Signs of over-hyped psychotherapy treatment?

Donald Meichenbaum and Scott Lilienfeld have recently published a short essay entitled: How to spot hype in the field of psychotherapy: A 19-item checklist.† This can be helpful for both counselors and future clients who are both hungry for finding “what works.”

Before giving their 19 warning signs they remind readers of two important factors:

• General factors in therapy (alliance, therapist skill, client commitment) do account for significant portion of the positive effects of many therapies but this should not be taken to mean that any therapy will work fine. In fact there is evidence that some therapies are harmful.
• It is helpful to have some self-doubt. Skepticism can be helpful, both in maintaining some humility and self-reflection of what we think works. The authors quote another who suggested to therapist that they should “love yourself as a person, doubt yourself as a therapist.” And to point to the challenge with this, they cite a study of 129 therapists where many therapists rated themselves as effective as 80% of all therapists while no one actually rated themselves as below average. Maybe these therapists live in Lake Wobegon?

Warning signs?

I will not repeat the actual language of their checklist but will give you a summary

1. Language. How do they talk about the intervention? Revolutionary? Ground-breaking? Do they use psycho and neuro-babble? The authors point out that dropping words like neural networks, body memories, and the like do not substitute for scientific evidence.
2. Illustrations. Does the “packaging” feel slick? Lots of scientific-looking images (brains, PET scans, etc.)?  Lots of explaining how something works but no evidence offered that it works (beyond anecdotes)?
3. In-group focus. How much do they refer to gurus, name-drop recognized leader endorsements? Do they offer special certifications that only they offer and special in-group activities that you can only get if you pay for it? Do they slough off critics and criticisms for not being on the inside. You can’t critique us because you didn’t see what only the in-group people see. 
4. Effectiveness. What evidence do they offer that it works? Anecdotes? Testimonies? Years of experience? Every treatment must start with anecdotes until it can get published research studies. But compare the language used to talk about effectiveness (and also lack of side effects) and the amount of published data. If the volume of data is limited, then the language should be as well. Also, are there any studies done by someone other than key authors and disciples?

These warning signs do not mean a treatment protocol will not work or is not a break-through. Certainly older well-accepted treatments may work less well than the new treatment. Just because the mainstream does not yet accept a new theory or intervention should not be a reason to reject it. But healthy skepticism is still warranted. Be wary of hype and over-promotion. Things that are said to work for everyone rarely do. Solutions to complex problems rarely can be found in a few quick steps or sessions.

Desperation pushes us to find solutions. I was challenged to find a solution to a friend’s mental health concerns. In exploring options we came across an intervention that held our interest. But upon further investigation we discovered it would cost $3,000 up front and take 30 sessions before knowing if it would be effective. A further review found many claims of huge successes and when we asked the practitioner about when it doesn’t work the answers given were clearly defensive. In addition, we could find no one at established university programs offering training and research provided could only be characterized as superficial despite the intervention being around for a nearly 20 years. Bottom line: we went looking for something else. The intervention might work but we didn’t want to risk the time it would take to find out if it would work.

†Meichenbaum, D. & Lilienfeld, S.O. (2018). How to spot hype in the field of psychotherapy: A 19-item checklist. Professional Psychology: Research and Practice, 49, 22-30.