Therapy Maze Can Be Depressing

Los Angeles Times, December 28, 2003, P. M5 By Brandon A. Gaudiano

With little regulation, bizarre psychological remedies abound.

Imagine you are in the midst of a crippling depression that is sapping your will to live. Or perhaps your anxiety has gotten so bad that you are housebound -- unable to go to work or even to the grocery store for fear of having a panic attack. You decide you need therapy, but you're unsure what could help you.

So you open the Yellow Pages, or you go on the Web. But there you find hundreds of possible answers -- a dizzying array of "revolutionary new" options from which to choose, many of which claim to offer pain-free, trouble-free solutions to all of your problems.

Here are just a few of the therapies available to the consumer for depression or anxiety: Eye Movement Desensitization and Reprocessing, Critical Incident Stress Debriefing, Emotion Freedom Techniques, Be Set Free Fast, Neurolinguistic Programming, Dolphin-Assisted Therapy, Past Life Therapy, Recovered Memory Therapy and Alien Abduction Therapy.

Plenty to choose from. But here's the problem: You have no way of knowing which are legitimate and which are fraudulent. You have no standard by which to make comparisons.

Other than being grossly negligent, licensed psychotherapists are given almost complete discretion as to what they do for their clients. In the eyes of the public, psychotherapy has always been a quasi-magical process. You go into the therapist's office, he or she asks you to talk about the things that are on your mind and -- hocus pocus -- you start feeling better. The public's lack of knowledge can provide fertile ground for charlatans offering snake-oil cure-alls for psychological problems.

A few years ago I came across a psychotherapy being heavily promoted on the Internet that promised to eliminate depression and anxiety in minutes. Developed by California psychologist Roger Callahan, it is called Thought Field Therapy and is a kind of psychological acupuncture in which therapists instruct patients to tap on parts of their bodies in a prescribed formula to correct disturbances in their "energy meridians."

Callahan claimed once on a BBC documentary that he had "cured" more people of phobias than all other clinicians in history put together.

Then, from his California residence, he proceeded to treat a woman in England over the telephone for a phobia of mice. She hung up on him after tapping on herself as he prescribed and feeling no better. Afterward, Callahan suggested that the woman's T-shirt might have been energy "toxic" and that the treatment would have worked if she had simply removed her clothing.

There's also a treatment for post-traumatic stress called Eye Movement Desensitization and Reprocessing. Similar to techniques used in other effective treatments for this condition, EMDR therapists ask clients to review the traumatic events repeatedly in their minds until their anxiety dissipates. What makes EMDR unique is that the therapist also moves index and middle fingers rapidly from left to right in front of the client, who is asked to visually track the movement while imagining the scene. But research shows that the eye movements appear to be completely superfluous, as people who are asked to keep their eyes still while recounting the events improve just as much as those who do the eye-wiggling.

Psychotherapy has few safeguards. For a particular medication to be approved by the Food and Drug Administration, it first must undergo controlled clinical trials in which it is shown to be safe and effective.

No such safeguards are necessary for new psychotherapies. Many therapists argue that we just don't know enough at this point about how to treat psychiatric problems to require this high standard for our treatments.

Others say they don't need research to tell them that their treatments work after they have witnessed years of "successes" firsthand.

But there are recent examples that should give us pause. A 10-year-old Colorado girl, for instance, was killed in 2000 when her therapists accidentally suffocated her with a blanket while trying to "rebirth" her.

There are many safe and scientifically supported psychotherapies, such as cognitive-behavioral therapy for depression and anxiety. Unfortunately, the mental health community has done a poor job of protecting consumers from the charlatans and the well-meaning-but-ill-trained who hang out a shingle.

A recent national survey conducted by Ronald Kessler at Harvard University suggested that more than 65% of people with anxiety attacks or severe depression used alternative medicines and "complementary" therapies. The EMDR Institute boasts of training well over 40,000 clinicians in finger-waving techniques.

Consumers have the power to effect change in this system, but they rarely use it. The next time you go to a psychotherapy session, questions will be your most powerful tool to protect yourself. What type of therapy are we doing? Has it been shown to be effective for the types of problems I'm experiencing based on controlled research studies? What are alternative approaches that are effective for my problems? These questions should be as commonplace as asking whether the person holds a license to practice.

If your therapist is evasive, defensive or just can't answer you, caveat emptor! Perhaps it's time to shop around for someone who can.

Brandon A. Gaudiano holds a master's degree in clinical psychology and is a consulting editor for the new journal the Scientific Review of Mental Health Practice.

http://www.latimes.com/news/printedition/opinion/la-oe-gaudiano28dec28,1,7196654.story