Is Primal Therapy woo?

[Moochie]

Hello Moochie.

I have already read the debunking primal therapy site. In fact, I check up on that site every once in awhile for changes. That is how I was directed here.

I have also read the "Your Stories" section.

I also noticed that you recommended the book, A New Guide to More Rational Living by Albert Ellis. I was given a copy of that book by a psychiatrist I was seeing several years before I underwent primal therapy (I too have undergone several psychotherapies). He gave me that book, and he gave me xanax 1mg. Although the book was fairly sensible, I must confess that the latter treatment was more effective for panic disorder.

I should point out that my experience with PT and other "therapies" occurred the better part of 40 years ago. I was a lot less skeptical then. As for the Ellis book, for the right person it is a very intelligent approach to the kinds of life problems that were then, as now, endemic. But it's not the answer for everyone.

I also read your description of primal therapy at an Australian center. Yikes! It almost seems as if they were playing a game of "one-upmanship" over Janov; if Janov won't allow you to smoke during the first 3 weeks, then they won't even allow you even to eat properly during that time, or to piss. Of course, the purpose of primal therapy is not deprivation. If those restrictions did not facilitate the return of prior painful feelings then there was no point to it, not even from the standpoint of primal therapy, which I realize you don't accept.

The PT I experienced was a complete sham, not least of all for the reasons I've already given here -- not that I realized it at the time. Like most people, I came to it after reading that first, seductive book Janov wrote. I was completely uncritical of the book, and for most of what followed. My skepticism came much later. From my point of view, the site I linked to, and which you claim to have read, nails PT extremely well. For me, Janov's ideas have no more credibility than L. Ron Hubbard's.

Anyway, thanks for your response.

Tom W

You're welcome.


M.

 

[Dancing David]

Welcome twrges!

Hello everyone.

I read this thread with great interest, because I underwent primal therapy a few years ago and I remain a proponent of it. In my case, I underwent primal therapy after I had finished my undergraduate education in Psychology in a conventional program, at a reputable university, and while I was taking graduate courses in Psychology. So I was aware beforehand that primal therapy was hypothetical and that it lacked statistical evidence to support it; and I understood beforehand that there were other forms of therapy (like rational emotive therapy) which did have statistical evidence.

\
I believe that is do have evidence of symptom reduction, analysis may be statistical or qualitative depending.

You may ask: if I knew beforehand that primal therapy had less statistical evidence of its effectiveness, then why did I undergo it? I underwent primal therapy because I believed it was a hypothesis which cohered with informal but obvious evidence in way which other therapies did not.
[/quote]
What do you mean by informal evidence? Like the evidence for other things that might or might not exist? (I am trying to be polite, I would normally mention Bigfoot).

Furthermore, I did not believe the evidence supporting rational emotive therapy and BT was convincing. Since I found RET and BT so unconvincing, I thought it may be reasonable to explore more hypothetical options; and I found the ideas underlying PT to be particularly plausible, for various reasons.

What was unconvincing?

You can take whatever path you choose, but what is your bias?

When did you go to school, what is your personal preference in theories? Are you a Freudian or Jungian of some sort? I personally like Jung a lot, very speculative mixed with some real gold.

While I was a student of Psychology, the available evidence of psychotherapy effectiveness indicated that all psychotherapies were equally effective.

Um sure, any data to back that, any recent studies that show that?

Even psychotherapies based upon nothing more than nodding occasionally and agreeing (eg client-centered therapy) were as effective as the products of decades of academic research.

research and data would be nice to see, anything from the last ten years would be good, anything in the last five would be better.

Even psychotherapies which were intended to be placebos turned out to be as effective as RET. Furthermore, the evidence indicated, that experience and education of the psychotherapist had no effect whatsoever on therapy outcomes. Those facts were accepted by all my professors and, insofar as I could tell, were accepted by essentially everyone in the field. As a result, it is somewhat of an exaggeration when others on this forum claim there is evidence supporting CBT's effectiveness.

So far this is just an assertion, I ask you to support your assertion, especially since data models have changed a lot in the last thirty years.

There is not evidence supporting the specific efficacy of CBT. There is only evidence supporting the modest effectiveness of talking about one's problems in general to someone else who listens; and if the listener practices CBT in the mean time then it does not hinder a successful outcome.

Data, evidence, citations?

(If I recall correctly, there was even a study done comparing the effectiveness of PhD psychologists against completely untrained people who lacked any formal education in psychology at all. That comparison was possible because, at that time, there were one or two US states (colorado?) which allowed people to practice psychotherapy without any formal training. Anyway, the outcome study indicated that completely untrained people were as effective as the PhD psychologists, which was unsurprising, given prior research showing that level of education of psychotherapists had no effect on therapy outcomes).

Data, evidence, citations?

Obviously, the lack of specific efficacy of other psychotherapies is not evidence in favor of primal therapy. After all, primal therapy lacks even the research necessary to show that it's no less effective than anything else. In that regard, primal therapy is uniquely unsupported, since almost everything else has such studies.

Nevertheless, I felt at the time that primal therapy was an interesting hypothesis. Also, I felt that an interesting hypothesis was more compelling and more important, than a tired theory. I obviously would have preferred that there be studies investigating the effectiveness of primal therapy, before I underwent it. However, such studies would not be forthcoming, because Janov had made claims which were far enough out on a limb, that he estranged himself from anyone who could conduct such studies.

I realize that Janov has made some claims which inspire skepticism among others in the field of Psychology. I also realize that the onus is on Janov to prove his claims and to substantiate his remarks--it's not the responsibility of others to prove him wrong.

However, at some point, primal therapy is not about Arthur Janov. At some point, it's not really crucial what Janov thinks. The claim that primal therapy is reliant on Janov appears ultimately to be a kind of ad hominem. Even if Janov died before evidence were produced, that would not mean that the opportunity for gathering evidence about it had passed.

In fact, I suspect that primal therapy would be particularly easy to study. I believe so, because one of the tenets of primal therapy is that these "regressive" experiences happen only occasionally and are only effective under specific circumstances. As a result, it would be easy to envision a "sham" therapy in which people are encouraged to scream their hearts out, but without the regressive experience which is claimed to be the curative element.

Before I underwent primal therapy, I had many reasons taken from informal evidence which suggested to me that it was plausible. I will not restate those reasons here because it would require considerably more space to do so than would be appropriate for this message. However, if this message develops into a conversation, then I'll go into further depth about my reasons for believing that primal therapy was a compelling hypothesis.

When I underwent primal therapy, I occasionally had episodes in which I experienced the return of prior painful events (by "return" here I mean vivid images accompanied by the original emotional state). After I had those episodes, I experienced the immediate and complete resolution of longstanding neurotic symptoms and those symptoms have not returned to this day.

neurosis?

That is a rather vague and non-specific label. maybe you should read some more recent research.

Of course, there is the possibility of placebo effect here, because I had already assumed even before primal therapy that those symptoms were the products of painful earlier experiences. Nevertheless, my own experience was at least provocative to me because I would not have expected a placebo cure to be so durable.

Obviously, my own anecdotal evidence will not be convincing to the members of this forum, for various and valid reasons.

Nevertheless, I do hope that psychologists eventually conduct research on primal therapy. After all, primal therapy might have something to it. You never know.

Tom W

Well Tom, there is a lot there, all I can say is that you haven't shown us any data, and I will be polite, but what is often taken to be true in one era (without evidence) may turn to be unsupported later by evidence.

It is up to the proponents of a treatment to investigate it.

 

[Dancing David]

.
...
I also noticed that you recommended the book, A New Guide to More Rational Living by Albert Ellis. I was given a copy of that book by a psychiatrist I was seeing several years before I underwent primal therapy (I too have undergone several psychotherapies). He gave me that book, and he gave me xanax 1mg. Although the book was fairly sensible, I must confess that the latter treatment was more effective for panic disorder.
...
Tom W

Usually the most effective strategy for moderate to severe symptoms is a combination of medication and therapy. One to bring down symptoms, the other to modify the person's life choices.

I have a bias against Xanax, it has a high sedating effect and is commonly abused. It also has a withdrawal effect.

 

[twerges]

defending primal therapy

Hello Dancing David.

(about CBT) What was unconvincing?

CBT said little that was non-obvious, and was found to be no more effective than any other psychotherapy. That was unconvincing.

With regard to my claims that all psychotherapies are equally effective and that training doesn't matter. You have requested "data, evidence, citations" to support those facts. While I was a student, those facts were widely acknowledged as true within the field, and were accepted by all my professors including one professor of sociology. There are hundreds of studies which demonstrate those facts. The notion of equivalence of psychotherapies was so well-known that it had a name within psychology, the "dodo bird effect" or "dodo bird conjecture" (which referred to Alice in Wonderland in which a dodo bird says "we all are winners and all must have prizes" or something similar).

One large meta-analysis (Smith,-Mary-L.; Glass, Gene V. American Psychologist; 1977 Sep Vol 32(9) 752-760) examined 375 studies of psychotherapy effectiveness. The meta-analysis concluded that

(from the meta-analysis) Few important differences in effectiveness could be established among many quite different types of psychotherapy. More generally, virtually no difference in effectiveness was observed between the class of all behavioral therapies (e.g., systematic desensitization and behavior modification) and the nonbehavioral therapies (e.g., Rogerian, psychodynamic, rational-emotive, and transactional analysis).

Laborsky et al performed a meta-analysis of all reasonably-controlled studies of psychotherapy effectiveness (Arch Gen Psychiatry. 1975 Aug;32(8):995-1008). They concluded:

(from Laborsky et al) For comparisons of psychotherapy with each other, most studies found insignificant differences...

A good recent book which summarizes the research of psychotherapy effectiveness is The Great Psychotherapy Debate: Models, Methods, and Findings (Paperback) by Wampold. In chapter 4 he examines the evidence for the relative efficacy of different psychotherapies. He writes:

(from Wampold) Accumulating evidence of the dodo bird conjecture is presented... With few exceptions, the results are consistent with the hypothesis that psychotherapies are uniformly efficacious.

There was also a study commissioned by the magazine Consumer Reports. The magazine hired several renowned psychologists (including Martin Seligman) to conduct a well-controlled study of psychotherapy effectiveness. The resultant study would be published in a journal (American Psychologist which is the official journal of the APA. Also, a readable summary of it would be presented in Consumer Reports so that consumers could make informed decisions about which psychotherapy to undergo.

(from Seligman at al (Am Psychol. 1995 Dec;50(12):965-74)) patients benefited very substantially from psychotherapy... and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters

Please note that social workers actually were very slightly more effective than doctors of psychology or psychiatry. However, the margin of superiority was very slight, although it was statistically significant because the study had such a large sample size.

I presented those four references because they are frequently cited and are wide-reaching. Two of them are meta-analyses of hundreds of controlled studies. One is a summary of all the research relevant to that question. One more is frequently cited and was conducted by a renowned figure in the field. Two of the studies were published in American Psychologist which is the "official journal" of the APA (of course there are 30+ other journals also published by the APA on various topics).

(from you) neurosis? That is a rather vague and non-specific label. maybe you should read some more recent research.

I used the term "neurosis" deliberately. I'm aware that term is infrequently used now in Psychology. However, it's useful when discussing primal therapy because Janov claims that many different psych disorders (depression, GAD, BPD, etc) all have the same causes and are not essentially different. As a result, it's convenient to use a more general term here.

(from you) You can take whatever path you choose, but what is your bias? When did you go to school, what is your personal preference in theories? Are you a Freudian or Jungian of some sort? I personally like Jung a lot, very speculative mixed with some real gold.

I went to a school which emphasized behaviorism and statistics. While I was there, the professors rarely mentioned Freud, Jung, etc.

While I was a student, I did not find any theories of psychopathology to be convincing.

I had grave doubts about psychoanalysis, because its leaders (Freud, Jung, etc) had all descended into the subconscious and all emerged with drastically different accounts of what resided there. In other words, there was very, very low inter-rater reliability of the contents of the subconscious.

I thought that radical behaviorism was astonishingly silly. I realize I'm kicking a dead horse here, but I was shocked that anyone could ever have believed that.

Let me digress briefly in order to explain one reason why I doubted radical behaviorism. I also have an undergraduate degree in computer science. While I was a psych student, I was familiar with old CPU architectures like the Intel 8080 from the early 1970s. Those CPUs are very primitive and have a few thousand transistors. Nevertheless, those CPUs had internal state, were capable of intermediate calculations, and could do things far beyond what Skinner claimed that our 100-billion-neuron brains could ever conceivably do, even in theory. As a result, I was taken aback when Skinner claimed that there was no "inner man" and could not be, as a matter of scientific principle. What did he think those 100 billion neurons were doing? Stimulus-response? Operant conditioning?

Much of the time, I felt that Skinner was simply confused. I felt that Skinner's errors were the result of very poor reasoning; his errors were not subtle. Skinner claimed to rule out the possibility of an "inner man" on methodological grounds. To me it was obvious that no methodological limitation could ever imply a limitation of the world.

While I was a student, the book I found most interesting was EC Tolman's Purposive Behaviorism in Animals and Men. I thought that book was far more interesting and plausible than what Skinner was doing.

Well Tom, there is a lot there, all I can say is that you haven't shown us any data

I hope I've answered that criticism.

I realize that Primal Therapy does not have outcome studies to support it, which obviously is a major shortcoming. However I have not claimed that primal therapy is supported by outcome studies. Instead, I claimed that primal therapy is an interesting and plausible hypothesis which deserves further investigation.

It is up to the proponents of a treatment to investigate it.

In my opinion, it's up to anyone who is in a position to conduct research, to investigate hypotheses which they feel are important and plausible.

Tom W

 

[twerges]

I have a bias against Xanax, it has a high sedating effect and is commonly abused. It also has a withdrawal effect.

I was very much in favor of Xanax. People with panic disorder often respond very well to it. I was in contact with many psychiatrists at the time who agreed that it was the most effective drug for panic disorder. I never experienced any sedation while I was taking it; it just took me back to normal.

I realize there is a bias against it, because of its abuse potential, and because of the "rebound effect". The rebound effect only happens if you take alot of it continuously then stop taking it. In my case, the psychiatrist dealt with those issues by prescribing 15 tablets per month and by telling me to take them only when I really needed them. I felt that was appropriate.

I tend to lean libertarian, so I don't believe that concerns about diversion of medication should ever influence prescribing behavior. I can understand why some people would wish to wage a "war on drugs," but it's gone too far when that war interferes with effective treatment. Nobody should ever have his treatment sacrificed or reduced because someone else is an addict.

(I realize this is off-topic).

Tom W

 

[Professor Yaffle]

An article on the Dodo Bird Verdict:

http://www.srmhp.org/0101/psychotherapy-equivalence.html

For over 60 years, claims have been made about the general equivalence of all forms of psychotherapy. In the past 2 decades, numerous meta-analyses have been published that bear on the question of psychotherapeutic equivalence (often referred to as the Dodo bird verdict). In this article we critically review meta-analytic work most relevant to this question and, based on our review, conclude that there is overwhelming evidence that the Dodo bird verdict is incorrect. Indeed, with few exceptions, all meta-analytic evidence points to substantial differences among psychological treatments, especially when comparing cognitive-behavioral treatments (including cognitive and behavioral interventions) with other forms of therapy. We discuss the implications of this evidence for current efforts to promote evidence-based psychotherapeutic practices.

 

[twerges]

Hello Moochie.

From my point of view, the site I linked to, and which you claim to have read...

I can quite assure you that I have read it.

(that site) nails PT extremely well.

In my opinion, the first 5 articles on that website, which deal with science etc, are good. Also, the articles called "checking the science" and "detecting real science" are good.

The other 30 or so articles appear to be a mixture of hearsay, anonymous accusation, insinuation, anonymous personal testimony, personal speculation of psychological effects supposedly at work in primal therapy (social pressure etc), and so on. Those 30 articles range from somewhat plausible ("group conformity"), to less plausible. Some of the articles ("personal attacks") include one-sided accounts of personal disputes. Other articles include descriptions of things which are incompatible with what I recall from when I was there. Some of the articles ("your stories") include negative testimonials which were solicited and which were written mostly by people who do not even claim to have undergone primal therapy at Janov's center. One of the articles ("Ethics") appears to rely on insinuation.

Speaking of skepticism. I would take a skeptical view toward articles on that website which rely on anonymous accusation or hearsay. The authors of that website are disaffected former members who apparently had bitter personal disputes with the other patients. As a result, their one-sided account of those disputes may not be objective.

Also, the debunking website contains descriptions of Janov's center which are starkly different from what I recall when I was there.

Of course, any questions regarding the credibility of anonymous testimony, have no bearing whatsoever on the articles from that website which deal with science. Those articles about science contain arguments which do not rely on anonymous personal testimony. In fact, the articles about science often make valid points.

 

[Jeff Corey]

An article on the Dodo Bird Verdict:

http://www.srmhp.org/0101/psychotherapy-equivalence.html

And from their conclusion:
"In conclusion, when the meta-analytic evidence is critically examined, there is no support whatsoever for the Dodo bird verdict. Psychotherapy equivalence, at least in its broadest form of general equivalence across all therapies, is most definitely a myth (cf. Beutler, 2000).Viewed in this light, this Dodo bird is clearly not akin to a phoenix, but more closely resembles a repeated, unsubstantiated rumor about the sighting of a bird that has long been extinct. In other words, the Dodo bird verdict is more likely to be an urban legend than a scientifically substantiated position."

 

[twerges]

Prof Yaffle,

Thanks for the link to a very informative paper. In light of evidence presented in that paper, perhaps I should reconsider my belief in the equivalence of psychotherapies.

If you don't mind, I'll address a few points from that paper.

(from the paper) a substantial number of informed psychotherapy researchers and clinicians consistently and confidently proclaim that there is no convincing evidence that different treatments are differentially effective and, furthermore, that the majority of evidence demonstrates the equivalence of all psychotherapies (e.g., Lambert & Bergin, 1994; Weinberger, 1995)... In the years following the Luborsky et al. (1975) article, attention to the Dodo bird verdict grew, with only a few challenges to it... It is now commonplace to see sweeping statements about the veracity of the Dodo bird verdict in the literature... Some recent examples include Zinbarg (2000), who wrote that "the well-known 'Dodo bird effect' from meta-analyses of psychotherapy outcome studies suggests that common factors...are sufficient for producing at least some degree of improvement" (p. 397), and Polkinghorne and Vernon (2000), who concluded that "[c]ontinuing studies ...produce a general equivalence in outcomes" (p. 494). Moreover...there are contemporary statements concerning the existence of psychotherapy equivalence that fail to even include references to supporting empirical evidence. Presumably, these authors felt that equivalence was so commonly accepted that there was no need to supply supporting citations... Beutler (1991) suggested that most therapists and psychotherapy researchers had accepted the Dodo bird verdict as true. Bergin and Garfield (1994)...concluded that there was "massive" evidence that psychotherapeutic techniques did not have specific effects.

Presumably, then, this author is offering an opinion different from that of many or most of his colleagues. He makes a compelling argument, and it seems quite plausible to me that he is correct and his colleagues mistaken. However his point seems disputed. (Of course, I also grant the possibility that the consensus has changed in the last few years and most of his colleagues would now agree with him).

The paper's argument is compelling. Perhaps I was mistaken when I asserted that the evidence implied that all psychotherapies are equally effective. When I formed that opinion, I had read the studies asserting equivalence which the paper cites, and I had been told by many experts that it was essentially the scientific consensus. Of course, the scientific consensus can change, that's why it's science.

 

[twerges]

Jeff,

You quoted the conclusion of the paper, as follows:

In conclusion, when the meta-analytic evidence is critically examined, there is no support whatsoever for the Dodo bird verdict. Psychotherapy equivalence, at least in its broadest form of general equivalence across all therapies, is most definitely a myth (cf. Beutler, 2000).Viewed in this light, this Dodo bird is clearly not akin to a phoenix, but more closely resembles a repeated, unsubstantiated rumor about the sighting of a bird that has long been extinct. In other words, the Dodo bird verdict is more likely to be an urban legend than a scientifically substantiated position

I disagree with the conclusion of that paper. The dodo bird conjecture was originally based on large meta-analyses that indicated equivalence. It's quite possible that those meta-analyses would yield different results through more careful categorization of therapies. Studies can have methodological problems. But that is not the same as a "repeated, unsubstantiated rumor" or an "urban legend". It appears that the author is engaged in rhetorical excess there.

 

[Moochie]

Hello Moochie.



The other 30 or so articles appear to be a mixture of hearsay, anonymous accusation, insinuation, anonymous personal testimony, personal speculation of psychological effects supposedly at work in primal therapy (social pressure etc), and so on. Those 30 articles range from somewhat plausible ("group conformity"), to less plausible. Some of the articles ("personal attacks") include one-sided accounts of personal disputes. Other articles include descriptions of things which are incompatible with what I recall from when I was there. Some of the articles ("your stories") include negative testimonials which were solicited and which were written mostly by people who do not even claim to have undergone primal therapy at Janov's center. One of the articles ("Ethics") appears to rely on insinuation.

You are right to be skeptical, of course. Where I'm coming from is personal observation and direct testimonials given by people I know and knew. That came first, and reading the content of that site echoed what I knew; that is to say the site came second, by several decades in fact.

I'm skeptical about a great number of things, including people's motivations, so while I to you appear as yet another anonymous voice in a very large pool of such voices, the same holds true for what you represent to me. The comments we make are either plausible and believable, or they're not. My purpose in saying what I say about PT is to answer a query that was posted here. I have no ulterior motive and do not "push" any particular answer for what may trouble individuals who might read what I write. I suggested the Ellis book because for some it can be a very helpful, cheap (if not free) alternative to months or years and thousands of dollars spent on "therapies" for which there is little or no evidence of efficacy and which are sometimes, as in the case of PT, based on the theoretical creations of people who themselves evince behavior that, to me, appears highly questionable.

At my age (58), I have very little reason to think one approach to emotional problems is superior to another, and this is based on my own experience and what we have learned about the subject in the decades since Freud and Jung et al. I do think that prevention is far preferable to all treatments extant today, and that for people like me, perhaps pharmacology is "the answer," at least until something better comes along.

On the subject of pharmacology, I've found the site http://www.bltc.com/ to be informative and illuminating.


Regards,

M.

 

[Dancing David]

Hello Dancing David.



CBT said little that was non-obvious, and was found to be no more effective than any other psychotherapy. That was unconvincing.

Thanks for the long response Tom. I shall try to be polite. I find your attitude somewhat disturbing and there appear to be some deficits in your 'arguments'. Certainly you are entitled to your opinion and I respect that but much of the reasoning seems bogus.

Stating that something is obvious is not usually considered a critique and when you consider that many less obvious ideas have defrauded people of money for little benefit, is seems to be a specious argument as well.

First off, you realize I hope that your data is way out of date. Given the way that psychology was practiced in the seventies and the inherent errors in meta-analysis. I really have to question how meaningful that study is.

I will read it and see, protocols were much sloppier in those days.

With regard to my claims that all psychotherapies are equally effective and that training doesn't matter. You have requested "data, evidence, citations" to support those facts. While I was a student, those facts were widely acknowledged as true within the field, and were accepted by all my professors including one professor of sociology.

that is an appeal to populism and an appeal to authority.

just because something is a commonly held belief does not mean it is a valid belief.

There are hundreds of studies which demonstrate those facts.

I doubt that at all, how many in the last ten years. I know I can find many that show you are wrong about the effectiveness of CBT, and will do so as needed.

Stating that there were hundreds of irrelevant and outdated studies is a further appeal to authority and somewhat of bombast.

Not very convincing.

You may have a personal bias against CBT, I have a bias against existential therapy in the extreme. however I can provide plenty of recent data which shows symptom reduction in CBT, the other therapies, not so much.

The notion of equivalence of psychotherapies was so well-known that it had a name within psychology, the "dodo bird effect" or "dodo bird conjecture" (which referred to Alice in Wonderland in which a dodo bird says "we all are winners and all must have prizes" or something similar).

God and the effectiveness of prayer are also commonly held beliefs.

One large meta-analysis (Smith,-Mary-L.; Glass, Gene V. American Psychologist; 1977 Sep Vol 32(9) 752-760) examined 375 studies of psychotherapy effectiveness. The meta-analysis concluded that

Thanks you that is data and research as opposed to an appeal to populism and authority.

I will read it and see if it is currently being replicated.

Laborsky et al performed a meta-analysis of all reasonably-controlled studies of psychotherapy effectiveness (Arch Gen Psychiatry. 1975 Aug;32(8):995-1008). They concluded:



A good recent book which summarizes the research of psychotherapy effectiveness is The Great Psychotherapy Debate: Models, Methods, and Findings (Paperback) by Wampold. In chapter 4 he examines the evidence for the relative efficacy of different psychotherapies. He writes:

What year was it published?

There was also a study commissioned by the magazine Consumer Reports. The magazine hired several renowned psychologists (including Martin Seligman) to conduct a well-controlled study of psychotherapy effectiveness. The resultant study would be published in a journal (American Psychologist which is the official journal of the APA. Also, a readable summary of it would be presented in Consumer Reports so that consumers could make informed decisions about which psychotherapy to undergo.

And where is the citation link?

This one
(from Seligman at al (Am Psychol. 1995 Dec;50(12):965-74))?

I will read it as well.

Please note that social workers actually were very slightly more effective than doctors of psychology or psychiatry. However, the margin of superiority was very slight, although it was statistically significant because the study had such a large sample size.

Which study, for clarity.

I presented those four references because they are frequently cited and are wide-reaching. Two of them are meta-analyses of hundreds of controlled studies.

And one is terribly out dated.

is there current replication, what is the critique of the meta-analysis?

One is a summary of all the research relevant to that question. One more is frequently cited and was conducted by a renowned figure in the field. Two of the studies were published in American Psychologist which is the "official journal" of the APA (of course there are 30+ other journals also published by the APA on various topics).

See you keep making vague references and appeals to authority, try referencing the studies by name and year. this just seems to be an appeal to authority.

How rigorous were the controls in the meta-analysis, did they meet today’s standards?

You do know how meta-analysis works don't you?

It is never definitive but only indicative of further areas to research.

I used the term "neurosis" deliberately. I'm aware that term is infrequently used now in Psychology. However, it's useful when discussing primal therapy because Janov claims that many different psych disorders (depression, GAD, BPD, etc) all have the same causes and are not essentially different. As a result, it's convenient to use a more general term here.

Unsubstantiated assertion. Ant evidence or data that is so?

I went to a school which emphasized behaviorism and statistics. While I was there, the professors rarely mentioned Freud, Jung, etc.

While I was a student, I did not find any theories of psychopathology to be convincing.

That is good, there are only three or four which have a research basis.

I had grave doubts about psychoanalysis, because its leaders (Freud, Jung, etc) had all descended into the subconscious and all emerged with drastically different accounts of what resided there. In other words, there was very, very low inter-rater reliability of the contents of the subconscious.

the subconscious is also a vague term with no scientific validity.

I thought that radical behaviorism was astonishingly silly. I realize I'm kicking a dead horse here, but I was shocked that anyone could ever have believed that.

I am told I am a methodologist but beware the radical behaviorists on this forum. they are nice but will hold you accountable for your data and research.

Let me digress briefly in order to explain one reason why I doubted radical behaviorism. I also have an undergraduate degree in computer science. While I was a psych student, I was familiar with old CPU architectures like the Intel 8080 from the early 1970s. Those CPUs are very primitive and have a few thousand transistors. Nevertheless, those CPUs had internal state, were capable of intermediate calculations, and could do things far beyond what Skinner claimed that our 100-billion-neuron brains could ever conceivably do, even in theory. As a result, I was taken aback when Skinner claimed that there was no "inner man" and could not be, as a matter of scientific principle. What did he think those 100 billion neurons were doing? Stimulus-response? Operant conditioning?

I do not think you understand modern radical behaviorism.

Much of the time, I felt that Skinner was simply confused. I felt that Skinner's errors were the result of very poor reasoning; his errors were not subtle. Skinner claimed to rule out the possibility of an "inner man" on methodological grounds. To me it was obvious that no methodological limitation could ever imply a limitation of the world.

While I was a student, the book I found most interesting was EC Tolman's Purposive Behaviorism in Animals and Men. I thought that book was far more interesting and plausible than what Skinner was doing.



I hope I've answered that criticism.

I realize that Primal Therapy does not have outcome studies to support it, which obviously is a major shortcoming. However I have not claimed that primal therapy is supported by outcome studies. Instead, I claimed that primal therapy is an interesting and plausible hypothesis which deserves further investigation.

What mechanism makes it plausible?

Seriously, I have worked a lot in mental health. I don't find the theory plausible.

What mechanism could be tested for?

Why isn't it used for PTSD?

In my opinion, it's up to anyone who is in a position to conduct research, to investigate hypotheses which they feel are important and plausible.

And the issue is that there is shortage of people who find it plausible or important. that is why the burden is on the claimant. I can say that shamanic path working is an effective form of counseling.

But then it is up to me to show that it really is.

Tom W

http://ajp.psychiatryonline.org/cgi/content/full/164/1/7
http://www.sciencedirect.com/scienc...serid=10&md5=306a911c411ead358ae663670fe67b21

(I can find lots more as well.)

Would indicate substantial effect for CBT in two separate groups, the problem is most other 'therapies' do not show that benefits at all.


So what is the most recent study which shows the Dodo effect?

 

[Dancing David]

I was very much in favor of Xanax. People with panic disorder often respond very well to it. I was in contact with many psychiatrists at the time who agreed that it was the most effective drug for panic disorder. I never experienced any sedation while I was taking it; it just took me back to normal.

Good, I am very glad it worked.

I realize there is a bias against it, because of its abuse potential, and because of the "rebound effect". The rebound effect only happens if you take alot of it continuously then stop taking it.

I had a friend who had it after two doses a day apart.

In my case, the psychiatrist dealt with those issues by prescribing 15 tablets per month and by telling me to take them only when I really needed them. I felt that was appropriate.

Well that is currently a rather large debate, the prescription of benzos PRN might have some issues. The doctors I knew were all for regular dosing. they did not prescribe Xanax because of the sedation and abuse profiles. they would prescribe other less sedating meds on a regualr schedule.

that was their preference.

Mine comes from years of case management, assesments and some crisis work.

The only people who requested Xanax were abusers, same for Ativan, small anecdotal sample, subject to confirmation bias.

I tend to lean libertarian, so I don't believe that concerns about diversion of medication should ever influence prescribing behavior. I can understand why some people would wish to wage a "war on drugs," but it's gone too far when that war interferes with effective treatment. Nobody should ever have his treatment sacrificed or reduced because someone else is an addict.

(I realize this is off-topic).

Tom W

I happen to feel that steady dosing is more effective.

Some medications are less efective for some people so, it is hard to cut hard fast lines.

More recently an anitdepressants are often prescribed to treat anxiety. With a recomendation for talk therapy.

 

[Jeff Corey]

double post

 

[Jeff Corey]

"I don't think you understand modern radical behaviorism."
Understatement.
Gaynor, S.T. (2004). Skepticism of caricatures: B.F. Skinner turns 100. Skeptical Inquirer, 28 (1), 26-29.

 

[twerges]

Hello Dancing David.

I shall try to be polite. I find your attitude somewhat disturbing and there appear to be some deficits in your 'arguments'.

Yikes, that was testy. You didn't succeed in being polite. I'm not sure I'm the one with an attitude problem here, since I have not engaged in name-calling. I'm not meaning to be combative here, I'm just saying.

Stating that something is obvious is not usually considered a critique

The purpose of science and of almost every field of investigation, is to produce non-trivial and non-obvious inferences or deductions. For that reason, any claim of obviousness is usually considered a critique, not only in the sciences but also in mathematics and other fields. For example, when mathematicians occasionally say to each other "that's trivial," they don't mean it as a compliment.

and when you consider that many less obvious ideas have defrauded people of money for little benefit, is seems to be a specious argument as well.

Whether or not other people have been defrauded, is a red herring and is not relevant to the original claim.

"With regard to my claims that all psychotherapies are equally effective and that training doesn't matter.... While I was a student, those facts were widely acknowledged as true within the field, and were accepted..."

that is an appeal to populism and an appeal to authority.

I may have been unclear in my remark. I wasn't saying that the claim is true because it's uttered by an authority. I was only saying that the claim was widespread among experts at the time and frequently cited in literature. I thought you might want to google for it.

I was not implying that the claim must be true because experts believe it or believed it.

Stating that there were hundreds of irrelevant and outdated studies is a further appeal to authority and somewhat of bombast.

The studies I cited were about therapeutic equivalence, which was the topic being discussed. As a result, they were not "irrelevant"; they were precisely relevant.

Even if they are outdated, how is that an appeal to authority?

Also, even if they are outdated, how is that a bombast? Do you mean it's bombastic because I'm invoking hundreds of studies, which is overdoing it? I don't get your meaning here.

God and the effectiveness of prayer are also commonly held beliefs.

I was not claiming that commonly held beliefs must be true.

You do know how meta-analysis works don't you?

Yes.

It is never definitive but only indicative of further areas to research.

I don't think any of the studies or papers regarding psychotherapy effectiveness are definitive.

"I used the term 'neurosis' deliberately... It's useful when discussing primal therapy because Janov claims that many different psych disorders...are not essentially different. As a result, it's convenient to use a more general term here."

Unsubstantiated assertion. Any evidence or data that is so?

You want "evidence or data" to show that a more general term is convenient in that circumstance? What kind of data are you thinking of?

I do not think you understand modern radical behaviorism.

I may not. The doctrine may have changed a lot.

I gained my knowledge of radical behaviorism by reading BF Skinner and some of his critics. I understood what Skinner was claiming because he was not obscure or difficult to understand, to his credit.

(your first link from psychiatryonline, which I apparently cannot include)

I read the paper you linked. It calls into question whether any psychotherapy (including CBT) is effective at all. It concludes as follows: "for how long should psychotherapy constitute a large part of treatments...without proof of efficacy in these days of evidence-based medicine?"

I don't see how that study disputes the dodo bird conjecture, or how it's relevant to primal therapy specifically. I don't understand why you linked to it, especially since it disputes your claim that CBT is effective. Could you clarify what you intended by citing it? I'm not saying it's unimportant; I just don't see what you're getting at.

(your second link, this one from sciencedirect)

I read the abstract. The paper appears to claim that CBT is effective for GAD. However, the paper is not a meta-analysis of comparative effectiveness studies which shows a differential effect, so I don't see how it's relevant to the dodo bird conjecture. Could you clarify the relevance?

What mechanism makes (primal therapy) plausible? Seriously, I have worked a lot in mental health. I don't find the theory plausible.

If you don't mind, I'll explain my reasons for thinking it's plausible in a subsequent post. I won't explain them here because this post is overlong already, and anyway I'm spent for the moment.

 

[sleepy_lioness]

"Obvious" and "non-obvious" are surely subjective concepts though? To take it to an extreme, to me it's obvious that brussels sprouts are one of the best foods known to man, while to my friend it's obvious that they're the devil's excrement.

One of the effects of many mental illnesses is that you begin to think in quite odd or unusual ways. Depression makes you truly, sincerely believe that life is awful, you're the worst person in the world, nothing will ever get better, and everybody hates you. You believe this as strongly as you believe that the sun will rise tomorrow.

CBT challenges this sort of belief and the thinking style that goes with it. When I'm depressed, it's *obvious* that nobody cares about me. I obsess about the times when people have been nasty or uncaring, and completely forget or discount all the times people have been nice to me. It's *obvious* that nobody wants to know me, as I discount the fact that all my friends have been calling me but I've chosen not to answer the phone. CBT taught me to stop discounting all the nice things and to start answering the phone when my friends call to see if I want to hang out. "Obvious" to anyone who wasn't depressed, but certainly not obvious to me without help.

There is a list, often used in CBT, of around 30 negative thoughts common to people with depression. These include things like "I'm a failure", "Nothing ever goes right for me" etc. Immediate responses to it typically range from astonishment ("I thought it was only me!") to mild paranoia ("You've been reading my mind!") to relief ("Thank God, it's just typical depression"). I think that this approach - gently showing people that what they consider to be their "true" situation is simply a function of the illness they are suffering - is far more appropriate and helpful than going on long wild goose chases for the purported origin of their negative beliefs about themselves.

I should say that I'm probably biased as I had three years of existentialist/humanist psychotherapy at great expense, and it didn't help me - if anything it made me worse. CBT, on the other hand, has been immensely valuable to me.

 

[Dancing David]

What I find distressing Twerges is my own personal bias against philosophical styles of argumentation.

I shall try to not engage if I can not control my own feelings. As it is a result of my reaction to what seems to me to be an a priori bias and assumption in your debate.

Take the obvious: It was so obvious that everyone ignored it, for years, decades in fact parishioners of therapy used made up stories and fables to justify their therapies. they ignored the obvious, that thoughts and emotions influence each other and as behaviors they influence behaviors as well.

Twerges
I read the paper you linked. It calls into question whether any psychotherapy (including CBT) is effective at all. It concludes as follows: "for how long should psychotherapy constitute a large part of treatments...without proof of efficacy in these days of evidence-based medicine?"

From the first link:
http://ajp.psychiatryonline.org/cgi/content/full/164/1/7

The authors report that both treatments are superior to placebo and equal to each other. The presence of a placebo group establishes that not only are the treatments equal, but effective (superior to placebo).

Which I admit is poor form on my part as I am citing a paper quoting a paper.

Then the second link:
http://www.sciencedirect.com/scienc...serid=10&md5=306a911c411ead358ae663670fe67b21

Results showed a large overall effect size (ES) that was moderated by age and modality of treatment. Specifically, the largest gains were found for younger adults and for individual treatment. Analyses also revealed overall maintenance of gains at 6- and 12-month follow-up.

Which is more of the usual type I try to cite.

So both of those, one a quote of a quote, would possibly indicate that there is an effect for CBT.



So take a trauma survivor who undergoes Freudian therapy (which we both disagree with), they are retraumatized, the old connections are made stronger and new associations are created. And so it goes for most forms of therapy until the advent of CBT, so obvious it may be, but the questions is one of effect.

Now to your general argument:

Which seems to run around this statement:

Twerges
I don't see how that study disputes the dodo bird conjecture

Outdated papers from a time period of poor definitions of symptoms, poor measurement of outcomes and vague terminology is indicative of what?

Please show recent large scale studies that demonstrate this effect?

In the seventies they were not even using inter rater reliability in many studies, they ere not running control to assure inter rater reliability. Often data was driven by qualitative reports without any attempt to provide an observable metric that might have inter rater validity.

So a meta study based upon a review of 300+ studies during this era has what validity?

What evidence is there that the studies did not use qualitative measures of outcome? Where the reporter just said "I think the patient/client' got better". That is a serious draw back to an older study, which you have not addressed.

So I ask you again, what recent large scale studies have shown that the 'dodo bird conjecture' is valid? It may have been a given at the time you went to school, but it may not be valid.

Twerges
I used the term "neurosis" deliberately. I'm aware that term is infrequently used now in Psychology. However, it's useful when discussing primal therapy because Janov claims that many different psych disorders (depression, GAD, BPD, etc) all have the same causes and are not essentially different. As a result, it's convenient to use a more general term here.

That is when I asked for further evidence that is great that Janow said that they have a similar basis and that a more general label might be applied.

to which I asked:

Unsubstantiated assertion. Ant evidence or data that is so?

Twerges You want "evidence or data" to show that a more general term is convenient in that circumstance? What kind of data are you thinking of?

So Janow stated that there was not a difference between diagnosis like BPD (by which I assume you may have meant BPD (borderline personality disorder) or BPD (bipolar disorder) and GAD (generalized anxiety disorder (with and without panic attacks).

To which I am saying, then it would be incumbent upon the person labeling those two disorders as 'neurosis' (which I don't see as appropriate to borderline PD) to demonstrate why they have a common basis for derivation of symptoms.

So the data would show that there is a common basis for the disorders and that there was a reason to lump them together.

I will stop here rather than continue into why outdated research (especially in psychology) may not be valid, I will merely repeat what I stated before:
-lack of stringent definitions
-lack of observable metrics
-lack of controls and protocols to control experimental bias

 

[Jeff Corey]

"Stimulus-response? Operant conditioning?"
No, twerges. Post 184 demonstrates you know bupkis about operant conditioning.

 

[Iconoclast08]

"Stimulus-response? Operant conditioning?"
No, twerges. Post 184 demonstrates you know bupkis about operant conditioning.

JREF prizes should be awarded to those who craftily deploy the word bupkis in any thread.