Dear Stevan,
Just a few points for the sake of an argument, stemming from what we
were talking about last week. I am sending it to you first because the
content relates in part to your lecture. You criticised me for not
questioning data and theories that concur with my own agenda. In fact I
do question them, but probably attach less significance to negative
results that I read than positive ones.
I feel that you (and everybody else in the scientific community) are
probably just as guilty of this form of backing up one's own agenda. In
the lectures you talked about, explained and emphasised hermeneutics at
the same time as talking about psychotherapy. It was not difficult to
pick up your own personal view (unless it was a double bluff and you
actually do find some merit in the concept of psychotherapy - which I
somehow doubt); by explaining psychotherapy in terms of hermeneutics in
such an emphatic fashion, the two are linked in our minds. Those of us
who go on to read Prioleau et al in depth realise that in fact this
empirical evidence that you cite is not particularly convincing,
especially if the commentaries are taken into consideration (more about
this later), but those who choose to follow up other topics and leave
PT are left with the opinion that "it's all hermeneutics because Stevan
said so". I am not saying that we are all mindless and cannot form
opinions, but the information on which many formed those opinions was
one sided. Even if the references were followed up (which, for
practical reasons - i.e. time - was not possible for all of the
treatments) it is only the commentaries that provide the alternative,
pro-psychotherapy view. Hermeneutics provides ONE discourse; another is
that PT does actually work.
Prioleau et al attempt to provide empirical evidence indicating that PT
is no better than placebo by examining a subset of the Smith et al
(1980) meta-analysis. Their results are far from conclusive, and again
seem to be a matter of interpretation. My major criticism is the
averaging out of effect sizes from different therapies, a point that is
made best by Andrews in the commentaries. Even the authors themselves
quote figures of .74 for the effect size of verbal psychotherapies
(p.304), but average them with an effect size of .35 for developmental
therapies. This was justified by pointing out that these comparisons
were made on different studies, and that such a comparison "may not be
legitimate". They don't actually explain why.
This issue is, I (and many others) believe is at the heart of the
problem; different therapies with different clients produce varying
results, and the averaging out of such varying methods of therapy is
misleading. It is hypothesised by Dahl that different people respond
differentially to different PTs. Future research needs to control for
this. A brief BIDS search for the latest meta-analyses did not locate
any recent evidence that this has been done. Until it is, we are
probably at the mercy of reputations and agendas causing gross
interpretation of results to back them up. Boyle (1994) feels that this
is a major factor in maintaining any redundant research programme. The
PT programme is not yet done; there are valid questions (such as that
iterated above) that are still to be answered.
On reflection I suppose that my criticisms pertain to anyone who
publicises positions and theories and who also has an agenda (including
me). I was considering my message last night, and I think that I found
a flaw in my own argument. Do you think that psychotherapy does work,
because of the patient and therapist reinforcing each other in a
hermeneutic fashion, but this nature leaves it impervious to empirical
investigation; or is your criticism more global, in that the
hermeneutic nature of PT is no better than placebo (as in Prioleau et
al)?
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