Selling Bad Therapy to Trauma Victims

by Jonathan Shedler Ph.D.

Some very interesting remarks about psychotherapy RCTs (many relevant to CFS trials). But I worry some people would agree with this, say evaluation is impossible (main argument of psychoanalysts in France for eg.) and take the opportunity to sell even worst treatments...

This is a tricky question, really.

https://www.psychologytoday.com/blo...ded/201711/selling-bad-therapy-trauma-victims

 

This is in fact just nonsense. He does not even identify the crucial difference between controlled trials and blinded controlled trials. He says that most science does not use randomised controlled trials but it does. CERN looking for the Higgs particle had to use a randomised controlled method, or at least an unselected controlled method. He is talking rubbish. His argument about flossing works because dentists say so is the worst of all arguments. It would be perfectly possible to do a randomised controlled trial of flossing - probably best to do a dose response study with people flossing either every day or once a week or twice a week.

Even Simon Wessely and Peter White can do better then this chap!!

 

I was a bit uncomfortable with some of his arguments, and you're completely right about his critics of RCTs in general. In fact it's not RCTs per se, but the way they are taylored for CBT to give results (lenght of treaments etc...), but in general, critics of CBT in psychiatry come from even worst theorists...

I"m really wondering what good psychiatry looks like (I guess a good psychiatrist is empathetic and listens to his patients, especially about medication side effects, but that's not enough...)

 

I'm guessing a good psychiatrist firmly stands with the patient, is well aware of the diagnostic uncertainty present in this area, and is pragmatic when it comes to treatment. So basically the opposite of White, Sharpe, etc.

 

Good psychiatry is awesome and I have had the privilege to come across it. It is humble, pragmatic and knowledgeable and does not give up when things do not work out but carries on until a human solution has been found. It has pretty much nothing to do with psychotherapy of any sort.

 

I read the article, and was pretty taken aback by the clear agenda shining through - which is that we just "know" therapy works, we don't care what RCTs show. RCTs fail to demonstrate its "true" effectiveness, because they don't provide enough sessions or the therapists they engage are just not good enough at it.

Its bit like saying that studies have failed to provide evidence of the existence of psychic abilities only because you can't test it under controlled conditions. Its still "real".

An awfully biased account written by someone with a huge personal and professional investment in psychotherapy who's not going to be dissuaded by a few negative RCT's.

Spend enough time/money on us, he argues, and eventually, you will benefit. Trust me, I'm a psychologist.

 

I don't have the energy to pick apart the multiple pieces of nonsense in that article so i'll just say its a perfect example of why the facepalm emoji is so necessary

 

We don't really know if they were bad at their job though, do we? The only thing we know for sure is the the writer thinks the dose of therapy give was insufficient.

He mentions that 75% of patients feel better after 40 sessions. But that must take about a year. Surely, by then, a lot of people will be feeling better anyway - especially if they were being treated for a recent trauma.

 

It basically seems to come down to science is failing our ideology so disregard it
Funny that it never comes down to science is not backing us up, why is that, lets find out why and improve our processes.