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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, April 23, 2019

Alternative Psychotherapies Claim Cognitive Disorders Are At Work

“It is a common but dangerous error to attribute all moral to mental obliquities”—an important statement made in 1842 by Thomas Hood, the poet and social thinker (“Song of the Shirt”, etc.). Hood said this in the course of rebuking Charles Dickens for taking a too lenient view of behavior associated with emotional disturbance, but curiously enough his comment can be part of a discussion of alternative psychotherapies (APs).

APs, as I have suggested the term, are psychological treatments that are neither based on systematic empirical evidence of effectiveness and safety, nor derived from conventional psychological theories current today. They are potentially harmful, sometimes seriously and directly so, sometimes in an indirect way because they use time and family resources and interfere with evidence-based treatment.

In addition to the commonalities just mentioned, some APs make a point of claiming that the emotional disorders they claim to treat are caused by or accompanied by cognitive problems of various kinds, which also need treatment because of the behavioral and other problems they can cause.

As the AP Recovered Memory Therapy (RMT) suggests in its name, emotional and behavioral disturbance is attributed by advocates of this view to repression of memory of traumatic events. This interference with cognition cannot be consciously overcome because it involves an emotional defense mechanism that saves the victim from the anxiety associated with a frightening memory. RMT proponents add to this claim of disturbed cognitive functioning the belief that the repressed memory operates “beneath the surface” to bring about unwanted behavior and unwanted emotional experiences that interfere with the person’s normal life. If the victim can be helped to remember a traumatic event, it is reasoned, the effects of the previously repressed memory will disappear. Unfortunately for this viewpoint, the evidence is that traumatic memories are not repressed and may be experienced vividly or be consciously avoided by the victim of the events. Other explanations than this cognitive one need to be found for behavioral and emotional problems following trauma—especially because RMT may well induce false memories of events that did not occur at all or did not occur in the form now remembered. However, RMT is a good example of the use of mental to explain moral obliquities.

The AP Attachment Therapy (AT) similarly assumes a cognitive factor in a claimed emotional disturbance. This disturbance, sometimes referred to by AT proponents as Attachment Disorder (not listed in any of the DSM volumes) and sometimes as Reactive Attachment Disorder (listed for years in DSM, but with changing definitions, all different from those used by AT proponents).  A cognitive problem often named by AT proponents as an aspect of attachment disorder is difficulty with cause-and-effect thinking. AT advocates have gone so far as saying that children whom they have diagnosed with attachment disorders cannot in fact connect causes with outcomes and that this is why they continue to show unwanted behavior even though severely punished for it. However, the idea that any human being of more than minimal intelligence, one who is able to learn some degree of language, cannot associate causes and effects is nonsensical. With a technique developed years ago by Caroline Rovee-Collier, where a baby’s kicking causes a mobile to turn, it can be shown that 2-month-olds learn the connection and kick when they see the mobile, in 7 to 9 minutes; 6-month-olds learn in only 1 to 3 minutes. A genuine failure to make all cause and effect connections would make most activities of daily living impossible—how, for example, to learn that you make the toothpaste come out by squeezing the tube? Some cause and effect associations are much more complicated and difficult to figure out (why does holding down the power button dissipate static electricity and let my laptop turn on?), but not knowing what causes a specific outcome is different from not knowing that effects have causes. It would appear that the AT claim about cause-and-effect thinking is in actual fact an attempt to describe situations where children are not easily disciplined through punishment or threats of punishment, and to do so using important-sounding terms that ordinarily refer to cognitive abilities. These situations are more likely to have to do with caregivers’ capacity to structure instruction, rewards, and punishments effectively than to result from children’s cognitive incapacity; if a child really could not associate cause and effect, this would be very obvious in all his or her behavior.

A third AT whose advocates use ideas about cognition to try to explain or support their views is represented by the various Parental Alienation (PA) treatments. PA proponents claim that children and adolescents whose parents are in high-conflict divorces may be “alienated” by the actions of a preferred parent and thus reject contact with the other parent. The rejecting attitude is said to be clearly PA when the child or adolescent (most commonly a young teenager) shows certain cognitive characteristics as well as avoiding a parent. The child is said to have “black and white thinking”, with a highly polarized view of the parents, one being considered “all good” and the other “all bad”. PA advocates also suggest that such children display “borrowed scenarios” in which they insist that all their beliefs and conclusions are their own, but in fact (according to the advocates) their stories and explanations actually belong to the preferred parent, who has “brainwashed” the child. These cognitive characteristics are argued to be created by the alienating actions of the preferred parent. Unfortunately for claims of the validity of these views, PA proponents have done nothing whatever to test whether children who avoid a parent are in fact different on these matters than other children matched for age and for family stress of some other type than divorce.  Before it can be argued that one parent’s actions caused a difference, it’s necessary to show that there actually is a difference.

Let’s consider briefly what kind of thinking we would expect of young adolescents. Note, to begin with, that every one of us has a maximum level of cognitive skill which we can display under ideal conditions, with plenty of time, no fatigue or other discomfort, and with information that is familiar to us. As soon as we are tired, under pressure, frightened, or having to deal with unfamiliar material, we no longer operate at that highest possible cognitive level. These constraints all apply to children and adolescents as well as to adults’ experiences.

At their best level of cognitive performance, many (but by no means all) young teenagers can use what Piaget called formal operational thought. They can consider how several factors affect an outcome and can deal with comparisons like differences in proportions. For an academic example, they could consider weighing things with a balance and how the scale is affected not just by the weight of an object but by the object’s position on the arm of the balance. Because they can consider ratios and proportions (for which they have to think about two factors simultaneously), they can also deal with probabilities and with the ways we can use them to predict what might happen in a given situation. They can use the “form” or structure of a problem to find comparisons or analogies that could guide their problem-solving. Under ideal circumstances, then, they would not do polarized, “black and white” thinking, but would be able to deal with multiple facts.

But is this what we would always expect to happen with, say, a 14-year-old, even if he or she could do these cognitive tasks under ideal conditions? No, it is not, and this is particularly true when the teenager is caught in a high-conflict divorce. Cognitive performance will not be at its best level when the adolescent is anxious in general, worried about unwanted outcomes, possibly frightened of one (or even both) parents, and deprived by the situation of ordinary freedom, friendship, activity, and fun. These factors alone would reduce the level of cognitive performance and make it less likely that the teenager could consider proportions, multiple causes and effects, or mixed characteristics of human beings. Add to this the fact that divorce and the new family situation are complex and unfamiliar to adolescents (even adults are not likely to feel they understand what is happening when they go through such transitions). The upshot is that there are plenty of reasons why kids in the midst of divorce might think in immature, all-or-nothing terms with or without any “brainwashing” from the preferred parent. It would not be surprising if this were to occur for young adolescents in any kind of severe family transition, divorce or otherwise—and to make their case, PA proponents need to show that children of high-conflict divorce show more polarization than do other children in other fraught circumstances. (They have not done so.)

AS long as proponents of APs push the idea of cognitive problems, it behooves the rest of us to give a good deal of thought to cognitive development and the circumstances that influence cognitive performance.


  1. Just checking if this comment thing works

  2. And it does-- but I have only just now figured out how to answer queries under the new system!