The ISTC "Baloney Watch" Archives
If your are looking for something that once appeared on the ISTC "Baloney Watch" pages, you'll find it here!  The baloney archives are broken up into four separate pages highlighting different types of nonsense reviewed on Talkingcure.com.  On this particular page, we review theoretical fads and fancies that have captured the field's collective interest at one time or another.

Theoretical Baloney

The "Procrustean Bed" of Therapy
You remember the story, right?  Procrusus is a nasty guy who snags unsuspecting passers-by and then forces them to sleep on one of two beds.  One is long, the other short.  The catch?  If the person is too short for the long bed, Procrustus puts them on the rack and stretches them until they fit.  Similarly, if a person is to long for the short bed, he lops off their legs.  The story is often applied to one of the inherent dangers in any human services settings.  To wit, we try to fit people to what we have to offer, rather than tailoring something that fits the person.

Now, think therapy here.  With the battle between various brands of therapy still being waged, clients often end up getting the treatment therapists know how to do rather than the service they would ideally want.  Not sure?  What about DBT?  Isn't that now considered the "right" treatment for BPD?  What about CBT?  Aren't we being told that this method is the treatment of choice for depression, anxiety, phobias, etc.  Oh sure, we say we tailor the treatment but really the field's tailoring amounts to merely sizing the same style shoe to everyone who walks in the door.

What gives?  Well, it is well known that therapy (of almost any bona fide variety that has been tested) works.  It is also well known that WHO the therapist is accounts for 8-9 times more of the variance in treatment outcome that what particular treatment approach is being applied.  Indeed, adherence to a particular approach does not improve treatment outcomes.  Indeed, effective therapists seem to be effective (or more effective) regardless of the approach they use.  What's more, simple matching between clients and therapists on variables such as age, gender, cultural background, don't appear to improve outcome.

The question, of course, is what makes some therapists more effective than others?  And that leads us back to Procrustus.  Anyone who has been in practice knows that day to day clinical work is fraught with ambiguity.  Treatment just doesn't work the simple way frequently written about in professional books or shown on video.  The temptation in this sea of confusion is to "make sense" of matters.  The problem is that matters are often sorted in a way that makes the most sense to the therapist!

Here's another interesting finding. Therapists choice of theory may have more to do with their childhood–no kidding now–than with their training.  Researchers Poznanski, Police, & McLennan interviewed more than a hundred therapists using a structured interview.  They also administered a number of personality measures.  Practitioners who identified with CBT had a greater affinity in their own lives for matters considered, "rational & objective" whereas experiential practitioners had a natural tendency toward the "intuitive." In essence, choice of model had more to do with WHO the therapist was personally than with their clients or training.  Indeed, choice of training appeared to be correlated with such pre-existing qualities.

Years ago, the team at ISTC introduced the idea of using the "client's theory of change" (you can read more about this by clicking here or earn CEU's by clicking here) to make sense of the client's experience.  Research shows that clients stay engaged longer and have better outcomes when treatment fits their theory!  For example, in a recent study, Detweiler-Bedell & Salovey (2003), found that understanding the client's previous mood repair strategies, suggested strategies significantly improve the chances of client compliance.  Bottom line: Effective therapists are those who first truly listen and then skillfully organize treatment around the ideas, strategies, etc. that make sense to their clients.

Detweiler-Bedell, J. & Saolvey, P. (2003).  Striving for happiness or fleeing from sadness?  Motivating mood repair using differentially framed messages.  Journal of Social and Clinical Psychology, 22, 627-664.
Huppert, J.D. et al. (2001).  Therapists, therapist variables, and CBT outcome.  Journal of Consulting and Clinical Psychology, 69(5), 747-755.
Poznanski, J. et al. (2004).  Theoretical identifies behind personalities of australian counselling and psychotherapy practitioners. Psychotherapy in Australia.

More Philosophical Nonsense
The field of therapy has often turned to philosophy for ideas. Most recently, this takes the form of borrowing from post-structuralist, post-modern, and feminist scholars. Recently, the journal Philosophy and Literature announced the winners of their Fourth Annual Bad Writing Contest. Top of the list were several thinkers from the above named traditions. First, Judith Butler, Literature Professor at Cal Berkeley and winner of the Guggenheim Fellowship. Described by some as "one of the ten smartest people on the planet, she won first prize for writing:

"The move from a structuralist account in which capital is understood to structure  social relations in relatively homologous ways to a view of hegemony in which power relations are subject to repetition, convergence, and rearticulation brought about the question of temporality into the thinking of structure, and a marked shift from a form of Althusserian theory that takes structural totalities as theoretical objects to one in which insights into the contingent possibility of structure inaugurate a renewed conception of hegemony as bound up with the contingent sites and strategies of the rearticulation of power."

Or how about this "runner-up" for educated non-sense from D.G. Leahy, a book published by the State University of New York:

"Total presence breaks on the univocal predication of the exterior absolute the absolute existent (of that of which it is not possible to univocally predicate an outside, while the equivocal predication of the outside of the absolute exterior is possible of that of which the reality so predicated is not the reality . . . ."

Oh well, you get the idea. Perhaps ten years from now, these same nonsensical ideas will capture the attention of the field in the same way that post-modern ideas seem to have caught on.

American Enterprise, 10(3), 15.

So, what does the research really say about the biopsychiatric model of mental disorders?
If you're unsure, download the attached paper. Jason Seidel, Psy.D. thoroughly reviews the research on the biological view of mental disorders. We don't want to give the answer away. We promise, however, that whatever your position, your eyes will be opened. Here's what Dr. Seidel says, "I wrote this paper after spending about ten years learning about the difference between the facts of psychobiology research, and the claims that are made about this research. To put it another way, there is plenty of distance between the results and the discussion. The paper was meant as an antithesis to what I perceived (and still perceive) to be a biopsychiatric juggernaut. My intention was not to provide a balanced portrayal of all sides of the research, but to critique the inconsistencies, incongruities, and mystifications of the biopsychiatric position that keep clinicians' heads in a whirl as much as they influence the purchasing behavior of "medical consumers". I believe that psychotropic medications have a place in our society, but what place, what for, and under what conditions, are difficult questions that many in the business of dispensing psychiatric drugs have not adequately addressed. At the end of the day, we still have no accord about the utility of pain, or our relationship to it" (January 15, 2002).

Click here to download the paper.

Click here to send feedback to Dr. Seidel.

We know...you were all just dying to know...
There is a full moon effect...wait a minute, no, the research says there is not...no, wait, there is...no...there isn't. For centuries, the notion that the moon influences human behavior in strange and bizarre ways has been popular. Talk to people who work in the ER and they will tell you it's true...stranger things happen, they believe, when there is a full moon. What does the data say? In a series of studies that appeared almost simultaneously, the results say: yes and no. In the Journal of Psychosocial Nursing, researchers unaware of the lunar hypothesis rated 100 subjects over the course of two years using a standardized scale. The severity of symptoms for people diagnosed schizophrenic were found gradually worsen and then peak at the time of the full moon. However, no such effect was found for people with so-called mood disorders. The researchers point out that the results could not be due to moonlight as the ratings were taken during the day. Neither could the effect be due to the electromagnetic pull of the moon, as such forces wax and wane within a full-moon cycle.

A series of other studies has found absolutely no such effect on the number of hospital or psychiatric admissions, police calls, etc. One recent study carefully followed hospital admissions and lengths of stay. Using the Farmer's Almanac to insure accuracy, the researchers found absolutely no correlation between the phases of the moon and psychiatric hospital admissions.

So which is it? Does or doesn't the moon affect people's moods? It would be easy to argue that the first study addressing, as it does, the effect on a specific group, using a standardized measure, provides evidence for the effect. And yet, it could just as easily be statistical artifact, a statistically significant finding resulting from chance rather than something real. After all, there is no logical reason for thinking that the findings make sense for schizophrenically diagnosed clients but not depressed. Our suggestion? Plead the "null hypothesis." When there is no data, we must conclude presently, there is no evidence for the effect.

The full moon effect (2001). Family Therapy Networker, 25(2), 14-15.

Szimhard, J. (2001). Beliefs, perceptions, and full moons at a psychiatric hospital. Skeptical Inquirer, 25(4), 9-10.

Is All the Talk in Mental Mealth about Respecting Diversity just that--talk?
You hear a lot about diversity coming from the field of mental health these days. From courses on the subject in graduate schools to mandated continuing education events dedicated to raising therapists' consciousness about the needs and qualities of special populations. Professional organizations have also jumped on the bandwagon, emphasizing "tolerance" and advocating "multiculturalism." And yet, the data say the field is anything but diverse and that tolerance of diversity--if it exists at all--is highly skewed. On the issue of politics and social policy, researcher Richard Redding found the field of psychology is dominated by liberal beliefs and policies and marked hostility toward conservative ideas and values. Redding documents how the biased perspective of the profession leads to the adoption of, and advocacy for, policy positions that have little or no support or are even contradicted by the existing research literature! For example, the APA advocated that teenagers were fully capable of making their own medical decisions (e.g., about abortion), yet were immature juveniles in need of protection when charged with a major crime like rape or murder. Even more troubling, he cites research showing that sociopolitical views of therapists affect clinical diagnosis, intervention, and treatment decisions! Perhaps the mismatch between the largely liberal body of therapists and mostly centrist and conservative public explains the high drop out rates from, and overall low utilization rates for, therapy. Ultimately though, the unchecked bias simply decreases the credibility of the profession as a whole.

Redding, R.E. (2001). Sociopolitical diversity in psychology. American Psychologist, 56(3), 205-215.

No wonder Mental Health Consumers are Confused
One thing there is certainly no shortage of in the world of mental health is experts. With so many of them, you'd think the world be the picture of health. And yet, even a cursory review of their advice shows why consumers are often confused by the advise the experts offer. The truth is, the experts are confusing. Take the issue of spanking, for example. The practice has been outlawed in some countries. On the one hand, experts like Professor Catherine Fiorello say, "emprical research shows that . . . children who are not spanked do better" while on the other, Dr. E from Psychology Today says, "As long as spanking is done in moderation, it's probably a safe parenting technique." Momentarily setting aside the "well, duh" reaction you might have to the latter statement, one has to wonder if the "experts" really know what they're talking about. A more parsimonious explanation for the diversity of opinion in mental health is that different ideas appeal ("sell" in other words) to different groups.

Translating this research into clinical practice: Buyer beware. As Abraham Lincoln once observed, "moral principle is a looser bond than pecuniary interest." Until the same ethical standards regarding financial disclosure that apply to research are applied to public statements, expert advice needs to be take with a grain of salt.

Fiorello, C. (2001). Common myths of children's behavior. Skeptical Inquirer, 25(3), 37-39, 44.

Epstein, R. (May/June 2001). Ask Dr. E. Psychology Today, 34(3), 74.

Six Myths about Clinical Practice . . .
In an award winning paper, research L. Bickman (1999) identified several popular beliefs held by practicing psychotherapists and the field in general regarding the effectiveness of treatment. Briefly, he found no empirical support for the ideas that effectiveness was assured by (1) experienced clinicians; (2) continuing education; (3) professional degree; (4) licensing; (5) accreditation; or (6) clinical supervision. Importantly, this does not mean that psychotherapy as practiced is ineffective. Rather, it underscores the idea that effective care has little to do with the stuff that continues to dominate professional discourse, training, and practice; that is treatment models and methods. What makes therapy work? Click here to find out!

Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 54(11), 965-979.

The Benefits of Not telling everything to your Therapist . . .
For years, it has been considered axiomatic that clients who keep secrets from their therapists are less likely to make progress. So pervasive is this belief, that no one complains when authors Gediman and Lieberman write in their book The Many Faces of Deceit, "Patients [sic] are deceptive in the therapeutic encounter . . . The patient fools himself or herself in an effort to protect self esteem" and gain the "sadomasochistic gratification" associated with "putting one over on the therapist." Yet, like many clinical beliefs, the research seems to say otherwise. A recent study by researchers at University of Notre Dame found that clients who keep some secrets may actually do better than those who don't hold anything back. Moreover, it seems like therapists thinking otherwise are bound to be disappointed--as many as 40% of the people in the study reported keeping a secret from the therapist. Most of the secrets were kept to avoid embarrassment or prevent the therapist from thinking they weren't making progress. The latter suggests that the therapist's view of the client as making progress is an important factor in retention and improvement in treatment while the former suggests that not every area of the client's life or experience need be explored.

Cooper, G. (1998). The secrets of good therapy. Family Therapy Networker, 22(3), 14-5.

Sexual Preference: The Chicken and the Egg
One would think that the removal of "Homosexuality" from the Diagnostic and Statistical Manual of Mental Disorders would have led to more tolerance of diversity as well as more research and thinking about the causes of sexual preference. Instead, there is as much intolerance as there ever was and the old view has simply been replaced with the "new and approved" orthodoxy--homosexuality (and heterosexuality for that matter) is completely and totally a biological phenomenon unaffected by environmental factors. Now, researchers have shown what all neuroscientists have known for years but which has not been embraced by the mental health professions. The brain is a plastic organism that is influenced by the environment as much as behavior is influenced by events which occur in it. Researchers at University of California at Berkeley found that sexual experience plays an important role in developing sexual identify and preference. The researcher notes, "differences in neuronal structure between straight and gay men, or even between men and women, could as easily be the result of their different sexual experiences as of any genetic or prenatal influence." In science, any orthodoxy is a clear sign that political factors--as important as they may be--are at play. The truth is apparently more complicated. The question of whether people deserve to be treated equally is not something that can be answered by science. It is an ethical question. The ethical choice is to treat everyone equally because that--simply put-- is the right thing to do--not because of whether someone does or does not have a choice over aspects of their behavior that some people find offensive.

Nature, 389(6653), 801.

What Causes Anorexia? More Baloney from Therapists . . .
Though the disorder isn't as popular at conferences and workshops as it was half a decade ago, a large number of people continue to suffer from Anorexia. Recall that numerous "psychogenic" explanations have been offered by experts regarding the debilitating condition: sexual abuse, infantilization by mother, low self-esteem, and difficulty adjusting to puberty. The result? Lots of explanations but not much improvement in treatment outcome. Now, researchers are finding that out that antibodies developed in response to strep throat might be the reason for the problem. In research on teenagers with the disorder, researcher Mae Sokal found they had five times the number of antibodies as the normal average. Will the field of therapy never learn? Susan Sontag long ago pointed out how mental interpretations dominated the thinking about TB. Recently, we learned that many of the so-called stress induced stomach ulcers were actually a result of a common bacteria rather than psychological factors.

Psychology Today (1998). Antibiotics for anorexia? 31, (3), 20.

Is it Time to Bury our Traditional Notions about Grief?
That's what researcher Camille Wortman reported in her presentation at the APA Convention. According to Dr. Wortman, the idea that people must react in a certain way or go through a series of stages in order to grieve is simply not supported by the evidence. For example, a significant percentage of people simply do not show significant signs of distress--even in response to the death of a spouse. Characterizing such responses as "stuffing" or "bottling up" emotions is, therefore, clinical myth and superstition. Moreover, the phenomenon of delayed grief--a popular clinical notion--is so rare as to make it virtually unknown to most therapists! Apparently, therapists are engaging in theory countertransference--the tendency for therapists to see their own operating theory in their clients. Finally, while most people ask themselves, "why me?" in response to a loss, getting an answer to the question is not related to resolution of the grief in the vast majority of the cases.

Shapiro, B. (October, 1997). Researchers question the way society grieves. APA Monitor, p. 36.

Revisiting Painful and Traumatic Memories . . . Definitely More Pain than Gain!
Old ideas die hard and one that has yet to leave the field of therapy is the notion that people benefit from revisiting and working through painful memories and emotions. Author Jill Litrell reviews the literature on this subject and finds that directing clients to re-experience painful emotions for the sake of simply experiencing ("reconnecting") the emotion is likely to do more harm than good. Littrell is careful to distinguish this old fashion and outmoded form of treatment with strategies known to be helpful (e.g., exposure).

Littrell, J. (1998). Is the re-experience of painful emotion therapeutic? Clinical Psychology Review, 18(1), 71-102.

Give me that ole' time emotion! Or, how to convince someone of something that isn't so . . . (play to their gender stereotypes)
Belief in the therapeutic effect of learning to display emotion has enjoyed considerable popularity since the 1960's. What have we learned about the genuine display of emotion? Well, researcher Janice Kelley found that people are more likely to believe an emotion is genuine when it is inconsistent with the gender stereotypes we hold--not when it is really genuine or not! For example, since men are generally expected to display anger and stubbornness, people are more likely to believe a man who expresses sadness, fear, or contriteness. Women, on the other hand, who are generally expected to express "tender emotions" are more likely to be seen as genuine, when they express resolve, anger, and firmness.

Kallen, L. (1998). Men don't cry, women don't fume. Psychology Today, 31(5), 20.

Postmodern Non-sense
Social Text--one of the leading journals of the postmodern movement. The article, according to the paper's abstract, was an attempt to bring the postmodern light to the rigid, scientific, and therefore, dark corridors of modern physics. The article was reviewed and accepted by the editors of the journal and appeared in the special issue alongside pieces written by some of the biggest names in the field (i.e., Sandra Harding, Steve Fuller, Dorothy Nelkin). The theme of the issue was that science is/was only one among many equally valid ways for knowing the world--no better or more effective than say religion or myth in understanding or making predictions about the world.

The only problem was that Dr. Sokol's entire paper was a hoax--it did not contain a single intelligible thought. Indeed, Dr. Sokol had written it in an attempt to show that "our understanding of the social and humanistic side of science has come down to such inane literary babble that even the experts cannot discriminate between it and nonsense" (p. 17). Consider the following choice bit of nonsense, "The pi of Euclid and the g of Newton, formerly thought to be constant and universal, are now perceived in their ineluctable historicity; and the putative observer becomes fatally decentered, disconnected from any epistemic link to a space-time point." As this short excerpt shows to anyone with even a passing familiarity with postmodernism, while the paper made no sense it did contain all the right "buzzwords."

It is possible that the hoax may not offend anyone in the postmodern camp. After all, a central tenet of the new philosophy is that language (words) is, in fact, all there is–all we know for sure. In this instance, they were absolutely right! The question is, given their understanding of physics, "Would you be willing to fly on a postmodern plane?"

Deconstruction Self-Destructs. Skeptic, 4(2), 17.