On Hype in the Field of Psychotherapy

The field of psychotherapy is filled with exaggerated and unsubstantiated claims.

And so, I would also like my work here in this website to pay homage to the late Scott Lilienfeld, who was such a significant figure in the field of psychotherapy and particularly in highlighting the prevalence of pseudoscience. 

I felt privileged to have collaborated with Scott on our Hype article ‘How to spot hype in the field of psychotherapy: A 19-item checklist’ in 2018. To support you in your pursuit of expertise, I have provided the actual checklist of all 19 points (plus 2 additional items I added after publication) for your ready reference at the end of this article.  The complete article has also been provided for you here: Hype article. 

I would at this juncture however, also like to include a few key thoughts on this below.

It is my hope that, if you take some time to consider the information I have included here and that is contained within my Legacy Courses, that the next time you receive an advertisement of training course of any kind in our field, perhaps one where you might get a certificate or the like, that you have an imaginary Scott Lilienfeld sitting next to you whispering into your ear saying:

“I think there's a bit of hype here.  You know, these look like some exaggerated claims."

"Did you see that they called their therapy a breakthrough?"

"Did you hear them call it revolutionary?"  

"Did you hear them say that one size fits all?"

"Did you see the way in which they only included anecdotal data to support their claims?"

"Did you see the way in which they indicated a particular guru had endorsed them?”

There's no data that indicates that people who get particular certificates actually get better treatment outcomes with others.  It’s difficult because I know you may well want to advertise a certificate on your website to attract folks to your practice. 

Here's the challenge:  It might be easy to spot hype.  You just need to go to various training websites or social media and look at the adverts you find.  And perhaps you can even spot hype in your own efforts, or in the efforts of your clinic.  But, here's the challenging part, what do you need to do to get beyond hype? 

That’s something I hope we will continue to cover rigorously here - both in my blog articles and in my Legacy Courses.

Thank you, as always, for your interest and attention.

21 Item Checklist for How to Spot Hype in the Field of Psychotherapy:

1. The promoters of a specific treatment approach might use such HYPE-related descriptors as ''cutting edge”, “game changing”, “amazing”, “liberating”, and “it will revolutionize your treatment practice”.
2. Advocates for a therapeutic approach state that their treatment is “transformative” and offer outlandish unsubstantiated claims for its superiority. E.g., “over 90% improvement rates”, “simple, but powerful” treatment approach, or “a breakthrough treatment”.
3. Make claims that you can learn from a “master”, “leading expert” or “guru” and use marketing terms like “powerful”, “transformative”, “unique and ultimate training," “life-changing benefits”, “deep psychological healing”, and moreover, assure that your “complete satisfaction is guaranteed”.
4. Advocates rely heavily on the use of acronyms (“acronym therapies”) and “psycho-babble” to sell their treatment approach.
5. Claim that the treatment approach could be applied successfully with patients who have a wide variety of psychiatric and physical conditions, and across multiple age groups, without any clinical trial demonstrations. Advocates often employ that their treatment approach “fits all” (“one size fits all”).
6. Claims that treatment approach is “evidence-based” and/or “scientifically proven”, because it has met the criteria of two (or a small number of) randomized controlled trials, but they do not report Effect Sizes, nor do not provide details about the exclusionary criteria of the patients (i.e., those trials are “cherry-picking” the patients). Also, such evidence does not report on the attrition and drop-out rates or follow-up data. Advocates often broadly and subjectively define “evidence” (e.g., anecdotes or “I saw it work with my patients, and that is my evidence”.)
7. Advocates state that “Over X number of studies have consistently demonstrated efficacy and superiority”, without citing or critiquing these studies.
8. Compare proposed treatment to “weak” comparison groups. Do not compare the treatment to “bona-fide” comparison groups that are intended to be effective.
9. Compare the proposed treatment versus a reduced, or weaker version of the comparative treatment. For example, see Foe et al. (1999) comparison of Prolonged Exposure versus Stress inoculation training (SIT), where the third application phase of SIT was omitted.
10. Do not report on possible “allegiance effects” of who conducted the controlled outcome studies. Moreover, the cited supportive studies that were initially conducted yielded more effective results than later conducted studies. (“Strike while the iron is hot”, and when the enthusiasm for the new therapeutic approach is highest.) For example, the efficacy of antidepressant medication has gone down as much as threefold in recent decades. Effect Sizes from studies from treatment studies drop off. The researchers’ confirmatory beliefs can act as a set of blinders.
11. Do not independently determine if the treatment rationale offered to the alternative treatment and control groups is judged as being as credible and believable as for the advocated treatment. This can lead to differences in expectancy effects across groups.
12. Do not highlight the role of non-specific treatment factors, such as therapeutic alliance, expectancy effects, and other placebo considerations. For example, does not include any measures of the ongoing quality of the therapeutic alliance, such as the Therapeutic Alliance Scales, or the Quality of Relationship Measures, or the session-by-session Treatment-informed Feedback.
13. Do not include a critical account of the scientific validity, or theoretical basis, for the effectiveness of the proposed treatment. Offers little scientific basis for the proposed change mechanisms for the treatment. See controversy over so-called “energy-based” treatments such as Tapping, Eye Movements, Magnetic fields, Meridian band techniques and the like. The intervention may work, but it has little to do with the proposed treatment model. The proposed treatment may do better than no treatment, or weak control and comparison groups because of non-specific factors, such as placebo effects.
14. Advocates use “neuro-babble” and “neuro-networks” and reductionism (often with colored versions of the brain) to explain the treatment approach. They resort to a dubious neurological basis for the explanation of their treatment approach. For example, patients who have experienced Attachment Disorders as children are told that the right side of their brain is “dead” and that they need treatment to revive it. There may be references made to their approach being “neuroscience-informed”. Every treatment approach is neuroscience informed - this is pure HYPE.
15. Advocates fail to discuss criticisms of their treatment approach. They fail to mention the results of dismantling studies that question the basis of their treatment approach.
16. Advocates tell their patients that “If this treatment does not help you, then nothing else will”. They convey an expectancy that reinforces treatment outcomes.
17. Advocates promote advanced training, sell paraphernalia, tapes that go along with their treatment approaches. They require that trainees sign statements that they will not share treatment protocols with others. “Commercialism is rampant”. They encourage participants to sign-up for more advanced follow-up training sessions.
18. Advocates are very defensive and “thin-skinned” about their approach. They often question the motives and background of those who have questioned the efficacy, theoretical basis of their treatment approach. They fail to question what they are proposing and readily dismiss sceptics. They may disregard “inconvenient truths” and offer “alternative facts”, thus, holding onto debunked theories.
19. The advocates of their treatment approach rely on the endorsements of leaders in the field. For example, some therapists in the trauma field cite Bessel van der Kolk as an advocate and endorser of their treatment approach.
20. Advocates establish a coterie of trainers and an international organization to promote the treatment. Advocates use public media (television, blogs, print) and they oversell their treatment approach. Advocates are “slick salespersons,” setting up clinics, training settings, and conferences.
21. The advocates will provide a Certificate that you have taken the training and can call yourself an “X therapist”. Offers to put you on a referral list of Certified X practitioners. There are no research findings that clinicians who receive Certificates for attending training obtain better patient treatment outcomes than clinicians who do not obtain such Certificates. Moreover, there are research findings that "one-shot" training workshops do NOT improve their clinical patient outcomes without engaging in Deliberate Practice with ongoing patient feedback.