email page print pageAll Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain
As psychotherapy turns the corner on its first century, it's being asked to ante up in the serious game of science. After ten decades of extraordinary (and often contradictory) claims and complicated theorizing, the profession is being challenged to show its cards. And from what we've seen so far, according to this book, psychotherapists may have only been holding a pair of deuces. Some fear that we may have been bluffing all along.
Among those demanding hard, empircal evidence of effectiveness is a small but growing cadre of mental health professionals, including the author of this book. Eisner is a practicing attorney (Los Angeles) as well as a licensed psychologist.
After a brief introductory chapter on the shortcomings of behavioral research and why the scientific method is usually ignored, Eisner plows right on into a variety of psychotherapeutic theories and approaches. The Freudian school is first to be taken to task. Eisner provides a thumbnail overview of the theory and then deconstructs three of Freud's most famous cases, those of Dora, the Rat-Man, and the Wolf-Man. Although admittedly superficial, Eisner's critiques are direct and effective, and suggest just how silly a theorist can get when he or she feels relatively safe as a pioneer in a new field. However, the most telling blow that Eisner gives to the psychoanalytic world is the exposure of an almost unbelievable absence of empirically based research. Although Freud considered himself a scientist, his method was anything but scientific, Eisner claims. Because his studies were single-case and naturalistic (so to speak), they were neither replicable nor disprovable, two of the cornerstones of the scientific method. Further, according to Eisner, no psychoanalytic research since Freud has provided evidence of value or validation. He claims that psychoanalysis "may be one of the greatest scientific hoaxes of the twentieth century" (p. 40).
Next in line, because (as he states) they are direct descendants of Freudian psychoanalysis, Eisner considers the "cathartic therapies," which include primal scream therapy, est, and bioenergetics. These, of course, make easy targets both because of their problematic theoretical underpinnings and because of an absolute lack of credible evidence for their effectiveness.
Another group of treatment modalities that lacks validation are those that Eisner terms recovered memory therapies. These approaches are also considered spin-offs of Freudian theory, because they emphasize repression, the unconscious, and forgotten traumas. The therapist's uncovering methods include hypnosis, dream interpretation, and occasionally the use of hypnotic medications such as sodium amytal.
The humanistic movement, beginning in the 1950s, fares only little better in the author's estimation. On one hand, unlike most other forms of psychotherapy, Eisner reports, at least this style has made gestures toward research. But unfortunately, the research has not generally supported Carl Rogers' belief in the therapeutic effectiveness of the basic qualities of empathy, unconditional positive regard, and genuineness. In addition, there are perhaps insurmountable difficulties in even operationalizing these concepts to make them amenable to empirical research. And finally, the classic meta-analysis of Smith and Glass found, according to Eisner, no measurable difference in outcome between Rogers' person-centered therapy and placebo treatment.
In the category of behavioral and cognitive therapies Eisner includes systematic desensitization, implosion therapy and Eye Movement Desensitization Reprocessing (EMDR), as well as the more widely known cognitive behavioral therapies of Ellis and Beck. Eisner considers each approach separately, however. He notes that at least one study has found systematic desensitization to be more effective in treating social phobia (public speaking) than both psychodynamic psychotherapy and a placebo control group, although generalizations of benefits to other client groups has not yet been shown. His brief overview of EMDR references three studies, which Eisner explains are only illustrative of methodological points. (The actual points being illustrated were unclear to me.) However, he concludes that it is "abundantly clear [that] EMDR does not require eye movements in order to be effective" (p. 126). As for Ellis' Rational Emotive Therapy (now known as Rational Emotive Behavior Therapy), Beck's Cognitive Behavior Therapy (CBT), and Interpersonal Psychotherapy (IPT), Eisner concludes that treatment effectiveness has not been demonstrated. He reports on a study that compared IPT and CBT with a medication group and a placebo control group. All four groups showed client-reported improvements - - unfortunately, Eisner notes, "There appears to be little, if any, clinical significance [in outcome] between the active treatment and the so-called placebo group" (p. 138).
Somewhat curiously, paired together in one chapter are reviews of the Strategic Therapy of Jay Haley and the Neurolinguistic Programming (NLP) approach started by Bandler and Grinder. About the former Eisner writes, "the most obvious shortcoming . . . is that no scientific confirmation exists" (p. 152). To the latter Eisner gives similarly short shrift: "Virtually no clinical support has been presented for the effectiveness of NLP" (p.158).
While most psychotherapists would find them strange bedfellows indeed, Eisner includes in this book past-lives therapy, de-possession techniques, appeals to angels and spirit guides, "Buddha Psychotherapy," Thought Field Therapy, Palm Therapy, and (no kidding) Alien Abduction Therapy. It is probably unnecessary to note that these approaches have not been seriously subjected to scientific inquiry.
In his concluding chapter, Eisner restates his central thesis: "[P]sychotherapy in its present form will not survive as a viable and reliable form of assistance to people with emotional problems. . . . The most fundamental symptom [of its pending death] is the total lack of adequate scientific evidence that it is effective" (p. 205).
The strength of this book is its clear and direct assessment of the credibility of the various approaches to psychotherapy. The reader - - especially if he or she has strong theoretical affiliations - - may not agree with Eisner's assessments, but would agree at least that Eisner is a devil's advocate for thinking about how one's own approach could be justified. The reader-therapist must ask him or herself, What's the rationale for my belief X, and my use of interventions Y and Z? What's the empirical support for my theory about psychotherapy?
The major hurdle over which the reader has to jump is Eisner's relative lack of distinction between mainstream approaches and far-end-of-the-galaxy theories involving space aliens and angels. Just because various theories share the characteristic of having little (or no) empirical support, the scientist should not necessarily conclude that they are equally suspect. Even the best scientists, working in areas of "hard" science, when faced with lack of empirical data, are forced to choose for their studies the most likely from among a group of similarly unproven hypotheses. The techniques used in this selection are experience, logic, and reasoning, tempered by intuition (yes, I know) and attempts to moderate personal biases.
A second and simpler reason for skepticism about the claim that psychotherapy is dead (or at least mortally wounded) is that there is no sign that its vital energy (i.e., economic foundation) is in any way waning. Graduate schools continue to produce large numbers of new therapists, and even this number isn't enough to satisfy demand. For example, California has recently passed into law a bill requiring a study of the shortage of mental health professionals with an eye to increasing the number available for public hire. One of the nations largest HMO's, Kaiser-Permanente, has standing advertisements for positions in social work and psychology.
In any case, while its conclusion that psychotherapy is dead may be premature, this book is important as a wake-up call to the profession - - Do the research! It wasn't so long ago that the medical sciences were in the same unhappy circumstance that psychotherapy is in today. The knowledge and technologies needed to design and carry out empirical studies were extremely limited. Snake oil salespersons competed with quacks and spiritualists for the consumer's dollars. Medicine didn't give up, and psychotherapy shouldn't either.Keith Harris, PhD, is a clinical psychologist and supervisor of Victor Valley Behavioral Health Center in San Bernardino county, California. Hisinterests include clinical supervision, the empirical basis forpsychotherapy research (and its design), human decision-making processes,and the shaping of human nature by evolutionary forces.