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Jean Mercer: Challenging the claim that “any treatment is better than no treatment at all”

May 23, 2010

In Jean Mercer’s latest posting on her PT blog (Dr Mercer’s blog has recently been featured in PT’s Essential Reads section) she challenges an unidentified therapist who has claimed that any treatment is better than no treatment. I have my suspicions on who that might be, but I will leave it at that because I’d much rather discuss the myth itself and what is wrong with it rather than name anyone because this is a myth that many therapists believe that has been shown to be wrong. Since it looks like she has once again had to close her blog to comments due to harassing, abusive multiple postings by sock puppets that she commonly gets, I’ll pick up the discussion here, if anyone with an interest in discussing this topic would like to comment.

Dr. Mercer is correct to challenge this myth that “any treatment is better than no treatment at all”.  The topic of this blog is potentially harmful treatments (PHTs) and the possibility of direct harm is one reason why this statement is not necessarily always true.

Another problem is that even if a therapy is not directly harmful but merely ineffective, there can be what Scott Lilienfeld has identified as opportunity costs. For example, if someone is getting a therapy that is doing no good and has no evidence that it will do any good, the person is spending valuable time and money on a therapy that will not ultimately help, so the draining of financial resources and valuable time is one way of indirect harm.

Another way a therapy can be indirectly harmful is if a therapy that doesn’t help makes unsupported claims that it is better than other treatments that do have good evidence of being effective. Making false claims about a therapy’s superiority to another therapy when it is not, could mislead the person and prevent that person from getting an effective therapy that could be helpful. Some conditions such as depression can for some people result in deterioration if not properly treated, so having a treatment that simply does nothing could be very harmful and result in the problem running a course of deterioration, when this did not have to happen, had the person gotten an effective treatment. There was actually a lawsuit over this. The psychiatrist of a depressed patient recommended he do psychoanalysis and he did not get better. Then, he went to another doctor and medication was recommended and he got better very quickly. He sued and won. This is not to say that medication is always a quick fix for depression, but it is an option that severely depressed people need to be made aware of.

Another example is Thought Field Therapy. Of course, tapping, in and of itself, does no harm, but what if someone, for example has obsessive-compulsive disorder, has been tapping for it for months on end, getting temporary placebo relief, but the problem keeps coming back? I have seen cases where such people were referred to very expensive voice technology treatments where literally for years, they were calling in regularly and checking virtually everything they ate to see if it was a toxin. Yet the OCD remained. I didn’t have clients like this, even when I was practicing VT because I did not allow people to continue paying me if they weren’t being helped. There were many times when I never cashed checks that people gave me because I did not feel it was right to accept payment if a treatment did not help. However, there are VT therapists who are more than happy to keep such people coming back. This is very harmful because there is a treatment called Exposure and Response Prevention for OCD that has very strong research support and has helped many people with OCD. Being misled into thinking tapping therapies will cure people, prevents them from getting real help.

And of course, as Dr. Mercer points out, when children are involved, the problem is compounded because while adults can be provided with informed consent, children have no real choice in the matter and must abide by the decisions made by their parents, even if the decisions are poor ones.

Does this mean that I would always recommend doing nothing? Of course not. Not as a generalization. However, there are cases where doing nothing might, at least for a period of time, be the best option. Sometimes medical doctors will advise a period of “watchful waiting” if there is no immediate danger and the treatment has risks that would outweigh doing nothing. The same is true for psychotherapy. For example, we have learned that a particular type of trauma debriefing called Critical Incident Stress Debriefing immediately after a trauma may do more harm than good and make PTSD more, rather than less likely than nothing at all. Thus, it may be better to wait and see if symptoms develop, rather than try to “prevent” them with a treatment that has been shown not to actually prevent PTSD. It turns out that the majority of people who experience a trauma do not develop PTSD and will recover on their own without any treatment.

I invite comments on this topic, but be forewarned that I will not post comments that do not address the topic at hand and attack people personally.

  1. Thank you, Monica.

    For the words about obsessive compulsive disorder and the treatment which might be effective.

    (Facing fears already there versus creating/excaberating new fears like at boot camp).

    And Mercer’s words on post-traumatic stress disorder: before, after and during.

    Your tapping example and Mercer’s “recovered memory’ are good examples of non-physical treatments where harm could be done.

    • Yes, it surprised me as well to read this, but statistically it is true. Rates of acceptance to medical school are higher than acceptance into a PhD program in clinical psychology. Medical school for psychiatry has a 48% average acceptance rate and PhD programs in clinical psychology have an average of only a 17% acceptance rate for practice oriented PhD clin psych programs and 11% for research oriented PhD clin psych programs and in the top programs, it is much lower than that. For instance, one year at Drexel, about 100 applicants were competing for only one spot to work with a particular professor. See p. 11 and 15 of this presentation, which cites the same stats as were given in the book I read:

      Click to access ApplyingtoGraduateSchoolinClinicalPsychology.pdf

      One caveat, though, is that medical school applicants do have a prerequisite of undergraduate science courses to fulfill that most psychology programs do not, although UCLA’s psychology program and some of the other top programs also require such courses. Provided the student has the prerequisites or is willing to go back and fulfill them, that person has a much better shot at medical school than a PhD clinical psych program. That doesn’t apply, of course, to PsyD programs or PhD programs in freestanding schools who accept a higher percentage of applicants, provided they can afford the tuition, since they tend not to provide the kinds of scholarships that universities do.

      • (Thank you for the information and the link about PhD and PsyD programmes. I actually wrote that comment on Monica Pignotti: the truth when you were talking about being objective).

  2. And another thing.

    A little treatment goes often a long way!

    What I mean to say: It does not have to be intense.

    (at least not in frequency or duration).

    It has to make an impression.

  3. And of course it depends on what the treatment is trying to accomplish. Psychotherapy does not “cure” psychoses such as schizophrenia, and is not a substitute for medication, but it may help stabilize a schizophrenic patient who would otherwise not be able to live independently.

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