Emotional Intelligence: A Consumer's Guide to Psychological Treatment
FDA FOR PSYCHOLOGICAL TREATMENTS?
Before a drug can be marketed, it must undergo extensive testing and finally receive
approval from the Food and Drug Administration (FDA),which ascertains that
it is safe, beneficial. and effective. And from time to time, we hear that substances
such as saccharin, which we had hitherto thought to be safe, may be dangerous
and quite possibly should be taken off the market. Should there not be such an FDA
for psychological treatment?
There are estimated to be some 130 different
"brands" of psychological treatment available (PariaH), and the number
grows annually. All of these are beneficial; some may be harmful to some people
or have negative side effects. Should there not be systematic evaluation of
these treatments before they are made available to the public?
Gerald Klerman, the former chief of the Alcohol, Drug Abuse, and Mental
Health Administration (ADAMHA) argues that such systematic evaluation must take
place if only because the consumer movement end the pending Notional Health
Insurance require it. Klerman points to the need to circumscribe legitimate mental
health activity.
He says:
We can attack the problem of defining boundaries in part by returning to the
practical problem that many therapeutic methods ore well-intended, but poorly established in terms of safety, efficacy and economy. One cannot demonstrate mark, however, is that they are precise and replicable, and they stay quite close to the client's initial complaints.
These kinds of assessments are the benchmark of the action therapies;
they have been very useful in demonstrating the effectiveness of these kinds
of treatments. Indeed, they are largely responsible for the growing popularity
of the action therapies, among both clients and therapists. But they are
not entirely without hazards. Some behaviors are elusive and difficult to
measure with precision and reliability. Problems of meaning are among
these. Some complaints, moreover, are very complex and intertwined. The
presence of multiple phobias, for example, which extend over a range of environments
and stimuli, makes assessment complex and difficult, In the
main, however, behavioral change, where it can be assessed, is the "kingpin"
of measures of therapeutic effectiveness.
THE VARIETY OF TREATMENT
It has recently been estimated that clients can choose from among 130 different
"brands" of therapy (Parloff, 1976). Each year the number of therapies
grows. And, of course, each "therapy" has its loyal adherents who
confidently proclaim its efficacy for a host of problems. Behavior modification,
Rolfing, insight therapy, rebirthing, cognitive therapy, lithium, flooding,
these and dozens more are possible choices. Unfortunately, it is extremely
difficult to make informed choices. While claims for success are
broad, the evidence is slim. Only a few controlled tests have been conducted
to assess the effectiveness of particular therapies, and even fewer tests have
been done to compare the relative efficacy of various treatments. Equally
important, little is known about the possible harmful effects a therapy might
have. There is no protection for the consumer of therapy analogous to the
protection afforded the consumer of drugs . The Federal Drug
the efficacy of a therapy in terms of the intentions of its proponents.... Neither
can a therapy be considered routine and acceptable on the basis of the testimony
of authorities that is, because outstanding members of the profession
are of the opinion that it is useful, safe and effective. I believe that only evidence
as to outcomes will suffice in the rigorous climate of consumerism and health insurance coverage.
(A.P.A. Monitor, 1979, p. 9)
The argument for evaluating therapies before they are available in the marketplace
is perfectly straightforward, but deceptively simple. Nicholas Cummings,
former president of the American Psychological Association and a longtime student
of psychotherapy, points out that a proper evaluation of the available therapies
might take as long as twenty years (Marshall, 1980). What are we to do in
the meantime? Simply let people suffer?
A more fundamental issue, however, arises from the nature of psychological treatment itself. Does psychological treatment come in the same kinds of measurable doses as, say, saccharin or red dye #2?
Clearly not, for we have already
seen that the non specific effects of psychotherapy are quite different from the very
specific effects of saccharin. For saccharin's effects will occur irrespective of the
circumstances under which it is taken, while psychotherapy's effects depend on
the circumstances-the individuals under treatment, their hopes and expectations,
the characteristics of the therapist, and other hard-to-measure variables.
Administration imposes stringent testing procedures on all new drugs before
they can be marketed: they must be effective; they must be relatively harmless;
side effects must be clearly stated. No governmental agency acts as
watchdog in the case of psychotherapy. Claims can be made with no concern
for evidence. Psychoanalysis, it will be recalled, was practiced for more
than a half century before its claim that it was an effective treatment was
scrutinized.
Nonetheless, choices have to be made...
Before a drug can be marketed, it must undergo extensive testing and finally receive
approval from the Food and Drug Administration (FDA),which ascertains that
it is safe, beneficial. and effective. And from time to time, we hear that substances
such as saccharin, which we had hitherto thought to be safe, may be dangerous
and quite possibly should be taken off the market. Should there not be such an FDA
for psychological treatment?
There are estimated to be some 130 different
"brands" of psychological treatment available (PariaH), and the number
grows annually. All of these are beneficial; some may be harmful to some people
or have negative side effects. Should there not be systematic evaluation of
these treatments before they are made available to the public?
Gerald Klerman, the former chief of the Alcohol, Drug Abuse, and Mental
Health Administration (ADAMHA) argues that such systematic evaluation must take
place if only because the consumer movement end the pending Notional Health
Insurance require it. Klerman points to the need to circumscribe legitimate mental
health activity.
He says:
We can attack the problem of defining boundaries in part by returning to the
practical problem that many therapeutic methods ore well-intended, but poorly established in terms of safety, efficacy and economy. One cannot demonstrate mark, however, is that they are precise and replicable, and they stay quite close to the client's initial complaints.
These kinds of assessments are the benchmark of the action therapies;
they have been very useful in demonstrating the effectiveness of these kinds
of treatments. Indeed, they are largely responsible for the growing popularity
of the action therapies, among both clients and therapists. But they are
not entirely without hazards. Some behaviors are elusive and difficult to
measure with precision and reliability. Problems of meaning are among
these. Some complaints, moreover, are very complex and intertwined. The
presence of multiple phobias, for example, which extend over a range of environments
and stimuli, makes assessment complex and difficult, In the
main, however, behavioral change, where it can be assessed, is the "kingpin"
of measures of therapeutic effectiveness.
THE VARIETY OF TREATMENT
It has recently been estimated that clients can choose from among 130 different
"brands" of therapy (Parloff, 1976). Each year the number of therapies
grows. And, of course, each "therapy" has its loyal adherents who
confidently proclaim its efficacy for a host of problems. Behavior modification,
Rolfing, insight therapy, rebirthing, cognitive therapy, lithium, flooding,
these and dozens more are possible choices. Unfortunately, it is extremely
difficult to make informed choices. While claims for success are
broad, the evidence is slim. Only a few controlled tests have been conducted
to assess the effectiveness of particular therapies, and even fewer tests have
been done to compare the relative efficacy of various treatments. Equally
important, little is known about the possible harmful effects a therapy might
have. There is no protection for the consumer of therapy analogous to the
protection afforded the consumer of drugs . The Federal Drug
the efficacy of a therapy in terms of the intentions of its proponents.... Neither
can a therapy be considered routine and acceptable on the basis of the testimony
of authorities that is, because outstanding members of the profession
are of the opinion that it is useful, safe and effective. I believe that only evidence
as to outcomes will suffice in the rigorous climate of consumerism and health insurance coverage.
(A.P.A. Monitor, 1979, p. 9)
The argument for evaluating therapies before they are available in the marketplace
is perfectly straightforward, but deceptively simple. Nicholas Cummings,
former president of the American Psychological Association and a longtime student
of psychotherapy, points out that a proper evaluation of the available therapies
might take as long as twenty years (Marshall, 1980). What are we to do in
the meantime? Simply let people suffer?
A more fundamental issue, however, arises from the nature of psychological treatment itself. Does psychological treatment come in the same kinds of measurable doses as, say, saccharin or red dye #2?
Clearly not, for we have already
seen that the non specific effects of psychotherapy are quite different from the very
specific effects of saccharin. For saccharin's effects will occur irrespective of the
circumstances under which it is taken, while psychotherapy's effects depend on
the circumstances-the individuals under treatment, their hopes and expectations,
the characteristics of the therapist, and other hard-to-measure variables.
Administration imposes stringent testing procedures on all new drugs before
they can be marketed: they must be effective; they must be relatively harmless;
side effects must be clearly stated. No governmental agency acts as
watchdog in the case of psychotherapy. Claims can be made with no concern
for evidence. Psychoanalysis, it will be recalled, was practiced for more
than a half century before its claim that it was an effective treatment was
scrutinized.
Nonetheless, choices have to be made...