Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Saturday, January 08, 2005

The Skeptics of "Energy" Therapies

Social Work Today

The Skeptics of "Energy" Therapies
By Matthew Robb, MSW, LCSW-C
Social Work Today
Vol. 4, No. 7, Page 30

Skeptics and scientists speak out on the growth of “energy” treatments that tout success stories over hard science.

First came a chance meeting. Then came the wooing, the rush of excitement, the romance and promises. Therapist Monica Pignotti, MSW, describes it as a seduction—and it was. She was smitten by its charm, dazzled by its swagger and sway. But after six years of on-and-off courtship, Pignotti decided on another course of action: She wanted out.

Today, the former New Yorker regards her embrace of Thought Field Therapy (TFT) with regret—and not a little embarrassment. “I really got swept away by this technique and lost my ability to think critically for awhile,” she recounts from her new home in Los Gatos, CA. “Initially, I was very skeptical, but soon I became quite taken with it.”

She first heard of TFT on an Internet forum for therapists. The year: 1996. Pignotti was no stranger to flamboyant pitches, but the miraculous, often breathless testimonials kept her reading. Therapists spoke of the ability to eliminate panic attacks, posttraumatic stress, depression, and eating disorders—not in months or years, but often in minutes. And by human touch.

Pignotti was intrigued but maintained her professional distance. She refused to climb aboard the bandwagon—until the day she witnessed TFT’s celebrated powers with her own eyes. “I tried TFT on myself and it instantly eliminated my anxieties,” she recalls. “I was just amazed at the power, so I started trying it on other people. Their phobias or traumas were eliminated immediately. It worked with so many people and produced so many sudden, very powerful results that looked to me like miracles.”

As Pignotti’s TFT caseload grew, so too did her dawning realization that the results were anything but miracles. In time, the honeymoon was over. Today, she believes her headlong conversion from skeptic to true believer (and back to skeptic) should serve as a cautionary lesson to therapists and clients alike.

Research psychologists familiar with Pignotti’s journey nod in assent and maintain that such conversions are becoming more common among social workers, not less. Pointing to the astonishing claims of TFT and its “energy psychology” offshoot—Emotional Freedom Techniques (EFT)—these skeptics ask one unflinching question: Where’s the proof?

“A Magic Bullet”
In the storied annals of psychotherapy, few techniques rival the idiosyncrasies of TFT. Trademarked and popularized in the early 1980s by California psychologist Roger J. Callahan, PhD, TFT almost seems designed to provoke disbelief. Yet, despite growing skepticism in the professional community—the American Psychological Association today refuses to grant continuing education credit for TFT workshops—adherents remain fiercely loyal to its practice and preservation.

“I was very taken with it,” Pignotti explains. “It didn’t work on everybody, but we explained away our failures, making it appear that we had a higher percentage of successes than we did, I realized later. I think what happened in many cases is that the treatments didn’t hold up over time, but we didn’t hear back from clients about that.”

Combining Western psychology and Chinese mind-body principles, TFT asserts that emotional disorders arise when disturbing thought patterns detune the human “meridian energy system,” causing blockages in a hypothesized low-level bioelectrical field. TFT practitioners say they can quickly diagnose and eliminate problems by instructing clients to tap acupressure points on their bodies in specific sequences. Central to TFT’s effectiveness is the wholesale elimination of identified toxins: wheat, sugar, polyester, potato chips, or others. Practitioners says they can diagnose clients by pushing on their extended arms and testing for resistance while the clients think of distressing events.

The ultimate armament in the TFT arsenal is Voice Technology (VT), a highly proprietary technique that Callahan claims is nearly 100% “effective” in eliminating a host of mental, emotional, and physical disorders. Notably, Callahan’s small cadre of VT practitioners assist their clients telephonically—but not before paying Callahan $100,000 for individualized training. Callahan calls the expense justified, given VT’s revolutionary powers, and says VT-trained therapists can recoup their investments by charging clients upward of $300 per session, often with a $1,500 minimum. Aside from the thorny issues of six-figure fees and phoned-in therapy, critics decry a process by which nonprofessionals can presumably begin training at sunrise and be practicing by sunset. Neither apologetic nor given to understatement, Callahan—well into his 70s—champions TFT as “the power therapy of the 21st century.” Says Pignotti, “[Callahan] says he has treated more people than any psychologist in history, which is probably true.” Also true: VT is treated as a trade secret. Before receiving instruction, students must sign confidentiality agreements.

“Callahan says VT is on par with the hard sciences,” Pignotti says, “but it’s neither precise nor objective.”

Then how to explain Pignotti’s involvement with it? “At the time,” she explains, “I wanted to believe it so badly because I had already made such a strong public commitment in support of TFT before the VT training and had so much emotional investment in it. I was really stunned when I found out what it was.”

Pignotti’s break with Callahan sent ripples through the TFT community. No mere cipher, she was one of Callahan’s most trusted associates, presiding over dozens of well-attended trainings on the Atlantic seaboard and authoring one of five articles that would appear in the Journal of Clinical Psychology. (Notably, Gary Craig—founder of EFT—also broke ranks with Callahan, dismissing TFT’s emphasis on finger-tapping sequence but retaining other key elements.)

“With VT,” Pignotti says, “I treated hundreds of clients. Treatments were fast, often taking just minutes. When a client’s problems returned, we would identify a toxin. I know some cases where clients were calling their VT therapists practically every time before they ate a meal to check if eating a certain food was OK. It practically became an obsession.”

Skepticism Grows
Over months and years, Pignotti saw her results pale next to Callahan’s extravagant claims. Seeking answers, she began comparing notes with other VT specialists, leading to occasional collaboration where they would test the same client simultaneously—often arriving at conflicting interpretations. “One practitioner would say it’s toxic, the other wouldn’t,” she recalls. “After awhile, that pretty much destroys reliability and validity.”

These under-the-radar experiments yielded something else: Despite claims of TFT’s rock-hard science, a given client’s identified toxicities might shift from day to day. Says Pignotti, “Roger’s pat answer was, ‘Nothing is perfect, but we have the closest to perfection there is.’” When cases proved intractable, VT practitioners would finger the default bogeyman—undetected toxins—thus kicking off another round of tapping and head scratching. “Despite the 98% claims,” Pignotti recalls, “there were a lot of anecdotes of TFT people who were calling Roger and not having good results. It was not sounding at all like a 98% success rate. There was too much that just wasn’t adding up for me.”

What became apparent to Pignotti was that Callahan didn’t have a good definition of “success.”

“TFT is all about self-report in the immediate moment,” she says. “There’s no rigorous scientific analysis. I couldn’t face it as first. I completely put it out of my mind.”

TFT: Not the Way Science Works
Scott O. Lilienfeld, PhD, and Jeffrey M. Lohr, PhD, know something about pseudoscience. Coeditors with Steven Jay Lynn, PhD, of the critically praised “Science and Pseudoscience in Clinical Psychology,” the university research psychologists say TFT and EFT are symptomatic of a larger, more worrisome trend—one that sees psychotherapy melding with spiritualism and the scientific method losing ground to intuition and mysticism. In this critical assessment, they are joined by Richard Gist, PhD, of the University of Missouri-Kansas City, and Brandon Gaudiano, PhD, research fellow at Brown University Medical School, among others.

Assessing Callahan’s claims of “98% success,” Emory University professor Lilienfeld retorts, “Hogwash. On what basis is he making that claim? Why hasn’t he conducted controlled studies—after 20 years of practicing TFT? The evidence for his claims is based totally on his testimonials. You have to trust him. But that’s not the way science works.” The standard of proof, Lilienfeld says, can be found in Hume’s Dictum: Extraordinary claims demand extraordinary evidence.

Lohr nods in agreement. “The research for TFT is virtually nonexistent. There is only basically testimony rather than rigorously controlled experimental research. I think they are promoting and marketing a procedure that they have trademarked, but trademarks are a marketing issue that has nothing to do with an empirically scientific enterprise. People say they feel different after undergoing the [TFT] procedure, but they can feel different in a variety of ways and for a variety of reasons, none of which have anything to do with the alleged specific influence of the therapeutic procedure.” And what of Gary Craig’s EFT? “There’s even less research on that,” Lohr counters.

Gist is more direct. “Rituals have always been used to provide us comfort, and these manualized, ritualistic things fill a very interesting need,” he says. “Market them, package them with a little bit of scientism, and they seem quite remarkable, especially to the desperate and gullible. It’s nice to be able to learn things with no more than a weekend of color slides and hyperbole, especially when it doesn’t even require you to take a test. They claim that TFT also works with cats and dogs.” Pausing to reflect, Gist adds, “We seem to have a lot more interest these days in the package and less interest in the content. Unfortunately, there’s a client born every minute.”

A Collection of Success Stories
Perhaps TFT’s most outspoken critic is Gaudiano, whose work at Brown University finds him testing the effectiveness of a variety of psychotherapies. In 2000, he introduced himself to the TFT community by way of a searing article in Skeptical Inquirer Magazine. Since then, he has sustained his offensive through his popular TFT-debunking Web site.

“The main point of TFT,” Gaudiano notes, “is that its promises always go beyond the data. Meanwhile, the permutations and offshoots of TFT are proliferating rapidly.”

He continues, “TFT is nothing new. It looks new. It’s marketed as new. But it doesn’t take much of a historian to look back on the practice of psychotherapy to understand that there have been literally hundreds of fad and fly-by-night therapies that have come and gone, basically using similar marketing strategies and promoting the same wild claims as ‘energy psychology’ today.” Gaudiano points to a recent study peer-reviewed and published in the Scientific Review of Mental Health Practice. “This study tested both sham and EFT-derived tapping procedures,” he says. “The results showed that the sham tapping treatments worked as well as the correct ones and, while neither worked that well, both could be explained by placebo effects.”

Gaudiano dismisses Callahan’s assertion that the Journal of Clinical Psychology’s decision to publish five (non–peer-reviewed) articles indicates support for TFT. “Callahan claimed that his work wasn’t being respected and looked at by the scientific community. So, in an unprecedented step, the journal’s editor published his claims without modification and then let independent researchers comment on them. Unfortunately, it speaks volumes of the state of affairs scientifically for TFT that they presented articles in which there was nothing even resembling a scientific study. Basically, they were a collection of success stories. For what Callahan charges for VT training, he could certainly fund a proper independent study.”

But might there be another explanation—that Callahan’s skeptics are envious of TFT? Gaudiano quietly demurs. “I would be happy to see any of these claims stand scientifically,” he says. “This is not about scientists not liking Dr. Callahan or not liking energy therapy or Eastern traditions. It’s not the content that most skeptics are disagreeing with. It’s the process by which these things are developed and promoted—the idea that they are not being promoted responsibly and that they could be harming people. There’s this assumption within the field, unfortunately, that we can do no harm. But we can and some people do.”

The Power of Personal Experience
Like that of his colleagues, Lilienfeld’s uneasiness transcends TFT. Of more concern, he says, is the trend that sees pop psychology becoming respectable among widening circles of mental health practitioners. Without energetic oversight by the National Association of Social Workers and the American Psychological Association—among others, he says—people savvy in marketing and Web design are exploiting fissures in the system. The losers: those in need of skilled help and our profession’s very credibility.

Gaudiano concurs. “Psychotherapy is a business these days. There’s a lot of money in it—especially for alternative approaches. People can take a course, read a book, get onto the Internet, and start marketing their own brand.” All without scientific evidence that it really works.

Lilienfeld wonders aloud where this science-light, marketing-heavy mind-set is leading the profession. But of one thing he is certain: Mental health professionals cannot abandon the scientific method. “There is an understandable desire for quick fixes,” he says. “But large numbers of clinicians today are not well-versed in the scientific method and often accept claims on the basis of authority alone. We have to be careful not to attract people into the mental health community who think scientific evidence should not be the arbiter of treatment decisions.”

— Matthew Robb, MSW, LCSW-C, is a social worker and freelance writer residing in suburban Washington, DC.