NY Times: The Dodo Bird is Dead

Big news this week from the paper of record, or at least the The Consumer category of the Well blog of the paper of record: The Dodo Bird is dead.

What’s that? You already knew that? You knew that it took European sailors all of about seventy-five years to wipe the species off the face of the earth back in the 17th century? Well, you are correct, or at least wikipedia says you are.

But Lewis Carroll, writing a couple hundred years later resurrected the bird as the inventor of the Caucus Race (not to be confused with the Caucasian race), wherein he tells the animals of Wonderland that the best way to dry themselves off is to race around in circles. The Dodo calls a halt to the proceedings when everyone looks dry. The participants want to know who won. “Everybody has won, and all must have prizes,” says the Dodo.

I’m sure Carroll was making some kind of topical allusion here, but  in 1936, a psychologist named Saul Rosenzweig re-resurrected the dodo and gave it a whole new meaning. Rosenzweig studied various forms of psychotherapy and concluded that they all worked about the same. Psychoanalysis was no more or less effective than behaviorism, he said. He christened it the dodo bird effect.

Now, the dodo bird  has haunted the mental health field ever since. Study after study has replicated it, leading some to conclude that all therapy is is equally dependent on what scientists call “non-specific factors” or “placebo effects.” To some people, this is a bad thing, an embarrassment, as it indicates that therapy is bunkum. To others, it’s a vindication of their belief that psychotherapy is an art, and that it is all about the relationship between two people, rather than about any specific technique.

I am firmly in the second category. But, as with many things, science is always proving me wrong. In this case, it’s because a group of researchers, most of them cognitive behavioral therapists, have,over the past fifteen or twenty years, done a series of studies showing that cognitive-behavioral therapy works better than other therapies. By “manualizing” therapy–i.e., by having a therapist work strictly out of an instruction book–they have, so they claim, managed to isolate the active ingredient in therapy from the therapist’s personality or other nonspecific factors. And by operationalizing outcomes–i.e., by deciding what constitutes successful therapy and developing scales to measure it–they have managed to provide a means to correlate therapy and outcome. And when they do that, they say, it turns out that CBT leads to superior outcomes.

There are all sorts of problems with this line of research, not the least of which is that it’s done by advocates, and advocacy is the enemy of scientific objectivity. But there’s also the problem of the comparison group, which is generally either a no-treatment group or a sham-treatment group. How do you do a sham treatment of a therapy that works via the placebo effect? you ask. Good question. The answer is that you make up a therapy as a stalking horse, one that not only doesn’t exist but that is being implemented by a therapist with no reason to believe in it. (Therapist belief being a major factor in therapy efficacy.) There are many other flaws in this research, detailed in Manufacturing Depression, chapter 13 (where I infiltrate a CBT training program) and in many academic papers, like this one.

But the obvious flaws have been eagerly overlooked by therapists and bureaucrats enchanted by the possibility of measuring something, anything, that can answer the demand for “evidence-based practice.” (Click here to see my account of this blight, along with a nice takedown of Marty Seligman and his cryptofascist maunderings about human flourishing.) And the recent Times article makes it clear just how effective this mythmaking has been. “In 2009,” Harriett Brown reports, “a meta-analysis conducted by leading mental-health researchers found that psychiatric patients in the United States and Britain rarely receive C.B.T., despite numerous trials demonstrating its effectiveness in treating common disorders.” Only 17 percent of us therapists are going by the book, which means, she writes, that “many patients are subjected to a kind of dim-sum approach — a little of this, a little of that, much of it derived more from the therapist’s biases and training than from the latest research findings.” It is as if we are still treating infections with bloodletting instead of antibiotics.

Brown doesn’t report any of the reservations about CBT research. She doesn’t even raise the question of how the outcome measures are tailor made to the therapy, let alone how the whole business is driven by a bottom-line approach that, at least according to some of us therapists (the ones who are going to go the way of the dodo, I guess), is inimical to the central genius of psychotherapy, which is that it allows people to step out for a moment from the continual preoccupation with the bottom line. She doesn’t even bother with the de rigeur “to be sure” paragraph that reporters use to cover their asses. Which means to me that while I was not paying attention, CBT’s superiority moved from the realm of contentious claim to uncontested fact.

Oh, well, I guess it’s time for me to wake up and smell the coffee. Or is that Kool-Aid I’m smelling?



One Response to “NY Times: The Dodo Bird is Dead”

  1. Pete says:

    The statement is unique to psychotherapy in the sense that it suggests that all forms of therapies, regardless of specific components, yield equivalent outcomes.

    It’s controversial because some clients may not respond as well to one form of therapy in comparison to another because each model of psychotherapy contains unique elements. Proponents of the Dodo-bird verdict believe that the statement is valid because most forms of therapy share common factors.

    Nonetheless, the Dodo bird is extinct and I don’t believe that therapists should follow that statement. The reason it is controversial is because a therapist who believes this will insist on using the same form of therapy that they have been trained in despite the fact that it is not producing any benefit to the client. It also discourages them from learning different approaches to help clients get through their problems. In my opinion, a good Psychotherapist will go through extensive training in a few theories and methods of therapy and use them when working with clients to determine the best fit. At the same time, they should also be willing to adopt a completely novel approach for the sake of their client and themselves.

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