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Pseudoscience in Therapy: A Skeptical Field Guide
When experiencing mental health challenges, we all deserve treatments that actually work. Whether you are a healthcare consumer, student, or mental health professional, this book will help you recognize implausible, ineffective, and even harmful therapy practices while also considering recent controversies. Research-supported interventions are identified in this book and expanded upon in a companion volume. Chapters cover every major mental disorder and are written by experts in their respective fields. Pseudoscience in Therapy is of interest to students taking courses in psychotherapy, counseling, clinical psychology, and behavior therapy, as well as practitioners looking for a guide to proven therapeutic techniques.
- GenresPsychology
374 pages, Hardcover
Published March 23, 2023
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November 8, 2023This book is meant for specialists in the field (i.e. therapists), so I’m not qualified to evaluate it. But here are a few miscellaneous takeaways:
- There’s a difference between “efficacy” and “effectiveness”:
The distinction helps explain why I’ve heard differing claims about whether psychotherapy has been proven to work: there’s strong evidence for its efficacy[2] but “[w]hen reviewing the effectiveness—or real-world—outcome measures for psychotherapy, the picture becomes murkier”[3].
- When discussing what’s actually proven to work for various mental health problems, two recommendations show up again and again and again: meds and/or cognitive-behavioral therapy (CBT). Not for all the conditions discussed, but for a lot of them.
- In some cases there are known good treatments that may be widely underutilized, like exposure therapy for anxiety.[4]
- Apparently the concept of PTSD is controversial[5], which was news to me. This doesn’t primarily mean skepticism about people’s symptoms or need for treatment (though the chapter does express concern over how PTSD diagnoses are used in court given that “PTSD symptoms are well-publicized, subjective, and easily feigned”[6]), but rather the usefulness of organizing/explaining them via a diagnosis of PTSD.
- “Approximately 1 in 10 people meet diagnostic criteria for insomnia disorder”[7]
- Weed has long-term effects on sleep:
- Various differences in sexual desire between men and women that I’d like to read more about:
- For people with neurocognitive disorders (such as Alzheimer’s), it’s really important that their caregiver be educated on how to deal with the condition. There are also a lot of issues with many medications often prescribed for these conditions, and the chapter warns that what are actually bad side effects of a medication are sometimes misidentified as being symptoms of the disease, in which case “providers may conclude that more of the drug is needed, rather than removing the offending culprit.”[10]
- Wtf is wrong with humanity:
- One of the authors of the “Couples Discord” chapter wrote a book called Great Myths of Intimate Relationships which sounds interesting; one of the myths, summarized in the chapter, is that “Opposites Attract”:
- Evidence backing the popular Gottman Therapy is very poor[13].
[1] Cara L. Santa Maria, “Thinking Critically about Therapy,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 3.
[2] Ibid.
[3] Ibid., 4.
[4] Dean McKay, “Anxiety,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 46.
[5] Gerald M. Rosen, Henry Otgaar, and Harald Merckelbach, “Trauma,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 69.
[6] Ibid., 78.
[7] Colleen E. Carney, Parky H. Lau, and Samlau Kutana, “Insomnia,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 142–43.
[8] Ibid., 149.
[9] Caroline F. Pukall, “Sexual Issues,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 168.
[10] Claudia Drossel and Jacqueline Pachis, “Significant Cognitive Decline,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 216.
[11] Devon L. L. Polaschek, “Antisocial Behavior,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 237, emphasis added.
[12] Erin F. Alexander and Matthew D. Johnson, “Couples Discord,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 330, emphasis added.
[13] Ibid., 332–34.
(crosspost)
- There’s a difference between “efficacy” and “effectiveness”:
Efficacy refers to the outcomes of clinical research under ideal conditions, with little attention paid to applicability. Effectiveness research, on the other hand, involves real-world settings and is considered by many to be a more useful standard than efficacy alone…[1]
The distinction helps explain why I’ve heard differing claims about whether psychotherapy has been proven to work: there’s strong evidence for its efficacy[2] but “[w]hen reviewing the effectiveness—or real-world—outcome measures for psychotherapy, the picture becomes murkier”[3].
- When discussing what’s actually proven to work for various mental health problems, two recommendations show up again and again and again: meds and/or cognitive-behavioral therapy (CBT). Not for all the conditions discussed, but for a lot of them.
- In some cases there are known good treatments that may be widely underutilized, like exposure therapy for anxiety.[4]
- Apparently the concept of PTSD is controversial[5], which was news to me. This doesn’t primarily mean skepticism about people’s symptoms or need for treatment (though the chapter does express concern over how PTSD diagnoses are used in court given that “PTSD symptoms are well-publicized, subjective, and easily feigned”[6]), but rather the usefulness of organizing/explaining them via a diagnosis of PTSD.
- “Approximately 1 in 10 people meet diagnostic criteria for insomnia disorder”[7]
- Weed has long-term effects on sleep:
Marijuana has sleep-interfering properties both in the short-term via rapid eye movement sleep (REM) suppression … and subsequent REM rebound (increased depth and intensity of REM sleep following deprivation), as well as the long-term, via slow wave sleep suppression…. The long-term negative effects of marijuana are slow to reverse, so marijuana cessation is unlikely to improve these side effects for several weeks to months…[8]
- Various differences in sexual desire between men and women that I’d like to read more about:
…most women do not include sexual fantasies in their experience of desire despite the fact that they report having sexual fantasies (Brotto et al., 2009). In addition, women typically display a pattern of “responsive desire” (i.e., sexual desire that emerges from or is triggered by an arousing sexual situation) within periods of “sexual neutrality,” as opposed to experiencing “spontaneous desire” (e.g., sexual desire that is present without much stimulation, usually in the form of thoughts or fantasies; Basson, 2000). Furthermore, 70% of women who were largely sexually satisfied reported that they wished to engage in sexual activity less than once per week (Cain et al., 2003).[9]
- For people with neurocognitive disorders (such as Alzheimer’s), it’s really important that their caregiver be educated on how to deal with the condition. There are also a lot of issues with many medications often prescribed for these conditions, and the chapter warns that what are actually bad side effects of a medication are sometimes misidentified as being symptoms of the disease, in which case “providers may conclude that more of the drug is needed, rather than removing the offending culprit.”[10]
- Wtf is wrong with humanity:
One early intervention using LSD appears to have caused significant harm…, although the specific contribution played by LSD has not been isolated from other treatment elements. During the 1960s, and informed by investigations into the effects of brainwashing during the Korean war, the Oak Ridge Social Therapy unit at Penetanguishene Hospital in Canada opened a highly experimental residential program that featured a patient-led community approach. It was based on the premise that people could be psychically torn down and rebuilt to improve their psychological health…. Patients were committed involuntarily after a conviction or court finding of not guilty by reason of insanity, resided continuously with other patients, and received very little input from staff. Instead, they were confined together, naked, in a sealed room, fed through wall-mounted tubes and invited to administer doses of various drugs including LSD and methedrine to one another….[11]
- One of the authors of the “Couples Discord” chapter wrote a book called Great Myths of Intimate Relationships which sounds interesting; one of the myths, summarized in the chapter, is that “Opposites Attract”:
They do not. Partner differences are far less frequent and intense than partner similarities. Couples perceive differences because they develop over time as the couple becomes more complementary. That is, couples condition one another into opposite, complementing roles (e.g., the quiet partner and the loud one; the logical partner and the emotional one) through their interactions with one another. … However, these differences develop over time as opposed to at the moment of initial attraction, and the notion that opposites attract has been consistently refuted by scientists…[12]
- Evidence backing the popular Gottman Therapy is very poor[13].
[1] Cara L. Santa Maria, “Thinking Critically about Therapy,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 3.
[2] Ibid.
[3] Ibid., 4.
[4] Dean McKay, “Anxiety,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 46.
[5] Gerald M. Rosen, Henry Otgaar, and Harald Merckelbach, “Trauma,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 69.
[6] Ibid., 78.
[7] Colleen E. Carney, Parky H. Lau, and Samlau Kutana, “Insomnia,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 142–43.
[8] Ibid., 149.
[9] Caroline F. Pukall, “Sexual Issues,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 168.
[10] Claudia Drossel and Jacqueline Pachis, “Significant Cognitive Decline,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 216.
[11] Devon L. L. Polaschek, “Antisocial Behavior,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 237, emphasis added.
[12] Erin F. Alexander and Matthew D. Johnson, “Couples Discord,” in Pseudoscience in Therapy: A Skeptical Field Guide (Cambridge, United Kingdom ; New York, NY: Cambridge University Press, 2023), 330, emphasis added.
[13] Ibid., 332–34.
(crosspost)
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January 15, 2024I don’t feel super qualified to review this book in terms of the accuracy of its content.
I think it’s most useful as a way of thinking critically about the state of psychotherapy as a whole rather than as a guidebook to The Most Effective Treatments Ever. We don’t have nearly enough information to say what the most effective treatment for any given person will be, only which treatments seem most likely to help, given the limited information we have right now, and which are unlikely to help or likely to harm.
I found it readable and learned a lot about current ongoing debates between researchers, some of which even show up as contradictions between chapters. (The author(s) of the PDs chapter believes adult ADHD is over-diagnosed and over-medicated, while the author(s) of the ADHD chapter seem to disagree.)
I think it’s most useful as a way of thinking critically about the state of psychotherapy as a whole rather than as a guidebook to The Most Effective Treatments Ever. We don’t have nearly enough information to say what the most effective treatment for any given person will be, only which treatments seem most likely to help, given the limited information we have right now, and which are unlikely to help or likely to harm.
I found it readable and learned a lot about current ongoing debates between researchers, some of which even show up as contradictions between chapters. (The author(s) of the PDs chapter believes adult ADHD is over-diagnosed and over-medicated, while the author(s) of the ADHD chapter seem to disagree.)
March 18, 2025
Not my typical read. The book was laid out in individual chapters that broke down different psychological illnesses. In each of the chapters. We talked about options that were science versus treatment that were based on evidence based trials. I thought it was really interesting to look at different psychological conditions ranging from ADHD, autism and schizophrenia, and see what has actually been proven in clinical trials versus things that have just been heavily marketed, but actually have no research based findings
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