Evidence From Clinical Psychology

(This article is incomplete as yet)

 

I will never forget my first clinical psychology class.  I still was holding on to primal theory, although I was critical of how it was in practice.  I was still weighing up as to whether to become a primal therapist in the future, only doing it in a more ethical way and reexamining the basic tenets and trying again to build a sound foundation of science.  Thank god for my college lecturers for saving me from that, I would have just been as bad as the primal therapists that came before me.  I was starting to realize that the primal-model is so severely flawed that even well intentioned primal therapists would do damage. But not only that it was becoming clear primal therapy was actually not a new science and was actually a sure way for a young scientist to get sidetracked into a “dead end”.

 

I remember how I wrote a short paper on how the theory of pain suppression (primal theory, although I didn’t call it that) would explain the fact that 90% of borderline personality disorder patients had some abuse in childhood.  I was amazed nobody seemed to link it up to “pain” or “Pain” in the college textbook (Barlow).  I was amazed at how strongly the lecturer disagreed with my paper, I was expecting praise.  Something was not right, and it took me a long time to work it all out.  He said my ideas were creative, but he said that a therapy dealing with painful reliving would be “ineffective or worse” due to a groove being created.  He said pain is not stored like fat cells, he told me about neurotransmitters like substance K (deep or chronic pain neurotransmitter). What he said explained a lot of things I had observed in primal therapy better than primal theory itself.  Later he photocopied the most recent research article for me about pain and pain neurotransmitters.  I read it, and started to try and figure out what was going on.  Why was I the only one in the class that thought I had the answers?  It was not until months later in my social psychology course, where I learned about falsifiability IN DETAIL, that I finally understood where I was going wrong.

 

The clinical psychology course was difficult for me.  Like my other courses in psychology, hardly a lecture went by that didn’t challenge a little part of my primal theory beliefs.  Although primal therapy was never mentioned directly, the material did address it’s assumptions. In almost every chapter there was some information that contradicted primal theory, usually in an indirect way.  I was in a state cognitive dissonance, where my beliefs didn’t match the new evidence, it was hard and often I would reject the new evidence.

 

 When I examined the treatment outcomes for the various disorders, I was shocked to find the results were much better than what I had observed in primal therapy.  I felt cheated, I had no idea that they were measuring the outcomes in a much fairer and scientific way and still getting really impressive results. For just one of many examples, one of the most common disorders social phobia now has relatively good treatments available:

      “Effective treatments have been developed for social phobia only in the past several years (Barlow &Lehman, 1996; Hofman, in press; S. Taylor, 1996; Turk, Heimberg, & Hope, 2001).  Rick Heimberg and colleagues developed a cognitive-behavioral group therapy in which groups of patients rehearse or role-play their socially phobic situations…[the therapy also involves other things]…a follow up after 5 years indicates that the therapeutic gains are maintained (Heimberg, Salzman, Holt, & Blendell, 1993).” Pages 150-160, Abnormal Psychology, 4th Ed. Barlow & Durand (2005) 

 

Then came my learning on labeling in clinical psychology. The lecturer did a SUPERB job of not only laying out the problems of labeling, like stigma, but also the benefits.  He explained that by using a fair labeling system it can help isolate the best treatments for each disorder.  Then came the shock, the labeling system did not involved the same randomness, reliance on genius, and gut feeling I had encountered in primal therapy.  It became apparent over time that people complaining about a therapy is not grounds for any psychiatric label.  They actually had criteria to meet in the DSM IV.  As mechanical as it sounded to me at first, I recognized the importance of these standards, not least of which it prevents abuse of patients. 

 

In college, I learned that a sociopath is not somebody who complains to many therapists, and goes from one therapist to another complaining, as I had heard in orientation in primal therapy.  A sociopath,  which along with psychopath, now loosely come under the umbrella called Antisocial Personality Disorder, is someone who meets severe and consistent criteria for abusive behavior towards others, usually physical violence, although often verbal too, and they usually were involved in conduct disorder in childhood, which tends to involve violence and cruelty to others and/or animals.  It is not someone who is a bit asocial or antisocial, as the name may suggest. I didn’t know that, I thought I knew all this stuff.  I didn’t know squat after all those years of reading Janov’s books and learning at the Primal Center.

 

The preceding paragraph only approximates the definition of sociopath, there is some disagreement, so I refer the reader to an article in Scientific American MIND, December 2007, January 2008 called “What ‘Psychopath’ Means.” This article offers a different take on the subject, and I agree with most of it, although I am unsure that ‘psychopath’ should be used in clinical psychology given the public’s understanding of the word.  Regardless, nowhere in clinical psychology does the term ‘psychopath’ or ’sociopath’ mean somebody who complains about his/her  psychotherapy, especially because primal therapy is sometimes an abusive process whereby you would expect  patients to jump from one therapist to another, complaining as they go.

 

Similarly with the word “psychotic”, in primal I found that it could be used freely.  For example, I even heard that a couple of former therapists were calling a senior therapist that, and it was not fair at all, no matter if I liked that person or not. In clinical psychology, first I learned that “psychotic” was a word not used so much, but was replaced with more definable labels like “schizophrenia”.  And I learned that schizophrenia had to involve a number of things, like hallucinations, had to persist for a certain amount of time, and in general a SEVERE dysfunction of brain and behavior. 

 

I also learned that many disorders seemed most common in poor families, (especially when you factor in the lack of reporting in poorer communities) which made me doubt whether money was not important in raising healthy kids, or maintaining mental health in adulthood.  In Janov’s books I had learned that a lack of touch and love were perhaps the sole or main causes of almost all problems, and that money was relatively unimportant.  In addition I learned in college that poor families often have closer physical contact with young children, and more often allow the child to sleep with the parents for a longer period.  Yet at the same time many correlations show a lack of finances correlating with a wide array of problems. Something was not adding up.

 

In the “facts and fictions in mental health” section in Scientific American MIND (p. 80-83), October / November 2007, Arkowitz and Lilienfeld dispel some of the myths about mental health treatments.  I bring it up here because of Janov’s attack and criticism of the talk therapies, which actually turn out to be shown to have more evidence for them than primal therapy. 

 

In the article, titled “The Best Medicine?” they discuss how medication compares to talk therapy.  They base their evaluation on the scientific data.  They give the pros and cons of antidepressants (SSRI’s and others) in a very balanced way. When it comes to psychotherapy they say:

 

“…Scientists have evaluated only a few types of psychotherapy, [Cognitive Behavioral Therapy] CBT has been the most extensively studied so far…Interpersonal psychotherapy (IPT) has the second greatest amount of supporting data” (p.81).

 

And:

 

“…two thirds of patients who undergo 12 to 16 sessions of CBT show improvement or remission” and that the cost often is less than or equals the cost of medication, and comes with none of the side effects of the medications.  They conclude that “we have learned that psychotherapy and drug therapy are both fairly effective.  We know that psychotherapy prevents relapse better than drug therapy does when treatment is discontinued, that there are few, if any, negative side effects of psychotherapy, and that psychotherapy is a safe and moderately effective treatment for depressed children and adolescents.  It can also change the biology associated with depression… . CBT and IPT (the two best empirically supported therapies for depression) and possibly other psychotherapies with some empirical support should be seriously considered for a depressed person seeking treatment.  If the response to psychotherapy is not adequate, other types of psychotherapy may be tried or a drug regimen may be added.  Although the combination of psychotherapy and drug therapy may be somewhat more effective than either alone, drug side effects can be problematic” (p.83). 

 

They also mention how pharmaceutical companies may create mistaken impressions with their advertisements.  I recommend the full article as I am leaving out lots of good details here. Primal therapy is not mentioned in the article and is not considered to be one of the empirically supported psychotherapies that they refer to in the article. 

 

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In the Scientific American MIND (October / November 2007) article “Brain Stains” (p. 46-53) professors of psychology Kelly Lambert and Scott O. Lilienfeld document one of the rare cases that a therapy using a repressed-memory model has been properly scutinized by outside independent researchers. 

 

The article discusses “recovered memory therapy” and although it is different from primal therapy, it has some similarities.  The criticisms of recovered memory therapy in the article sometimes also apply to primal therapy (for example the attack on the assumptions behind the therapies sometimes apply to both).  But also the article gives a rare opportunity to see behind the hype of recovered memory therapy (which in its own literature sounded like a cure all):

 

“According to a 1996 Crime Victims Compensation Program in Washington State, recovered-memory therapy may have unwanted negative effects on many patients.  In this survey of 183 claims of repressed memories of childhood abuse, 30 cases were randomly selected for further profiling….The following information was gleaned:

…

-100% remained in therapy three years after the first memory surfaced in therapy, more than half were in therapy five years later

-10% indicated that they had thoughts of suicide prior to therapy; this level increased to 67% following therapy.

- Hospitalizations increased from 7% prior to memory recovery to 37% following therapy.

- Self mutilations increased from 3% to 27%

-83% of the patients were employed prior to therapy; only 10% were employed three years into therapy.

-77% were married prior to therapy; 48% of those were seperated or divorced after three years of therapy.

-23% of patients who had children lost parental custody.

-100% were estranged from extended families.”  (p. 50)