"Why Ineffective Psychotherapies Appear to Work" (2014)

[Dolphin]

Free full text:
https://www.researchgate.net/profil...ectiveness/links/5531b5e80cf20ea0a071beb8.pdf

Perspect Psychol Sci. 2014 Jul;9(4):355-87. doi: 10.1177/1745691614535216.

Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness.

Lilienfeld SO1, Ritschel LA2, Lynn SJ3, Cautin RL4, Latzman RD5.
Author information

Abstract

The past 40 years have generated numerous insights regarding errors in human reasoning.

Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial.

We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective.

We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control.

We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories:

(a) the perception of client change in its actual absence,

(b) misinterpretations of actual client change stemming from extratherapeutic factors,

and

(c) misinterpretations of actual client change stemming from nonspecific treatment factors.

These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective.

We
(a) examine how methodological safeguards help to control for different CSTEs,
(b) delineate fruitful directions for research on CSTEs,
and
(c) consider the implications of CSTEs for everyday clinical practice.

An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.

© The Author(s) 2014.

KEYWORDS:
confirmation bias; effectiveness; efficacy; illusory correlation; placebo effect; psychotherapy; regression to the mean; science–practice gap; spontaneous remission

PMID:

26173271

DOI:

10.1177/1745691614535216
[PubMed]

 

[Dolphin]

This is a long paper. A lot of it is summarised in

Table 1. Causes of Spurious Therapeutic Effectiveness and Research Safeguards Against Them

If you weren't sure what a particular point in the table meant, you could look up the section in the text.

 

[Dolphin]

I thought this paper was very good.
It could help people critically analyse psychological papers.
Moreover most of the same points could also be applied to alternative and complementary therapies and indeed any posited therapy.

 

[Dolphin]

The history of medicine offers a powerful cautionary tale regarding the hazards of naive realism (Bigby, 1998). Most medical scholars agree that the history of physical treatments administered prior to about 1890 is essentially tantamount to the history of the placebo effect. Along with ineffective medications, such interventions as bloodletting, blistering, purging, and leeching were routinely prescribed and presumed to be beneficial based on little more than informal clinical observations (Grove & Meehl, 1996; see Belofsky, 2013, for a review of bizarre but widely accepted medical practices through the ages). Even today, medicine has its share of ineffective interventions. A recent meta-analysis estimated that 40% of widely used medical procedures (e.g., intensive glucose lowering in Type 2 diabetes, induction of hypothermia for intracranial aneurysms) are useless or harmful (Prasad et al., 2012).

 

[SilverbladeTE]

As I keep pointing out across the web:
PEOPLE ARE PEOPLE, here, then, here, now or back then
i.e. As groups, cultures, way we behave we Humans behave much the same, whether it's Rome Circa AD 1, a group or Cherokee in 1850, or UK today.

nearly always the "accepted wisdom" prevails NO MATTER HWAT THE ACTUAL REALITY IS!
this is why the saying: "The definition of insanity is doing the same thing again and again, and expecting a different outcome!" is so pithily valid in away

I've been reading stuff about the U.S. Civil War and way many of the dumb generals (Mostly Northern) and doctors behaved...yet many of these same folk thought the Indians and Chinese were "barbaric savages" or whatever.
And like wise the Chinese and Japanese "Establishment" demanded for long and weary that *we* were the barbaric savages, which lead our piratical empires to blow the living hell out of the very backward Chinese and Japanese military etc (they were technologically/militarily backward because their governments demanded that be so).
(and yes, we were piratical empires, still are, it's just the way we Humans work. very few decent Human beings have great power.)

So, when you have hard clear Science, say ballistics or chemistry, you can be very empirical and precise, kind of hard ot "fudge" things.
But, people always want ot fudge things, we can't help it, it's Human Nature. Good training and logic helps as does genuine peer review.
yet when it comes to psychology...how can you really ever have certainty? It's almost impossible, we can't even identify or quantify the actual "mind" which precludes therefore any certainty at all!
This means that "observer bias" is almost always going to be a very serious problem to psychological research.

And then Human nature makes it worse.
There is no way in HELL that most of the psychologists with tenure, power, who work for the government etc can EVER admit they were wrong, there is so much pressure on them.
This is why you'd really need a second set of very "neutral" and utterly unrelated psychologists to do any objective follow up. How often is that really going to happen?

So if psychologists A has a bee up his bonnet that "ME is psychological!" there's almost now ay he can ever admit that he is wrong. Not gonna happen 99/100 cases until the entire culture he is in says otherwise.