In October 2012, a team of researchers from Simmons College, the University of Scranton and DePaul University conducted a Delphi poll, i.e., a structured, two-round systematic forecasting method, to identify “pseudoscientific, unvalidated, potentially harmful or ‘quack’ psychotherapies” used in the treatment of children and adolescents. This past April, the authors published their findings.
Lead researcher Gerald P. Koocher, Ph.D., dean, College of Science and Health at DePaul University in Chicago, previously professor of psychology, health sciences dean and associate provost at Simmons College in Boston, together with Simmons’ graduate students Madeline R. McMann and Annika O. Stout, polled 139 doctoral-level mental health experts for this study.
John C. Norcross, Ph.D., ABPP, from the University of Scranton co-led the project. Their published findings note “little attention has focused on identifying ineffective treatments and invalid tests for youth. That is, what does not work beyond the passage of time alone, expectancy, base rates or credible placebo.”
The study focused on 35 assessment techniques and 67 treatment methods; a 5-point Likert scale was used to evaluate each tool. Eleven tests earned a mean rating above 4.25 on the 5-point scale; 42 received average ratings above 4.25 in the second round. The respondents unanimously discredited enneagrams, the Szondi Test, Brain Balance, biorhythms, Hand Test, handwriting analysis, Animal Naming Test, Fairy Tale Test, Blacky Test, IQ test scale scores and the Holtzman Inkblot Test for their purported assessment uses among children and adolescents.
Popular projective tools such as the Children’s Apperception Test, Roberts Apperception Test and Rorschach Inkblot technique, although rated 3.45, 3.19 and 3.64, respectively, were not totally discredited.
The study authors did not discredit Communication Cards, which are used to improve social skills; Picture Exchange Communication; System Self-Control Training for the treatment of attention deficit hyperactive disorder; and the TEACCH approach for the treatment of autism.
Koocher notes in his published findings that instruments with “obsolete or sparse research” and/or those that relied on “narrow theoretical approaches” tended to draw more skepticism. For instance, the Blacky Test depends on Freud’s psychosexual theory of development for construct validity, he notes, and the Szondi Test is grounded in “hereditobiology.”
The study authors report that some of the discredited instruments continue to gain followers as demonstrated by the various programs and schools that offer certification in certain techniques.
While the authors acknowledge that some assessments and treatments may prove to be successful for some clients, factors such as chance, time, accident or placebo should be considered when evaluating outcomes. “The proper comparison is to outperforming chance and placebo, not whether a method happens to succeed on occasion,” the study says.
Miriam J. Voran, Ph.D., adjunct assistant professor of psychiatry in the Geisel School of Medicine at Dartmouth College, cites the study as “an important project to help the field, and the public, distinguish what works from what doesn’t,” and, for the most part, agrees with the experts.
“There is one area that I happen to follow closely in which their ratings are slow to catch up with the scientific times. In the area of psychodynamic treatments for autism, there is actually research from an Israeli group that demonstrates the effectiveness of dynamically-informed treatments for young children,” she says. “And Allan Shore has recently summarized the neuroscience evidence that supports addressing affect and dissociative defense in autistic children – and that’s the focus of psychodynamic treatments. Ours is indeed an ever-changing field and the pendulum of scientific opinion keeps moving.”
Koocher and his co-authors hope the results of the Delphi poll prompt a wider, more in-depth discussion among industry professionals about the assessment techniques and treatments used with children and adolescents.
By Phyllis Hanlon