Dr. David Tolin: Setting a Positive Example for the Profession of Evidence-Based Practice in Action
Usually the topics I discuss in this blog involve potentially harmful or pseudoscientific practices, but this posting is an exception and just the opposite. I have some good news, for a change. Dr David Tolin is an expert in treating Obsessive Compulsive Disorder (OCD) and in the reality show, The OCD Project, people can watch evidence-based practice in action. Dr. Tolin uses Exposure and Response Prevention (ERP) on the six participants on the show.
In spite of this, Dr. Tolin has his critics, as there are those who are ignorant about the strong evidence base the therapy he practices have, and have made some very harsh comments, calling him cruel for doing the kinds of heavy duty exposures that are necessary to successfully treat OCD. The latest episode featured a scene where one of his colleagues was doing an exposure session on Arine, a client with a fear of contamination where she was instructed to dunk scones in a toilet and then eat them. This toilet dunking may look like a kooky, crazy therapy but it really is not. There is a sound, evidence-based reason for having clients to this far with their exposures because the research shows that the mild exposures just don’t cut it. This is what it takes for people to get over OCD. So yes, I am defending dunking scones in toilets as an effective exposure-based therapy for people with OCD who have a fear of contamination!
It is instructive to observe the differences between the way Dr. Tolin deals with criticism and the way proponents of questionable therapies deal with criticism. Dr. Tolin responds to criticism by presenting actual evidence that ERP is highly effective. He never personally attacks his critics. He doesn’t have to because he can refute them with evidence. In contrast, proponents of questionable therapies do not refute their critics with evidence. Instead, they engage in ad hominem attacks, arguments from authority, straw man arguments, sue their critics and engage in all out libelous smear campaigns.
Legitimate mental health professionals with evidence-based practices have no need to do that. Dr. Tolin calmly presents his evidence and is very civil to critics, attempting to educate them but acknowledging they have the right to disagree with him. No need to sue and write nasty letters to deans or any of the rest of the nasty things certain other people have done to their critics. Proponents of questionable therapies promote them before the evidence is in. Tolin waited until after the research was done, to disseminate ERP and he serves his clients well.