Taking Issue with Newsweek
For those of you who read Newsweek, you may have read a column by their science editor, Sharon Begley, which asks the question: “Why do psychologists reject science?” (“Ignoring the Evidence,” published Oct. 12). While I’m not certain what Ms. Begley was trying to achieve with her column, she did manage to spark a good bit of conversation among psychologists. As a scientist-practitioner who devoted 30 years of my professional life to clinical practice in both rural and suburban Mississippi before coming to APA as the Executive Director for Professional Practice, and the voice for thousands of my professional colleagues, I was really upset by some of the contentions and accusations Ms. Begley made in her column.
Let’s begin with a little context: Ms. Begley’s opinion piece is based on a journal article to be published in the November issue of “Psychological Science in the Public Interest,” a publication of the Association for Psychological Science, an organization not to be confused with the American Psychological Association, which is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists.
While the journal article does have some positive points and ideas to consider regarding how psychologists can improve the treatment of certain disorders, Ms. Begley’s reporting of the article does more to harm than it does to inform. She offers generally false assertions about the practice of clinical psychologists and presents a very one-sided view of the issue.
But most alarming is the column’s potential to discourage the 57 million Americans with mental health disorders from seeking needed treatment or to encourage those in treatment to drop out of treatment.
In her column, Ms. Begley does admit that cognitive and cognitive-behavior therapy are effective interventions for many disorders and “bring more durable benefits with lower relapse rates than drugs.” But she fails to acknowledge that research has also shown us that other treatment techniques also work.
Instead, she seems to endorse the positions that “relatively few psychologists learn or practice” effective treatments and that clinical psychologists are “deeply ambivalent about the role of science” and “lack solid science training” (as stated by the authors of the study and journal article.) The basis for these statements—and her apparent support of them—is certainly unclear and not backed with good evidence.
Practicing psychologists are health professionals with the highest level of training in human behavior. The education and training they receive to earn their doctorate is rigorous and demanding and most often involves a research based dissertation to complete their degree. The American Psychological Association has a code of ethics for its members that dictates psychologists must base their clinical judgments on scientific and professional knowledge. Licensed psychologists practice within their areas of expertise as required by state regulations and our ethical principles.
APA’s policy on evidence-based psychological practice mirrors the Institute of Medicine’s definition of evidence-based practice as “the integration of best research evidence with clinical expertise and patient values.”
To say that most practicing psychologists reject science and research when treating patients, as Ms. Begley contends, is simply wrong.
As psychologists, we do embrace our science and research base, but we also understand the importance of the therapeutic relationship to healing and growth. We care about helping our patients improve the overall quality of their lives, and we are not narrowly focused on eliminating one particular symptom (even though getting rid of a symptom is part of improving quality of life.) We combine our understanding of the research with how to best understand the patients who come into our offices with their complicated problems. We work collaboratively to achieve the goals that are important to them.
We have to realize the limitations of science in regard to the generalization of research results to the individual patient. Studies do not always take into account or offer a good match for the complexity of the patient’s problems or the diversity of factors in a patient such as cultural background, lifestyles choices, values, or treatment preferences.
Using our best expertise and clinical judgment, psychologists must be able to critically consider what our science tells us. And then we determine how to best include that knowledge to help our patients achieve the best results. The psychologists’ code of ethics demands that we base our clinical judgments on scientific and professional knowledge, that we practice within our areas of competency, and that we do no harm.
It’s unfortunate that Ms. Begley’s column did not strive to do the same. And for someone who espouses the value of science, Ms. Begley’s column was very short on evidence for her assertions.
Filed under: Being in Therapy, Uncategorized
Doctors and Psychologists Don’t Hate Science—They Treat Real Patients:
A Reply to Sharon Begley and Newsweek
Ivan J. Miller ©2009
Sharon Begley is wrong when she compares the medical profession to “hysterical conservatives” who “seem to hate science,” as she did in her Newsweek column on May 4, 2009 in “Why Doctors Hate Science.” She is wrong when she claims that “psychologists reject science” as she did in her column on October 2, 2009 in “Ignoring the Evidence.” While she finds a few legitimate examples of problems, she is pushing a narrow interpretation of science that is not in the best interest of patients. When it comes to good science, good treatment, and good use of scientific evidence, medical doctors and psychologists are a lot closer to the mark than Begley and the critics she embraces.
In “Doctors Hate Science,” Begley decides that science shows that hypertension patients should be treated with inexpensive diuretics rather than medications that have fewer side effects because both lower blood pressure. Not if you ask the patient who knows that the diuretic causes frequent urination. Who would want to pee more than a dozen times a day, wake twice at night to go to the bathroom, fear getting stuck in a traffic jam without access to a toilet, avoid long meetings, get fatigued during exercise, and lose sexual function? There are good reasons that doctors prescribe more expensive anti-hypertensive medications that have fewer side effects than diuretics.
More—the entire article is available at:
http://www.ivanjmiller.com/treatrealpatients_article.html
Excellent
Thank you
I had sent an editorial type article to the APA Monitor, mentioning that perhaps it should go to you instead, and to the executive office of the Practice Affairs section, but without even acknowledgement of receipt of either email. Should I send it to you directly?
Best
Gerry Young
Editor, Psychological Injury and Law
Dr Nordal
Thanks so much for this thoughtful response to the Newsweek article. You did such a nice job articulating the tightrope we psychologists walk between science and human to human interaction and relationship. It is in that walk that I believe we truly offer unique and valuable services to our clients and patients.
Dr. Nordal -
My wife and I are very much enjoying the conversation that has been sparked by the Newsweek article. We have seen interesting comments from many different perspectives across a variety of forums, some populated mostly by professionals and others by individuals outside of the field.
Today on Psychotherapy Brown Bag, we published a response to your blog post. Although our opinions differ strongly from those you express here and our comments directly contradict quotes form this text, we hope you will see it as a civil response intended to continue the conversation on an extremely important topic.
Best of luck to you.
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/10/apa-responds-to-newsweekand-we-respond-to-apa.html
It is not true that psychotherapists do not trust science. Psychotherapists distrust pseudo-science. Sterile research, created in an artificial setting to simulate psychotherapy is distrusted because clinicians generally recognize that too many of the variables that contribute to successful outcome cannot be uniformly replicated in a mechanistic fashion.
The entire evidence-based practice movement, whether within medicine or psychology does not seem yet to incorporate much of what we know about the interpersonal dynamics of healing. In psychotherapy, we have known for decades that most of the well-studied treatment approaches, from behavioral to cognitive to psychodynamic produce roughly equivalent outcomes in the aggregate. (See Lambert, for example).Clearly, there is something going on besides treatment protocols, or else these results would diverge. Good practice in psychotherapy is not confined to the treatment protocol; it seems to always involve the relationship between patient and therapist.
I agree wholeheartedly with Dr. Permut.
In addition, whether seeing an individual, a couple, or a family, many therapists now come at the problem from an ecological-systemic perspective. Even when I am using a behavioral or cognitive-behavioral intervention, I am always using it in terms of the much broader context of the client’s biochemistry, marriage, family life, career issues, and the quality of connections within the community. Context is everything, after all.
It is frustrating to see how few therapists seem to realize that marital and/or family therapy is actually more effective than individual therapy for many so-called “Axis I” disorders; yet it is not often the treatment of choice, either because so many insurance carriers do not cover it, or perhaps because the therapist him/herself is not comfortable in those more complex settings.
Regardless, the question of what constitutes effective psychotherapy is so much more complex and interesting than what sometimes pops up in controlled laboratory research, as Dr. Permut explained so well. Ms. Begley might want to explore her own personal context in order to get a deeper understanding of why she writes such seemingly slanted, critical “ambush/attack essays” that avoid the more fascinating aspects of our shared human existence.
I read with interest the article by Dr. Nordal, and all of the excellent comments that followed. I do not know Sharon Begley, but I would caution a bet, that she may have some ulterior motives in writing such a biased and scathing article about the field of Psychology. I find myself wondering if she may have some connection with either the health insurance companies or factions of the government that seek to foil health care reform in this country. As Ivan Miller has alluded, the cheapest medicine, is not always the best for an individual patient, with individual needs, values and biochemical make-ups. Because of our stringent training and code of ethics, as well as our proven record of conducting and understanding research and statistics, we Psychologists are among the least likely of health care practitioners to err on the side of personal preferences vs. what is best for our patients. Another factor that leads to our credibility with the public is that we are among the least likely health care practitioners to be manipulated by drug companies (at least some of which, are notorious for their biased research practices). Another strength that we tend to possess is our collective willingness to question our own techniques and even our motives in prescribing a particular form of treatment. I am not trying to say that we are perfect. We clearly make mistakes, like everyone else. However, as a group we tend to hold ourselves to extremely high standards. It is my educated and humble opinion that we as a group, need to remain proud of our ability to be able to cope effectively with just the sort of ambiguity that exists in clinical practice. It is to our enormous credit that many of us have been able to avoid selling out to those forces in our culture that would seek to minimize our ability to use our skills in the service of our patients above all others.
SJParks, Ph.D. Carrboro, North Carolina
I would ask that APA through whatever means get the word out that Dr. Nordal stated so well in this post. It is time we stood up for true science rather than pseudo science as Dr. Permut stated so well. Healing the human mind and spirit is so much more complicated than much of the scientific research that I have read. While it is useful to guide our treatment decisions there is a small problem with naively generalizing the results from studies to the general population of people whom we see in clinical practice. In neuropsychology this would be called a problem with ecological validity. It has taken me twenty some years of practice to appreciate that it takes understanding of studies in psychology, education, sociology, neurology, physics and yes even religion to construct a model of human behavior that both makes sense and allows for me to be able to understand what types of interventions are most helpful to the array of problems presented to me by my clients.
I do believe that Ms. Begley is right to alert consumers that they need to ask questions of their provider to be sure there is some scientific base to the work they do but way off base in her contention that we ignore science. As a local retailer said….” Our best consumer is an educated consumer.” However, I also agree with others that if she had applied the same scientific principals that she espouses that we (psychologists) ignore, it is likely she would have written a very different article.
Lastly, I would strongly encourage and support APA to send Dr. Nordal’s response to every news and media outlet to get the word out. Heck maybe she could challenge Ms. Begley to a public debate on the subject.
I will tell you that she has inspired me to work harder on some projects in our state, Maryland, to get the word out about the kinds of experiences, training, and yes integration of science into the practice of psychotherapy that psychologists bring to the healthcare table. I would urge every practicing psychologist to get involved with efforts to educate the public and our legislators about our training and skills. I believe that it is high time we moved out of the academic world that psychology has often lived in for so long, realize we are running a business that is actually good for people when ethically practiced, and let people know what and how we help people heal.
Hello Dr. Nordal-
Thank you so much your immediate and appropriate response to Ms. Begley’s artricle. Colleagues and I were discussing this piece this weekend and concurred with your point of view.
It is very frustrating and limiting to think that much of the public will read her piece and only gain her perspective, which is unfortunate and potentially dangerous.
I am hopeful that the public will have access to your piece and others responses who share in depicting a more accurate and respectful view of psychologists – and can appreciate how we do practice and use researched validated interventions effectively coupled with our intense training and knowledge of behavior to help and heal.
Again, thank you for adding your insightful and supportive comments to such a weak and biased article.
With much appreciation and hope to move the field of psychology in a positive direction!
@ Steevie Parks
You open your comment saying that you do not know Sharon Begley but you would wager she seeks to foil health care reform. This line of thinking is exactly what she is talking about. You said it yourself, you do not know her. So leave it there. Instead you postulate that she wants to see the health insurance companies win. In reality she wrote several articles promoting the public option and denouncing the lies made against it.
As for your claim that psychologists are the least manipulated by the drug companies, I wonder why? Could it be that psychologists can only prescribe drugs in two states (NM and LA) after completing a masters program in psychopharmacology?
Researching treatments is not done enough and not taken seriously enough either. An example would be Eye Movement Desensitization and Reprocessing (EMDR). Practitioners must pay to become certified in this specific technique and it has been shown that the eye movement part of the treatment is completely superfluous yet it is still incorporated.
Saying all that, I do realize that diagnosing and treating complex psychological disorders is not easy. A greater embrace of science would be a good thing though, there is no reason to have a backlash against it.
I disagree with Dr. Nordal. I have seen way to many professionals who are using junk science methods to “treat” clients. Everything from EFT & TFT to various other “energy” treatments. The example of EMDR touches on this somewhat. You can take out the E, M, R and it works. Using clients as test subjects because of a belief and anecdotal evidence is wrong.
A science based model is nothing to fight against. And while Dr. Nordal takes issue with the article being short on evidence I do not see any evidence in her statement to back up her assertions. There is plenty of evidence to back up the claims made in the Begley article.
For me a big part of the problem is also that enforcement of the ethical codes mentioned is in many cases almost non-existant.
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