Download Science and Pseudoscience in Clinical Psychology, 2nd Edition Pdf free

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This valued resource helps practitioners and students evaluate the merits of popular yet controversial practices in clinical psychology and allied fields, and base treatment decisions on the best available research. Leading authorities review widely used therapies for a range of child, adolescent, and adult disorders, differentiating between those that can stand up to the rigors of science and those that cannot. Questionable assessment and diagnostic techniques and self-help models are also examined. The volume provides essential skills for thinking critically as a practitioner, evaluating the validity of scientific claims, and steering clear of treatments that are ineffective or even harmful.

Download Science and Pseudoscience in Clinical Psychology, 2nd Edition Pdf free

Download Science and Pseudoscience in Clinical Psychology, 2nd Edition Pdf free

New to This Edition
*Reflects the significant growth of evidence-based practices in the last decade.
*Updated throughout with the latest treatment research.
*Chapter on attachment therapy.
*Chapter on controversial interventions for child and adolescent antisocial behavior.
*Addresses changes in DSM-5.

The Scientist–Practitioner Gap Revisiting “A View from the Bridge” a Decade Later I was sitting in a courtroom, watching the title of this book—Science and Pseudoscience in Clinical Psychology—in action. A pediatric psychologist, a woman with a PhD in clinical psychology from a prestigious university, was testifying about the reasons for her sure and certain diagnosis that the accused woman was a “Munchausen by proxy” mother, and that the woman’s teenage son was not in fact ill with an immune disorder but rather was “in collusion” with his disturbed mother to produce his symptoms. Let’s call this expert Dr. M. No one disputes that some mothers have induced physical symptoms in their children and subjected them to repeated hospitalizations; some cases have been captured on hospital video cameras. There is a term for this cruel behavior; we call it child abuse. When the child dies at the hands of an abusive parent, we have a term for that, too; we call it murder. But many clinicians suffer from syndromophilia. They have never met a behavior they can’t label as a mental disorder. One case is an oddity, two is a coincidence, and three is an epidemic. Once a syndrome is labeled, it spawns experts who are ready and willing to identify it, treat it, and train others to be ever alert for signs of it. No new disorder is “rare” to these experts; it is “mistaken” for something else or “underdiagnosed.” When the new diagnosis is received with skepticism and controversy, a common reaction is not to reject it but to rename it: Munchausen by proxy (MBP) became “factitious disorder by proxy” in the DSM-IV’s appendix—the interim limbo for contentious labels—and was promoted to “factitious disorder imposed on another” in DSM-5 (American Psychiatric Association, 2013). When multiple personality disorder x Foreword (MPD) officially entered DSM-III in 1980, setting off a hysterical epidemic of cases that grew into the thousands throughout the 1980s and 1990s, it wasn’t science or skepticism that ended this psychiatric folly, but malpractice suits. DSM-IV took no stand, but quietly renamed the diagnosis “dissociative identity disorder.” It remains in DSM-5 (see Lilienfeld & Lynn, Chapter 5, this volume). When I was writing the foreword to the first edition in 2003, it seemed that Munchausen by proxy, or by any other name, would become the latest trendy disorder to capture clinical and media attention (Mart, 1999). Mercifully, it didn’t, but Dr. M’s testimony in the courtroom that day revealed the pseudoscientific assumptions, methods, and ways of thinking that are still too common in clinical practice, as other chapters in this volume will consider in depth: • Dr. M relied on projective tests to determine whether or not the mother had psychological problems, apparently unaware that these tests have serious problems of reliability and validity (see Hunsley, Lee, Wood, & Taylor, Chapter 3, this volume). Moreover, what could those tests reveal? Evidence of a “mental disorder” in this defendant would not reliably indicate that she was an MBP mother. For that matter, all too many abusive parents have no discernible “mental disorder.” • Dr. M knew nothing about the importance of testing clinical assumptions empirically, let alone of operationally defining her terms. What does “in collusion” mean? How does an MBP mother’s behavior differ from that of any mother of a chronically sick child, or, for that matter, from that of any loving mother? • Dr. M knew nothing about the confirmation bias or the principle of falsifiability, and how these might affect clinical diagnosis (Tavris & Aronson, 2007). Once she decided this mother was a Munchausen case, that was that. Nothing the mother did or said could change her mind. This is because, she testified, Munchausen mothers are so deceptively charming, educated, and persuasive. Nothing the child said could change her mind. This is because, she said, the child naturally wants to remain with his mother, in spite of her abusiveness. No testimony from immunologists that the child really did have an immune disorder could change her mind. This is because, she explained, Munchausen mothers force doctors to impose treatments on their children by interpreting “borderline” medical conditions as problems needing intervention. • Dr. M understood nothing about the social psychology of diagnosis— for example, how a rare problem, such as “dissociative identity disorder” or “Munchausen by proxy” syndrome, becomes overreported when clinicians start looking for it everywhere and are rewarded with fame, acclaim, and income when they find it (Acocella, 1999). Foreword xi • Dr. M understood nothing about the problem of error rates (Mart, 1999): that in their zeal to avoid false negatives (failing to identify mothers who are harming their children), clinicians might significantly boost the rate of false positives (mistakenly labeling mothers as having MBP syndrome). “This disorder destroys families,” she said, without apparently pausing to consider that mistaken diagnoses do the same. In short, Dr. M managed to get a PhD in clinical psychology without having acquired a core understanding of the basic principles of scientific thinking. Is Dr. M an anachronism, doomed to extinction by the rise of evidencebased practice in medicine and empirically supported therapies in psychology? I suspect that many clinical scientists would say yes. After all, the establishment of the Psychological Clinical Science Accreditation System (PCSAS) is surely evidence of a sea change in clinical training: a nationwide effort to improve low training standards in graduate programs by identifying and accrediting outstanding clinical graduate programs that train highquality researchers. PCSAS is certainly an important step forward in closing the gap. But, as Lilienfeld (2013) has observed, “PCSAS recognizes only research-oriented programs; it neglects practitioner-oriented programs that are doing a solid job of training their students to think and practice scientifically. As the PCSAS initiative progresses, we must remain cognizant of the pressing need to train clinicians to think and operate scientifically.” Dr. M would still be at home in most graduate clinical psychology programs and psychiatric residencies today, where students can earn a PhD or an MD without ever having considered the basic epistemological assumptions and methods of their profession: What kinds of evidence are needed before we can draw strong conclusions? Are there alternative hypotheses that I have not considered? Why are so many diagnoses of mental illness based on consensus—a group vote—rather than on empirical evidence, and what does this process reveal about problems of reliability and validity in diagnosis? An ethnographic study of the training of psychiatrists showed that psychiatric residents learn how to make quick diagnoses, prescribe medication, and, in a dwindling number of locations, do psychodynamic talk therapy, but rarely do they learn to be skeptical, ask questions, analyze research, or consider alternative explanations or treatments (Luhrmann, 2000). Psychiatric training has not improved in the decade since; on the contrary, the move toward psychiatrist-as-medication-dispenser has escalated (Kirk, Gomory, & Cohen, 2013). Moreover, despite decades of controlled research that have shown which therapies are most efficacious for specific problems, most of the results have not yet filtered down to the great majority of practitioners. Large numbers of people with anxiety disorders do not receive exposurebased methods, and most children with autism spectrum disorders are xii Foreword receiving unsupported interventions (Lilienfeld, 2013; Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013). Most people with depression routinely are given antidepressants but not cognitive-behavioral therapy, and, as meta-analyses repeatedly find, antidepressants are largely placebic for people with all but the severest form of depression (Kirsch et al., 2008; Fournier et al., 2010; see Walach & Kirsch, Chapter 12, this volume). Most dishearteningly, large numbers of clinicians continue to use suggestive techniques, such as hypnosis and guided imagery, to recover allegedly repressed memories of abuse (Baker, McFall, & Shoham, 2008; Lilienfeld et al., 2013). Scott Lilienfeld and colleagues (2013) have identified several sources of clinicians’ resistance to evidence-based practice. One is that many therapists want to believe that if the client changes, it was because of what the therapist did, thereby overlooking other factors in the client’s life that might have contributed to improvement. Many therapists still hold the psychodynamic belief that early childhood experience is the cause of adult emotional problems. Many don’t understand complex statistics or know how to interpret the literature on outcomes of psychotherapy (and hence don’t read the journals). Many still have the view that it is up to skeptics to prove their position that some therapy doesn’t help, rather than up to proponents of that therapy to show that it does. Most or all of these sources of resistance may be subsumed under the banner of self-justification: The way I do things is the right way, and if you tell me it’s the wrong way and I need to learn some statistics, you are insulting my competence and professionalism and deep understanding of human nature, so the hell with you (Tavris & Aronson, 2007). For their part, the general public is no better informed about advances in clinical science. Because psychotherapists tend to be the ones who are writing advice columns, writing pop-psych books, going on talk shows, and testifying as experts in court cases, the public is largely ignorant of the kind of research done by psychological scientists on clinical issues. Here are just a few of the widely held beliefs, promoted by many psychotherapists, that have been discredited by empirical evidence and that are dispelled in the pages of this edited volume: • Almost all abused children become abusive parents. • Almost all children of alcoholics become alcoholic. • Children never lie about sexual abuse. • Childhood trauma invariably produces emotional symptoms that carry on into adulthood. • Memory works like a tape recorder, clicking on at the moment of birth. • Hypnosis can reliably uncover buried memories. • Traumatic experiences are usually repressed. • Hypnosis reliably uncovers accurate memories.

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