The state of evidence-based therapy in colleges and how you can help make it better

I once posted a guest entry from Patty Guzikowski about how to find a therapist for atheists.  In it she discussed evidence-based treatment in psychology and how it is not the default means of treating people with mental illnesses.

Well, today I received the following email.  If you are a psychology student, take particular note.

Hey there,

There’s a point and a question to this email, but also a wee bit of a preface. Feel free to skip to paragraph 3 if you’re short on time/patience.
I’m a psychology and Human Development & Psych Services double major at [a university in Chicago]. I applied here specifically for their focus on research and picking therapies and treatments that have been shown to work.  I also grew up in a family that used almost exclusively alternative medicine. Homeopathy, essential oils, energy healing, applied kinesiology, crystals, cranial sacral therapy, and on and on. My mother makes her business out of some of this. I’m a skeptic.

So when I was taking a class on psychotherapy (an upper level seminar, no less), I nearly fell off my chair when the professor started spouting the importance of getting our patients onto vitamin mega-doses, and 4x the FDA recommendation for fish oil. What she said about replacing SSRI’s as compared to dietary changes doesn’t bear repeating. She also informed us that one of the most ignored causes of depression was ‘mirror neurons taking in ugly buildings’. I promptly dropped the class. I hadn’t bought the book, and my schedule wasn’t constrained, so it was easy. But this wasn’t the first time evidence went out the window in my psych classes. And I know I’m not the only one with this trouble.

The Freedom From Religion Foundation has The Therapist Project to collect names of LT’s who don’t use supernatural stuff in their practice. I want to create a database of programs and specific program information about psychology graduate and undergraduate programs and their support of evidence based treatment versus alt-med or other unhelpful/harmful treatments. We need the next generation of therapists to focus on what actually works, and to pick universities that will support that. Ive offered to do this with the FRFF, but haven’t heard back yet. Regardless, I think it’s an important enough job to do, and I’m willing to do it.

So here’s what I spent a wayyy too long preface getting ready to ask. Would you be willing to help spread the word, or suggest people who could? I know mental illness has been a newer blog topic, and you’ve discussed the level of ridiculous it is that we need to clarify between EBT (evidence-based therapies) and non-EBT. I’m looking to reach out to anyone who has majored in psychology at any American university in the last ten years. I’d want to know about any experiences they had with professors encouraging alt-med, their overview as a skeptic of the program they were enrolled in, etc. I’m not sure what the end format would be to the database, but names would not be published without permission. However, I need to start with some raw anectdata. Any help you could give in passing the message on or linking me to people who can would be much appreciated, and could be redeemed for a huge hug and impromptu happy-dancing if we’re ever in the same area. Contacts could email me at this address (donovanable[at]gmail[dot]com) or through pervasivegoodness.com. The more people I can get to respond, the more helpful this will be to future students.

Thanks so much :)

Why yes, I am very willing to help spread the word.  Mental illness, especially with non-evidence-based therapy lurking about, is definitely a cause the skeptic movement needs to take up.  We have the potential to make a positive change in so many lives and to convince people that their sickness can be managed.

If this is a project with which you can help, you can also go to http://evidencebasededucation.weebly.com/ to submit stuff.

Spread the word far and wide.

About JT Eberhard

When not defending the planet from inevitable apocalypse at the rotting hands of the undead, JT is a writer and public speaker about atheism, gay rights, and more. He spent two and a half years with the Secular Student Alliance as their first high school organizer. During that time he built the SSA’s high school program and oversaw the development of groups nationwide. JT is also the co-founder of the popular Skepticon conference and served as the events lead organizer during its first three years.

  • iknklast

    This is such an important topic. When I started treatment, the only therapists my MD would refer me to were Christian therapists. Finally, the therapist I ended up with (a Christian therapist) took pity on me and referred me to a secular therapist (who happened to be a Christian, but it was five years before I found that out – he had no problem with my lack of belief, and didn’t use God/Jesus or any other supernatural entity in therapy).

    Of course, when our colleges are busy spouting pseudoscientific psychobabble about “learning styles” and other things that have little to no evidentiary support, and when they spend so much time teaching the idea that “all ideas are equally valid” (except my ideas that students should actually be taught some basic math skills before they take college level science classes), well, we shouldn’t expect critical thinking.

    Perhaps it would be useful if all psychology majors read “50 Great Myths of Popular Psychology” before they went to their classes. Then they might be encouraged to think more critically about what their teachers present in class.

    • http://sinmantyx.wordpress.com/ M. A. Melby

      NO – we do not spend time teaching students that all ideas are equally valid. In my experience, they come in with that idea and it needs to be slowly destroyed.

      I suspect that some students confuse the concept of respect for PEOPLE with respect for ideas. They confuse being open to the contributions of everyone with allowing people to say anything free of criticism. They confuse being open to different perspectives with opinions being equal in value.

      Thing is – I don’t think they is too much that can be done about this. If we take a note from William Perry’s description of cognitive development of college students, extreme relativism is simply a transitional stage between dualist thinking (definite right and wrong answers that come from authority) and what he calls “commitment” (constructing your own stances).

      It is unfortunate that the student writing the letter dropped the class before having a real, informed and open discussion with the teacher about the teacher’s recommendations – trying to find out if those recommendations were based on evidence, presenting any evidence counter to those recommendations, and actually engaging in critical thinking. I understand her position as a student however – you don’t want to spend all that money on a class and find it intolerable and confronting an instructor can be awkward.

      • http://pervasivegoodness.com Donovanable

        I am the student in question. I didn’t want to elaborate and thus bore JT, so I’ll clarify here. I did drop the class without talking to the instructor, something I would have preferred to do. Discussion and debate do a lot more good than one student of twenty disappearing before names are even learned. However, it was the last day to change classes, and I had only a few hours to find a replacement. Her justification for the statements I did mention was that she had tried it, and *she* felt better. She mentioned at one point that there wasn’t much research yet, but it seemed to do her patients well.
        I would have liked to discuss the serious concerns I have with that idea with her. Critical thinking is important, very much so. It is possible there are therapies and treatments out there that sound strange but work. But, until we test them and prove them helpful, recommending them to clients without background is unethical. Presenting them as valid in a lecture-styled class meant to teach effective methods of psychotherapy isn’t good either.
        This type of class experience wasn’t a one-time occasion. In the last cycle of classes I had another professor explain that trying to understand things rationally was going to hamper our journey. It was too late to replace the class, and I lost lots of time and money. My goal here is to give prospective students a heads up.

        • http://sinmantyx.wordpress.com/ M. A. Melby

          Understandable – not meant to criticize.

          At least she was clear on the basis of what she was saying, but I would also be concerned that she was presenting ideas in a way that would encourage students to use anecdotal evidence as too strong a basis for recommended treatments.

          The concept of “rationality” being counter to one’s “journey” seems a bit bizarre. I can see, perhaps, seeing being too critical at the beginning on a course to be intimidating – I suppose. Many times the beginning of a course (or module within a course) is a good time to assess our current ideas. It’s important to get them out in the open (or at least the forefront of our minds) or the new information will simply be layered on top of the old; and the old will never be examined or integrated with the new.

          I’m REALLY being a devil’s advocate here. I trust your experience, and I like the idea of identifying rigorous and non-rigorous programs.

          I get the impression (with the little exposure I’ve gotten to psychology via educational research) that there will always be a certain “art” to all sorts of health professions; because many of the experiments (especially in psychology and pediatrics) that would illuminate our understanding are also impossible (due to practical concerns or ethical concerns). A great deal of learning theory are based on frankly pretty horrifying experiments done a long time ago that would never be IRB approved today. Generalizing the results of various studies to extend to an individual inappropriately, is also a basic limitation of basing treatment on available evidence.

          I swear some people, in light of those real limitations, wave their arms and just do whatever – and allow rumor, personal experience, tradition, fads, charismatic advocacy of particular approaches, etc guide their practice even when good solid evidence exists. (Oh, and even then, there is the publication bias!) I KNOW this happens in Education.

          I think your initiative is wonderful. I wish you the best of luck. I have no doubt that you will be a credit to your chosen field.

  • Randomfactor

    Absolute worst doctor I have ever encountered was a goddist psychiatrist who ALSO laid heavy on the pharmaceuticals. (To be fair, that was why I went to him rather than a psychologist, prescribing ability.)

    Fired him and never went back.

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  • http://www.alstefanelli.com Al Stefanelli

    I was diagnosed with Major Depressive Disorder back in the late 1990′s. After spending several years trying to find a therapist that wasn’t trying to hawk a alt-EBT CD or book, or trying to convince of the healing power of prayer, I gave up.

    Tried again about five years ago, but the only therapist who took my insurance was part of a Pastoral Care ministry. Desperate, I tried her but after four or five sessions I wanted to strangle her.

    So, here we are, fifteen or so years later and I have still not found a therapist, and now that I am getting Medicare and living on a fixed income, I can no longer afford one even if I found one.

    In the mean time, there is chocolate and cigarettes…

    The issue with therapists and god is not a new one, nor is therapists and crystals, oils, energy, magnets and all sorts of batshittery.

    Hopefully, this will change. However, I am still keeping my supply of Hershey’s Kisses to stock, and my ash tray close by.

  • Joe T

    @4 Al stefanelli
    “Cigarettes and chocolate milk” by Rufus Wainright was written for you…

    • http://www.alstefanelli.com Al Stefanelli

      Never heard of it. Getting my Google on it now. ;)

  • Kylie Sturgess

    The World Skeptics Congress in Berlin (early-bird tickets ending soon!), happening in May, will feature a presentation by Tomasz Witkowski on this very topic:

    Psychology is full of excellent discoveries but also dangerous myths, frauds and urban legends. Many of the latter are taught at universities and are popular among psychologists and psychotherapeutists. Some of such pseudo theories are promoted in the field of self-help business or psychotherapy, e.g. the belief in the power of positive thinking, the conviction that early childhood experiences determine who we become as adults or assumption that people project key aspects of their personalities onto ambiguous stimuli like inkblots etc. Most of them create real harm for physically or mentally ill people. This lecture will present psychology’s most dangerous myths and the empirical evidence to show their real value as well as author’s suggestions how to overcome them.

    According to the website, he is the founder of the Polish Skeptics Club, and specialises in debunking pseudoscience, particularly in the field of social science, psychotherapy, and diagnosis. He is the author of seven books including “Forbidden psychology. Between charlatanism and science“.

  • http://mamamara.wordpress.com Mara

    I’m incredibly lucky that the very first therapist I tried was able to handle my atheism. I’m fairly sure she isn’t an atheist herself but she does a good job of not trying to use religion or spirituality to solve my problems. And the fact that I’m not 100% sure of her own beliefs is a sign that she’s a good therapist :D

    I could never have done talk therapy with someone who felt the need to spout Christianity at me. ::shudders:: And while I need my drugs, I’ve also needed my therapy. I wouldn’t be where I am today without the combination.

    Of course, I’m also lucky to live in a very liberal and multicultural area, so I’d be willing to bet that we have a higher percentage of therapists who would shrug, toss their Christian platitudes out the window, and move on to a more useful tactic.

  • Kylie Sturgess

    By the way – Chapters 8 – 11 (in fact, many of the other chapters as well) of the 2011 book

    “50 great myths of popular psychology: shattering widespread misconceptions about human behavior” by  Scott O. Lilienfeld, Steven Jay Lynn, John Ruscio, Barry L. Beyerstein

    covers the concerns that have been raised and Lilienfeld has spoken at skeptics conventions in the past about the book (Beyerstein, of course, has died, but is well-known for his contributions too).

  • http://littlepemo.tumblr.com/ pemo

    I’ve been in and out of therapy for anxiety and depression for about a decade, and I’ve always had difficulty telling the evidence-based stuff from the fakery. One tried to push The Secret on me, and that was a very good sign that he was a charlatan. My most recent therapist has suggested stuff by a Dr. Dan Siegel, which I’m having difficulty determining is good stuff or nonsense (I get a very self-aggrandizing vibe from him, which is a major strike). She insists he’s working in an evidence-based realm, but when I hear on his guided recordings discussion of “the wisdom of the body” or “energy”, I just want to shut it off. But then again, maybe he’s just trying to appeal to the newagers.

    I know to avoid the homeopaths and the spiritualists, but when it comes to everything else I have a tough time deciding, particularly when the practitioner in question brings out scientific terms and statistics. I’m not educated enough to know if what they’re talking about has evidence, but I’m too skeptical to place full confidence in things that might just work. It’s frustrating.

    Anyway, if there’s any resource out there that outlines what has been proven to work and what hasn’t, I’d love to know about it.

    • http://pervasivegoodness.com Donovanable

      I’m *not* a therapist but when studying E-B Therapy, and when researching on my own, these stood out to me. Some are more dense, but they’re original research or reports.
      This is a pdf of the APA’s (American Psychological Association) report on what evidence based therapy should be and where we should be going.
      http://www.apa.org/practice/resources/evidence/evidence-based-report.pdf
      This is actually a book, but at the bottom are free videos by the author. He cites a lot of studies and posts them as he discusses, which gave me a lot of other things to look at. He’s easy to listen to, and not technical. However, when he talks about ‘therapies’, it’s important to know that he means therapies that are standardized in the research setting, and all of them appear to be APA approved types. i.e., not things like The Secret.
      http://www.bacp.co.uk/publications/NEW%20PUBLICATIONS/erfmc.php
      This is one of the more cited meta-analyses, one of the reasons CBT is popular as a treatment.
      http://www.ncbi.nlm.nih.gov/pubmed/16199119
      Another source could be a recent psychopathology textbook. Mine always had a lot of recent research on treatment, and of course, included a ton of citations.
      Again, I’m NOT a therapist. I can’t make any suggestions about your treatment. But these were things I liked and learned from when I was trying to figure out what had evidence and what was woo.

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