Journal Article

Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness

Ritschel, Lorie A., Cautin, Robin L., Lilienfeld, Scott O., Lynn, Steven Jay, Latzman, Robert D.

2014

Overview

The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy—naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.

• Publisher: Sage Publications,SAGE Publications,SAGE PUBLICATIONS, INC
• Subject: Applied psychology / Appreciation / Biological and medical sciences / Causality / Change agents / Changes / Classification / Clients / Clinical medicine / Clinical psychology / Clinical skills / Cognition / Cognitive bias / Cognitive therapy / Confirmatory bias / Educational improvement / Errors / Evidence Based Practice / Medical personnel / Medical sciences / Mental health / Mental health professionals / Mental health services / Miscellaneous / Modeling (Psychology) / Observation / Placebo effect / Placebos / Psychiatry / Psychological research / Psychological symptoms / Psychologists / Psychology / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Psychotherapies. Psychological and clinical counseling / Psychotherapy / Realism / Safeguards / Treatment methods / Treatments