Science and Pseudoscience in Clinical Psychology, Part I PSYC 4500: Introduction to Clinical Psychology Brett Deacon,

1. Science and Pseudoscience in Clinical Psychology, Part I PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.September 3, 2013

2. From Last Class • What clinical psychologists do • Clinical psychology vs. related professions • Getting into graduate school • Training models in clinical psychology

3. Note about Readings • Lilienfeld and Lett articles

4. Questions for Pignotti (2007) response paper due this Thursday 1. Do anecdotal observations of client improvements in TFT, or the personal experience of improvement when undergoing TFT oneself, constitute scientific evidence of its effectiveness? Why or why not? 2. What mechanisms are in place in TFT to prevent its underlying theory, and its apparent effectiveness, from being falsified? 3. In response to criticisms of TFT, Callahan did not produce data supporting his treatment but instead suggested skeptics try it for themselves so they could see how well it worked. Should honest scientists take him up on this offer? Why or why not?

5. Science in Mental Health: Does it Matter? • Why are we spending an entire week on science and pseudoscience? • Does it matter whether or not the behavior of mental health professionals is based on science? • Who does Dr. Deacon think he is, criticizing what other mental health professionals do? Does he think he’s better than everyone else? Why can’t he respect the right of trained mental health professionals to practice as they see fit?

6. Candace Newmaker (1989-2000)

7. Candace Newmaker’s Attachment Therapy • http://en.wikipedia.org/wiki/Candace_Newmaker • Candace and JeaneNewmaker traveled to Evergreen, Colorado in April, 2000, for a $7,000 two-week "intensive" session of Attachment Therapy with Connell Watkins, upon a referral from a licensed psychologist in North Carolina.[1][2][3] • Candace died during the second week of the intensive with Watkins during what has been called a "rebirthing" session. Participating in the fatal session as therapists were Watkins and Julie Ponder, along with Candace's "therapeutic foster parents", Brita St Clair and Jack McDaniel, and Jeanne Newmaker.[3] • Following the script for that day's treatment, Candace was wrapped in a flannel sheet to simulate a womb and told to extract herself from it, with the apparent expectation that the experience would help her "attach" to her adoptive mother. Four of the adults used their hands, feet, and large pillows to resist all her attempts to free herself, while she complained, pleaded, and even screamed for help and air. Candace stated several times during the session that she was dying, to which Ponder responded, "You want to die? OK, then die. Go ahead, die right now".[1] Twenty minutes into the session, Candace had vomited and urinated inside of the sheet; she was nonetheless kept restrained.[2]

8. Candace Newmaker’s Attachment Therapy • Forty minutes into the session, Jeane asked Candace "Baby, do you want to be born?" Candace faintly responded "no"; this would ultimately be her last word. To this, Ponder replied, "Quitter, quitter, quitter, quitter! Quit, quit, quit, quit. She's a quitter!".[4]JeaneNewmaker, who said later she felt rejected by Candace's inability to be reborn, was asked by Watkins to leave the room, in order that Candace would not "pick up on (Jeane's) sorrow". Soon thereafter, Watkins requested the same of McDaniel and Brita St. Clair, leaving only herself and Ponder in the room with Candace. After talking for five minutes, the two unwrapped Candace and found that she was motionless, blue on the fingertips and lips, and not breathing. Upon seeing this, Watkins declared, "Oh there she is, she's sleeping in her vomit." Whereupon the mother, who had been watching on a monitor in another room, rushed into the room, remarked on Candace's color, and began CPR while Watkins called 9-1-1. When paramedics arrived ten minutes later, McDaniel told them that Candace had been left alone for five minutes during a rebirthing session and was not breathing. The paramedics surmised that Candace had been unconscious and possibly not breathing for some time. Paramedics were able to restore the girl's pulse and she was flown by helicopter to a hospital in Denver; she was declared brain-dead the next day, the consequence of asphyxia.[1][3][5]

9. Ethics, Science, and Pseudoscience • APA ethics code (http://www.apa.org/ethics/code2002.html#general) • Principle A: Beneficence and Nonmaleficence • “Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons.”

10. Values • Mayo Clinic Mission Statement: http://www.mayoclinic.org/about/missionvalues.html • Primary Value: The needs of the patient come first. • Additional values: respect, compassion, integrity, healing, teamwork, excellence, innovation, stewardship

11. How is Science Relevant to “The Needs of the Patient Come First?” • Mr. H and his wife (DID) • Billy (7-year-old boy with “schizophrenia”) • Mr. R (blood phobia) • Ms. S (social phobia in medical school) • Laura Delano’s experience in the mental healthy system: http://www.youtube.com/watch?v=yj5wfS0WXrQ

12. Science and Pseudoscience in Wyoming: Our Therapist Survey • N = 51; 15 psychologists, 14 counselors, 13 social workers, 9 others • 50/51 (98%) of therapists respondents claim to use cognitive-behavioral therapy in the treatment of clients with anxiety disorders • We asked about use of specific techniques for clients seen in past 12 months with OCD, PTSD, social phobia, and panic disorder

13. Treatments for OCD: What Works? • Can you pick out the technique(s) that have been shown to be effective in the treatment of OCD in scientific research? Breathing retraining Art therapy Progressive muscle relaxation Psychodynamic therapy Meditation Thought-field therapy Therapist-assisted exposure

14. OCD Treatments used by Wyoming Psychotherapists • 1 Progressive muscle relaxation (75.8%) • 2. Breathing retraining (72.7%) • 3. Meditation (63.6%) • 4. Psychodynamic therapy (57.6%) ---------------------------------------------------------------- • 5. Therapist-assisted exposure (27.3%) • 6. Art therapy (24.2%) • 7. Thought-field therapy (24.2%)

15. OCD Treatments used by Wyoming “Anxiety Specialists” • Therapist-assisted exposure • Specialists: 22.2% • Non-specialists: 29.2% • Thought-field therapy • Specialists: 55.6% • Non-specialists: 12.5%

16. Anxiety Treatments used by Wyoming Psychotherapists • Highly similar findings for other anxiety disorders • Why does these findings matter?

17. Thought Field Therapy • Description: http://www.youtube.com/watch?v=6IzsjuyMpoE • Pignotti (2007) article

18. Thought Field Therapy • APA definition of evidence-based treatment • Do TFT therapists engage in evidence-based treatment?

19. Dissemination of Evidence-Based Practice in Psychology • Movement toward “evidence-based medicine” has come to psychology (sort of) • Increasing pressure for accountability from insurance companies and managed care • Current emphasis in the field: dissemination • To therapists • To clients • How well is it working?

20. Barriers to Dissemination • Lack of training opportunities in science-based practice; frequent training in models antagonistic (to varying degrees) to science-based practice • Widespread misconceptions about psychotherapy and psychotherapy research • Psychotherapy can’t be studied scientifically • All therapies are equally effective • A good relationship with the client is necessary and sufficient for recovery • Clinical intuition is more valuable than scientific evidence • My client is a unique individual so group-level research doesn’t apply to him/her