective.
    I try(in therapy and self therapy) to use the present as a fixed point to look at me thoughts and feelings.

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