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The Illusion of Psychotherapy
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Table of Contents

Preface, Acknowledgments, 1. Introduction, 2. Psychotherapy's Face to the World: The Summary Assessments of its Effectiveness, 3. Recent Tests of the Effectiveness of Individual and Group Psychotherapy, 4. Recent Tests of the Effectiveness of Family Therapy, 5. The Failure of Psychotherapy as Science, 6. Conclusion: Why Does Psychotherapy Persist?, References, Index

About the Author

William Epstein

Reviews

-[T]his book presents a considerable challenge to supporters of psychotherapy.- --Jeremy Holmes, Journal of Medical Ethics -This work should be read by three audiences at least: the sprawling popu-lation of therapists who try to minister to innumerable human and behav-ioral ills with miscellaneous credentials; insurance companies and public policy makers who pay for counseling and psychological treatment because they believe individuals are primarily to blame for (or can overcome) such troubles in society as unemployment, deviance, family disorganization, single and teenage parenthood, drug and alcohol addiction, learning disability, mental illness; and the reading public can learn how much therapy depends on faith and hope, not on proven science. If these audiences do read this comprehensive work they will be outraged at first, and then very thoughtful. Why? This is the most thorough and exhaustive review in decades of scores of studies about the effectiveness of various psychotherapies--the real life outcomes assessed as objectively as present science permits, rather than through the subjective views of practitioners. The results: (1) fragmentary and ambiguous evidence of minor positive gains in some cases; (2) little or no credible objective evidence of change or improvement in behavior or func-tioning.- --Robert Morris, Emeritus Professor, Brandeis University, Cardinal Medeiros Lecturer, University of Massachusetts -Debunkers do not make themselves popular among those who believe in the myths being unmasked. William M. Epstein will surely find himself un-welcome in the swollen community of psychotherapists. But the rest of us-- citizens and policy makers alike--are very much in his debt. He has scruti-nized the scientific claims of a vast array of psychotherapeutic practitioners and found that these claims do not meet the minimum standards of scien-tific proof. More than that, he gives us good reason to suspect that many therapies may not only be ineffective but harmful. . . . His is a voice that demands to be heard.- --Andrew J. Polsky, Associate Professor of Political Science, Hunter College -Observers of the excessive American tendency to push for client personal reform where a problem requires money, services, or other resources will be delighted with this effort to set the record straight. Scientists and others who ask for evidence of treatment outcomes will be pleased with this refusal to substitute faith and conviction for experimental rigor. There remains room for debate: Are Epstein's criteria too tough? Is the evidence objectively read? Would better research controls make a difference? Is there any place to be claimed for psychotherapy? Professor Epstein is to be applauded for helping to set the terms of that debate and challenging the field to ask why so many unproven claims persist.- --Alfred J. Kahn, Professor Emeritus and Co-Di-rector, The Columbia University School of Social Work -Although Epstein's contention that psychotherapy is on balance harmful remains speculative, The Illusion of Psychotherapy establishes a salutary new benchmark of rigor for the design and evaluation of outcome studies.- -- Frederick Crews, Professor of English, University of California, Berkeley

"[T]his book presents a considerable challenge to supporters of psychotherapy." --Jeremy Holmes, Journal of Medical Ethics "This work should be read by three audiences at least: the sprawling popu-lation of therapists who try to minister to innumerable human and behav-ioral ills with miscellaneous credentials; insurance companies and public policy makers who pay for counseling and psychological treatment because they believe individuals are primarily to blame for (or can overcome) such troubles in society as unemployment, deviance, family disorganization, single and teenage parenthood, drug and alcohol addiction, learning disability, mental illness; and the reading public can learn how much therapy depends on faith and hope, not on proven science. If these audiences do read this comprehensive work they will be outraged at first, and then very thoughtful. Why? This is the most thorough and exhaustive review in decades of scores of studies about the effectiveness of various psychotherapies--the real life outcomes assessed as objectively as present science permits, rather than through the subjective views of practitioners. The results: (1) fragmentary and ambiguous evidence of minor positive gains in some cases; (2) little or no credible objective evidence of change or improvement in behavior or func-tioning." --Robert Morris, Emeritus Professor, Brandeis University, Cardinal Medeiros Lecturer, University of Massachusetts "Debunkers do not make themselves popular among those who believe in the myths being unmasked. William M. Epstein will surely find himself un-welcome in the swollen community of psychotherapists. But the rest of us-- citizens and policy makers alike--are very much in his debt. He has scruti-nized the scientific claims of a vast array of psychotherapeutic practitioners and found that these claims do not meet the minimum standards of scien-tific proof. More than that, he gives us good reason to suspect that many therapies may not only be ineffective but harmful. . . . His is a voice that demands to be heard." --Andrew J. Polsky, Associate Professor of Political Science, Hunter College "Observers of the excessive American tendency to push for client personal reform where a problem requires money, services, or other resources will be delighted with this effort to set the record straight. Scientists and others who ask for evidence of treatment outcomes will be pleased with this refusal to substitute faith and conviction for experimental rigor. There remains room for debate: Are Epstein's criteria too tough? Is the evidence objectively read? Would better research controls make a difference? Is there any place to be claimed for psychotherapy? Professor Epstein is to be applauded for helping to set the terms of that debate and challenging the field to ask why so many unproven claims persist." --Alfred J. Kahn, Professor Emeritus and Co-Di-rector, The Columbia University School of Social Work "Although Epstein's contention that psychotherapy is on balance harmful remains speculative, The Illusion of Psychotherapy establishes a salutary new benchmark of rigor for the design and evaluation of outcome studies." -- Frederick Crews, Professor of English, University of California, Berkeley

"[T]his book presents a considerable challenge to supporters of psychotherapy." --Jeremy Holmes, Journal of Medical Ethics "This work should be read by three audiences at least: the sprawling popu-lation of therapists who try to minister to innumerable human and behav-ioral ills with miscellaneous credentials; insurance companies and public policy makers who pay for counseling and psychological treatment because they believe individuals are primarily to blame for (or can overcome) such troubles in society as unemployment, deviance, family disorganization, single and teenage parenthood, drug and alcohol addiction, learning disability, mental illness; and the reading public can learn how much therapy depends on faith and hope, not on proven science. If these audiences do read this comprehensive work they will be outraged at first, and then very thoughtful. Why? This is the most thorough and exhaustive review in decades of scores of studies about the effectiveness of various psychotherapies--the real life outcomes assessed as objectively as present science permits, rather than through the subjective views of practitioners. The results: (1) fragmentary and ambiguous evidence of minor positive gains in some cases; (2) little or no credible objective evidence of change or improvement in behavior or func-tioning." --Robert Morris, Emeritus Professor, Brandeis University, Cardinal Medeiros Lecturer, University of Massachusetts "Debunkers do not make themselves popular among those who believe in the myths being unmasked. William M. Epstein will surely find himself un-welcome in the swollen community of psychotherapists. But the rest of us-- citizens and policy makers alike--are very much in his debt. He has scruti-nized the scientific claims of a vast array of psychotherapeutic practitioners and found that these claims do not meet the minimum standards of scien-tific proof. More than that, he gives us good reason to suspect that many therapies may not only be ineffective but harmful. . . . His is a voice that demands to be heard." --Andrew J. Polsky, Associate Professor of Political Science, Hunter College "Observers of the excessive American tendency to push for client personal reform where a problem requires money, services, or other resources will be delighted with this effort to set the record straight. Scientists and others who ask for evidence of treatment outcomes will be pleased with this refusal to substitute faith and conviction for experimental rigor. There remains room for debate: Are Epstein's criteria too tough? Is the evidence objectively read? Would better research controls make a difference? Is there any place to be claimed for psychotherapy? Professor Epstein is to be applauded for helping to set the terms of that debate and challenging the field to ask why so many unproven claims persist." --Alfred J. Kahn, Professor Emeritus and Co-Di-rector, The Columbia University School of Social Work "Although Epstein's contention that psychotherapy is on balance harmful remains speculative, The Illusion of Psychotherapy establishes a salutary new benchmark of rigor for the design and evaluation of outcome studies." -- Frederick Crews, Professor of English, University of California, Berkeley

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