The Therapy Guru

In a previous posting, I discussed why my colleagues and I would like to see the end of the reign of therapy gurus in the mental health professions. The title of this posting The Therapy Guru is a generic one — there is obviously more than one therapy guru. Let there be no misinterpretation (as some have already tried although no reasonable person would misinterpret my statements in the way they have been by certain anonymous WordPress bloggers). The revolution currently taking place in the mental health profession is a nonviolent one that is fought only with science, critical thinking, sound evidence and our Constitutional rights to free speech which includes the freedom to criticize and expose therapy gurus. Those are our only “weapons”. The 47 colleagues who signed my statement of support and others are all working to make this happen in various different ways. Some are prominent scholars, researchers and clinicians, some are just a few years into their careers and other are still graduate students. What they all have in common is that they want to see that mental health consumers get the best possible treatment available and they have the courage to stand up to therapy gurus or their followers who attempt to silence those who challenge them.

To clarify what I mean when I use the term, therapy guru, I mean anyone in the mental health profession who is promoting a practice that lacks scientific support, has acquired a following of believers and dismisses and/or attacks anyone who challenges his or her claims. Obviously there are many therapy gurus in existence today. Therapy gurus are not a new phenomenon. Far from it. They date back at least as far as Franz Mesmer, who lived in the 18th Century and promoted a treatment based on pseudoscientific theories of animal magnetism. Then there was Sigmund Freud, who also fit into that category, given the volumes of material he wrote that have little scientific support, coupled by the fallings out he had with disciples who deviated from his ideas (note that I am not saying here that anyone who has a falling out with someone is a therapy guru — it depends on the reasons and context). There was also Milton Erickson, still revered by many today. Here is an example of one of his proposed treatments of a disobedient child which appears to be a precursor to some of the holding therapies and restraint practices used today on children. There were many therapy gurus who were very popular in the 1970s and 80s, including Arthur Janov, author of the 1970 bestseller, The Primal Scream and founder of Primal Therapy who still has an institute in operation today. It was also in the 1980s that Roger Callahan began his development of what is now known as Thought Field Therapy.

In the 1990s, there were many therapy gurus who were making claims about recovering repressed memories from childhood, claims that fly in the face of everything we now know about how memory works. This so-called “recovered memory therapy” was devastating, not only to the clients who suffered years of highly emotionally painful therapy that made them worse, but also broke up families when parents were falsely accused of sexual abuse, based only on memories recovered in therapy. One of the survivors of such therapy, Jeanette Bartha, has a blog about her experiences with the therapy guru she ultimately sued and is the author of a forthcoming book. She stated in one of her comments what is a typical reaction to therapy gurus:

I asked the nurse that was going to testify for me during my suit against the psychiatrist why they didn’t stop him. She said that many staff persons thought he was a nut case. If they didn’t follow his orders, they would have been insubordinate. She then told me that the bottom line was that they really didn’t know if he was correct – he was the expert. And, as I’ve said many times on this blog, he was a forerunner in diagnosing and treating MPD. So his opinions weighed heavy.

Some of the scholars whose research challenged the recovered memory people, such as Elizabeth Loftus have been dragged through years and years of baseless lawsuits and smear campaigns from true believers who considered her the enemy, not unlike some of the followers of certain therapists consider me the enemy. Carol Tavris was also sued in this same lawsuit, but the case against her was more quickly dismissed. In an Amicus for her case, Taus v Loftus, psychologist Richard J. McNally stated:

The notion that traumatic events can be repressed and later recovered is the most pernicious bit of folklore ever to infect psychology and psychiatry. It has provided the theoretical basis for “recovered memory therapy” — the worst catastrophe to befall the mental health field since the lobotomy era.

and

Needless to say, repression advocates have vigorously attempted to frighten clinical scientists from discovering the truth about cases regarding alleged repressed and recovered memories of trauma. Legal action against Loftus et al. appears to be little more than an attempt to squelch inquiry into matters of profound social significance.

These are strong statements, but they are no exaggeration and I certainly can relate to that, given my own experience with the legal system although thankfully the case against me brought by Ronald Federici was quickly dismissed. In contrast, Elizabeth Loftus was dragged through years of legal proceedings that she did not deserve.

All of this shows the length that followers of therapy gurus or the gurus themselves will go to, in order to silence anyone who challenges them.

One way to tell if someone is a therapy guru is the manner in which that individual deals with difficult, critical questions that are posed. Sure, they will answer the easy questions that are not a threat to their favored theories and claims, but try asking difficult questions that challenge. What typically follows is either an argument from authority (essentially saying trust me, I’m an expert) or personal (ad hominem) attacks against those who asked the questions, unfounded accusations, smear campaigns which are made very easy to carry out in anonymity via the internet, legal threats and sometimes even following through with those threats.

Therapy gurus also engage in propaganda tactics to promote their particular brand of therapy. One of the main tactics is what Eileen Gambrill has discussed as a certain type of problem framing. Problems are claimed to be highly prevalent when no such evidence of prevalence exists, beyond anecdotes and problems are framed as mental illnesses that are claimed to be under treated and will not go away or will get worse without treatment.

Of course, not all therapy gurus are that extreme. For example, Roger Callahan has not sued his critics. The only time he sued anyone was when one of his former students, a psychologist who he accused of violating a trade secret agreement and Callahan lost that case.  He has since reconciled with the psychologist in question, who never seriously disagreed with him in the first place. That being said, even thought Callahan has not viciously gone after people who challenge him, he is not tolerant of having them around. For example, when I announced the results of my controlled study which was eventually published, that showed Voice Technology was not what he had claimed and attempted to have a discussion about it on his list serv, I was banished from his list serv and asked to resign from the Association for TFT, which I gladly did. Even though he has not gone after me, this is still a form of silencing critics that is not healthy, if a therapy intervention is to develop in a research program that provides good evidence that it does what is claimed, rather than market expensive treatments in the absence of such evidence.

Another less extreme example of a conflict with a therapy guru is the experience I had with Steve Hassan on a now-defunct list serv called Freedom of Mind that discussed his work. When I challenged him on a statement he made in a 2009 CNN appearance regarding the death of Jett Travolta, rather than being open to discussion, he brought in one of his supporters who then proceeded to attack me and is still, a year and a half later, attacking me on the internet. Steve Hassan, unfortunately, took my disagreement with him very personally, making it evident that in my experience, he was not open to serious questions and challenges to his work. This is what I would consider another hallmark indicator of a therapy guru. Steve Hassan also makes unsupported claims of the superiority of his post-cult therapy to that of other therapists and charges fees that in my opinion are quite excessive, given his Masters-level credentials.

I am fully aware that some people who would otherwise agree with me on my other choices, might disagree with me about Steve Hassan and that is certainly their right. However, for years, I tried to give him every benefit of the doubt. Since I have changed my position on Thought Field Therapy and informed myself on the process Evidence Based Practice and the process of scientific inquiry, I have found him to be most unsupportive as well as voicing outright objections to my position, urging me to remain silent about Thought Field Therapy (not because he was in favor of it, but because he feared I would suffer negative repercussions and should keep a low profile — although his intentions were obviously to help me, this especially surprised me, since I had previously thought he valued such public stances and it would seem to me that speaking out against Scientology would pose a much greater risk and he never objected to that). He also remarked that he “liked” me better before I made this change to a more evidence-based stance.

Whether extreme or not, therapy gurus are not good for mental health practice and its consumers. So yes, I would like to see the days of the reign of the therapy guru (and there are still many of them out there) come to an end and am working, through nonviolent means, such as critical publications and internet activism, to make that happen and replace that with evidence-based practice and mental health professionals who develop their therapies in such a way that they are open to challenges and contrary evidence and thoughtfully answer critical questions, regardless of who is asking them. Of course, nobody can be forced to respond to such questions nor do I ever attempt to use force, but if a mental health professional decides not to respond to certain critical questions, that too, is information that is of value to mental health consumers. As the late psychologist Margaret Singer pointed out, the way in which a prospective therapist responds to questions (or not) that are asked is an indicator that can be used to assess that therapist.

There are many wonderful caring therapists offering services today who do give thoughtful responses to even the most difficult challenging questions, respect their clients’ values and use the interventions that have the best evidence for their effectiveness. If no such interventions exist for a particular client, then such a therapist is honest with the client about the existing evidence or lack thereof and does not make unsupported claims that the therapy has been shown to be effective. Such therapists typically stay away from infomercial-like promotions that use client testimonials, recognizing that testimonials are not valid evidence for effectiveness of their therapy. Instead, such therapists assess each client who comes to them, using reliable and valid assessment tools to measure their progress and if they are not making progress or are getting worse, they change what they are doing rather than using the rationalization that one must get worse before one gets better.

Just in case anyone wants to accuse me of going after anyone in mental health who has managed to establish a reputation as a leader or innovator, no, that is not the case. Here are just a few of a number people who I do not consider “therapy gurus” who are (or were, as some are deceased) leaders and innovators in the mental health professions (these are just a few examples — this is not intended to be an exhaustive list, so if I left anyone out, don’t make assumptions):

Mary Richmond (perhaps the earliest advocate of empirically supported social work practice even though she never held a faculty position), Jane Addams, Margaret Singer, BF Skinner (although I do have philosophical disagreements with some of his writings, he was indisputably scientific in his work and did not make unsupported claims), Paul Meehl, Robyn Dawes, Aaron Beck (founder of CBT), Albert Ellis (although he did have fallings out with various people, he was honest, never misrepresented anything and made a significant contribution with REBT), Edna Foa (a clinician who has probably done more research than any other clinician in existence today), Richard J. McNally (another prolific clinical psychologist and researcher), Scott Lilienfeld, David Tolin, Steven Hayes (founder of Acceptance and Commitment Therapy — this is not the same “Steven Hayes” as the serial killer, the Scientologist or the South African sociologist — those are three very different people although he has had to take a lot of kidding about the former), Bruce Thyer, Eileen Gambrill and others too numerous to mention. Many of the people who signed my statement of support fall into that category. As you can see, I am not just naming people with whom I agree. These are people who I consider to have well-earned, well deserved reputations.

I hope this clarifies what I mean by therapy gurus and what I have done and intend to continue doing to counteract them. Obviously, the contents of this posting, as all postings I make, as I previously noted, constitute my opinion and I make no claims of being infallible. In response to the anonymous WordPress bloggers who have accused me of being a judge, jury and executioner, I use the word, judge, as a verb, not as a noun and I consider myself neither a jury nor an executioner. Anyone who is unhappy with my placement of those I have into the category of therapy guru, is free to disagree with me and I will also note that change is always possible. Those who are promoting therapies that lack evidence and making unsupported claims can cease doing so and instead of promoting expensive interventions, invest in research and submit that research to peer review and publication in reputable journals. Such “gurus” are also free to stop smear campaigns against critics and arguments from authority and instead, thoughtfully respond to and consider their criticism. Regardless of who the criticism came from, it’s the content and validity of the criticism itself  that matters. These are simple suggestions, not demands.