Since the 1990s, the movement toward evidence-based medicine has been associated with a term for medical practices that are not evidence-based. These are often referred to as complementary and alternative (CAM) methods. Complementary methods are those that are used together with conventional evidence-based treatments; readers can no doubt figure out that alternative medical practices are used on their own. CAM approaches are without clear evidence of safety or effectiveness—if that evidence were present, they would just be medicine, not CAM.
Similar terminology for psychological treatments has lagged. People do not usually speak of complementary and alternative psychotherapies (“CAPs”). One real reason for this is that unconventional psychological treatments are rarely used in a complementary fashion together with conventional treatments. Unconventional treatments are generally put forward as alternatives to conventional therapies. As a result of this situation, I suggested in a book published some years ago (“Alternative Psychotherapies”, Rowman & Littlefield, 2014) that we simply use the term alternative psychotherapies (or therapies, or treatments, or interventions) to describe unconventional treatments that lack clear evidence of safety or effectiveness. Alternative psychotherapies are of particular interest because they can do both direct and indirect harm to clients. We see, for example, that “conversion therapies” intended to change sexual orientation can do direct harm by increasing depression and suicidality, and indirect harm by using up family resources that could be used better in other ways.
Having spent years looking at alternative psychotherapies for children like Attachment Therapy (AKA Holding Therapy), I am interested in what all of these treatments have in common. I notice, certainly, that proprietary treatments for parental alienation (a child’s rejection of one divorced parent in circumstances thought to indicate persuasion by the preferred parent) meet requirements to be called alternative psychotherapies. Interventions like Family Bridges or Turning Points for Families have never presented adequate evidence of effectiveness and have shown little or no concern about safety issues. But Family Bridges and Holding Therapy are vastly different in most ways. Are there points they share as alternative psychotherapies?
I am going to describe some characteristics that I think are shared by various alternative psychotherapies, including those directed at parental alienation. Please note, though, that I am taking the opportunity to use this blog as a way to speculate on points that are not yet clear to me. Some of what I mention here does not come from the published work of parental alienation proponents (for example), but from organizations that serve to popularize certain viewpoints. For Attachment Therapy, an example would be radzebra.org. For parental alienation therapies, the organization Family Access—Fighting for Children’s Rights has become very active in the last year or so and is moving from webinars into a subscription television service.
I. Proponents of alternative psychotherapies state that conventional treatments exacerbate children’s problems. Such exacerbation may be attributed to the vulnerability of conventional therapists, who believe lying children or allow themselves to be manipulated by children or parents.
II. Proponents of some alternative psychotherapies have argued that children’s experiences of distress during treatment were minimal when compared to the predicted negative outcomes of remaining untreated or treated only by conventional methods.
III. Proponents of some alternative psychotherapies warn against attention to children’s statements or wishes, on the grounds that mental health problems will be worsened if children are allowed to exercise autonomy; children are also characterized as liars who must be called to account.
IV. Proponents of alternative psychotherapies predict serious long-term consequences for children who do not receive their recommended treatments. Proponents of Attachment Therapy have long claimed that untreated children will be violent in childhood and will grow up to be serial killers (Ted Bundy has often been cited as an example). In a recent email, Family Access claimed that children who did not receive parental alienation interventions as recommended would be sociopaths in adulthood.
V. Proponents of alternative psychotherapies may create alternative diagnostic categories and announce them as “not yet” in DSM-5 or ICD-11, implying that these diagnostic manuals will eventually accept the categories.
VI. Proponents of alternative psychotherapies claim that only people they have trained can carry out their methods, and that extensive conventional training is not needed, or that the treatments are not actually mental health treatments so no licensure is required.
VII. Proponents of alternative psychotherapies may claim scientific evidence for their methods when in fact there is no evidence that meets the usual standards required for support of psychological treatment.
VIII. Proponents of alternative psychotherapies may respond to criticism by personal attacks rather than by discussion of evidence or of planned systematic outcome research.
It’s my impression that alternative psychotherapies share these as well as other characteristics. I would be interested in hearing others’ comments about additions to or deletions from this list.