The Scientist-Therapist Chasm in Psychology

Its origins and persistence, by guest columnist Carol Tavris

Since the founding of Skeptic magazine in 1992 we have covered many fads and fallacies in psychology, from satanic panics, repressed/recovered memories of sexual abuse, and attachment therapies of the 1990s, to DEI training programs, anti-racism workshops, and trans contagions of today. With a graduate degree in experimental psychology myself, trained as I was to employ objective research methods and statistical analyses to determine what is likely to be true, false, or indeterminate, I have long wondered why psychology continues to be infected with bad and bogus ideas. This week’s guest columnist, renowned social psychologist Carol Tavris, has been studying this problem throughout her career and provides a cogent—albeit disturbing—answer. —MS

Dr. Carol Tavris is a social psychologist and writer on many topics in psychological science. Her books include Mistakes Were Made (But Not by Me) (with Elliot Aronson); Estrogen Matters (with Avrum Bluming, M.D.); The Mismeasure of Woman; and Anger: The Misunderstood Emotion. She is also the coauthor, with Carole Wade, of two popular textbooks in introductory psychology,  Psychology and Invitation to Psychology. A Fellow of the Association for Psychological Science, Tavris has received numerous awards for her efforts to promote science, skepticism, critical thinking, and gender equity. 

Cover art for Vol. 2, No. 3, 1994, by Art Director and Skeptic co-founder Pat Linse (1947-2021). Pieces of art above and below were produced by Pat in that issue, by hand—pen and ink or on scratch board—as she did for dozens of editions of Skeptic over the years before artwork was produced with the aid of computers.

A fellow editor at Skeptic, ever on the alert for psychobabble in all its incarnations, was going over the 2024 convention program for the American Psychological Association (APA), and wrote to Michael Shermer and me to express his surprise at the absence of science and skepticism in most of the presentations. Research was pretty much replaced by advocacy and ideology, he said, certainly on anything to do with racism, transgender issues, and diversity. He was also faintly alarmed by some of the “continuing education” courses a member could take, for credit, such as this one:

Feminist Alchemy: From Object to Human

Presentation Abstract: A citizen of the world, I grew up in the oldest colony in the Americas—Puerto Rico. I drank the waters of colonization and was poisoned with gendered racism. As a result, I became an objectified entity. Such dehumanization ignited a transformative journey. I connected with ancestrxs, recovered my historical memory, and bonded with a feminist spirituality of color. Fighting oppression, I exorcised my colonial mentality and pledged to combat the Typhon of oppression. In this testimonio I share my journey of an alchemical transformation from being a colonized object to a liberated human. I follow the path of the warrior of the light—a Global Majority psychospiritual construct.

To be sure, this speaker is in the Division of Humanist Psychology, so spiritual-humanist talks are to be expected; but aren’t even humanist psychologists entitled to wonder what kind of psychotherapy this psychotherapist practices? Alchemical transformation therapy? What if her clients don’t share her psychospiritual beliefs? How far even the humanists have fallen from their own intellectual origins, which were to generate a “third force” in psychology (after behaviorism and psychoanalysis) that would produce an “authentic” human science of psychology, not replace it. Founded by Abraham Maslow, Carl Rogers, and Rollo May, humanist psychology may not have been empirically based, but many of its ideas were smart and invigorating. The division once gave B.F. Skinner its highest award for his actual contributions to improving humanity.

I was nonetheless surprised by my editor’s surprise. By the 1980s, the APA had already become a professional guild for psychotherapists rather than a home for scientists, and every year the APA would do some egregious thing that sent more of its scientists out the door. The chasm between therapists and researchers over “recovered memory therapy” was the last straw for many on the science side; the APA couldn’t even issue a public position paper repudiating the misunderstandings about memory that were fueling that epidemic, for fear of offending its practitioner members. Memory scientists and many others resigned, eventually forming, in 1988, the Association for Psychological Science (APS).

“But why does so much psychological nonsense persist?” Michael persisted, “including the belief that memories can be repressed and recovered in pure form? Didn’t the experimental psychologists stomp that one to death?” Because I have been trying to answer these questions for what feels like a century, I sent him an article that I wrote over two decades ago on the chasm between psychotherapists and psychological scientists. His reply was: “Let’s publish it!” Well, what writer wouldn’t want one of her favorite essays to be reprinted every 20 years? So here it is—with a brief postscript on where we are now.

Mind Games: Psychological Warfare Between Therapists and Scientists 

[shortened from the original article in The Chronicle of Higher Education, February 28, 2003]

While lecturing to a large group of lawyers, judges, mediators, and others involved in the family-court system in Los Angeles, I asked how many knew what a “social psychologist” was. Three people shyly raised their hands. That response was typical, and it's the reason I don't tell people anymore that I'm a social psychologist: They think I'm a therapist who gives lots of parties. If I tell them I'm a psychological scientist, they think I'm a pompous therapist, because everyone knows that “psychological science” is an oxymoron—like jumbo shrimp or corporate ethics.

In fact, in many states, I cannot call myself a psychologist at all, as the word is reserved for someone who has an advanced degree in clinical psychology and a license to practice psychotherapy. That immediately rules out the many other kinds of psychologists who conduct scientific research in their respective specialties, including child development, gerontology, neurobiology, emotions, sleep, behavioral genetics, memory and cognition, sexual behavior and attitudes, trauma, learning, language…and social psychology, the study of how situations and other people affect every human activity from love to war. 

For the public, however, the word “psychologist” has only one meaning: psychotherapist. It is true that clinical psychologists practice therapy, but many psychologists are not clinicians and most therapists are not clinical psychologists. The word “psychotherapist” is unregulated. It includes people who have advanced training in psychology, along with those who get a “certification” in some therapeutic specialty; clinical social workers and marriage, family, and child counselors; psychoanalysts and psychiatrists; and countless others who have no training in anything. Starting tomorrow, I could package and market my own highly effective approach, Chocolate Immersion Therapy, and offer a weekend workshop to train neophytes ($695, chocolate included). I could carry out any kind of unvalidated, cockamamie therapy I wanted, and I would not be guilty of a single crime. Unless I described myself as a psychologist.

As a result of such proliferation of psychotherapists, the work of psychological scientists who do research and teach at colleges and universities tends to be invisible outside the academy. It is the psychotherapists who get public attention, because they turn up on talk shows, offer advice in books and newspaper columns, and are interviewed in the aftermath of every disaster or horrible crime—for example, speculating on the motives and childhoods of the perpetrators. Our society runs on the advice of mental-health professionals, who are often called upon in legal settings to determine whether a child has been molested, a prisoner up for parole is still dangerous, a defendant is lying or insane, a mother is fit to have custody of her children, and on and on. Yet while the public assumes, vaguely, that therapists must be “scientists” of some sort, many of the widely accepted claims promulgated by therapists are based on subjective clinical opinions and have been resoundingly disproved by empirical research conducted by psychological scientists. Here are just a few examples:

• Low self-esteem causes aggressiveness, drug use, prejudice, and low achievement.

• Abused children almost inevitably become abusive parents, causing a “cycle of abuse.”

• Therapy is beneficial for most survivors of disasters, especially if intervention is rapid.

• Memory works like a tape recorder, clicking on at the moment of birth; memories can be accurately retrieved through hypnosis, dream analysis, or other therapeutic methods.

• Traumatic experiences, particularly of a sexual nature, are typically “repressed” from memory, or split off from consciousness through “dissociation.”

• The way that parents treat a child in the first five years (three years) (one year) (five minutes) of life is crucial to the child's later intellectual and emotional success.

Indeed, the split between the research and practice wings of psychology has grown so wide that many psychologists now speak glumly of the “scientist-practitioner gap,” although that is like saying there is an “Arab-Israeli gap” in the Middle East. It is a war, involving deeply held beliefs, political passions, views of human nature and the nature of knowledge, and—as all wars ultimately do—money and livelihoods. The war spilled out of academic labs and therapists' offices and into the public arena during the 1980s and 1990s, when three epidemics of hysteria caught fire across the country: the rise of claims of “repressed memories” of childhood sexual abuse; the growing number of cases of “multiple personality disorder” (MPD), from a handful before 1980 to tens of thousands by 1995; and the proliferation of daycare sex-abuse scandals, which put hundreds of nursery-school teachers in prison on the “testimony” of 3 and 4-year-old children.

All three epidemics were fomented and perpetuated by the mistaken beliefs of psychotherapists: that “children never lie about sexual abuse”; that childhood trauma causes the personality to “split” into several, even thousands of identities; that, if you don't remember being sexually abused in childhood, that's evidence that you were; that it is possible to be raped by your father every day for 16 years and to “repress” the memory until it is “uncovered” in therapy; that hypnosis, dream analysis, and free association of fantasies are reliable methods of uncovering accurate memories (on the contrary, such techniques have been shown to increase confabulation, imagination, and memory errors, while inflating the belief that the retrieved memories are accurate). These epidemics began to subside as a result of the painstaking research of psychological scientists.

But psychotherapeutic nonsense is a Hydra: Slay one set of mistaken ideas, and it takes on another name and trundles along. Others rise in their place. “Rebirthing,” physically abusive practices that supposedly help adopted or troubled children form attachments to their parents, continue even though prohibited in Colorado, because 10-year-old Candace Newmaker was smothered to death during a procedure in which she was expected to fight her through a “birth canal” of suffocating blankets and pillows. After the child’s death, one member of the Colorado Mental Health Grievance Board noted with dismay that her hairdresser's training took 1,500 hours, whereas anyone could take a two-week course and become “certified” in “rebirthing.” And yet the basic premise—that children (and adults) can recover from trauma, insecure attachment, or other psychological problems by “reliving” their births or being subjected to punitive and coercive restraints—has no scientific validity whatsoever.

To understand how the gap between psychological scientists and clinicians grew, it is necessary to understand a little about therapy and a little about science, and how their goals and methods diverged. For many years, the training of most clinical psychologists was based on a “scientist-practitioner” model. Ideally, clinicians would study the research on human behavior and apply relevant findings to their clinical practice. Clinical psychologists who are educated at major universities are still trained in this model. They study, for example, the origins of various mental disorders and the most effective ways to treat them, such as cognitive-behavior therapy for anxiety, depression, eating disorders, anger, and obsessive-compulsive disorder. They have also sought to identify which interventions are unhelpful or potentially harmful. For example, independent assessments of a popular post-trauma intervention called Critical Incident Stress Debriefing find that most survivors benefit just as much by simply talking with friends and other survivors as with debriefers. Sometimes, CISD even slows recovery, by preventing victims from drawing on their own wellsprings of resilience. And, sometimes, it harms people—for example, by having survivors ventilate their emotions without also learning good methods of coping with them.

Of course, tensions exist between researchers and practitioners in any field—medicine, engineering, education. Whenever one group is doing research and the other is working in an applied domain, their interests and training will differ. The goal of the clinician, in psychology or medicine, is to help the suffering individual; the goal of the psychological or medical researcher is to explain and predict the behavior or course of illness in people in general. That is why many clinicians argue that empirical research cannot possibly capture the complex human beings who come to their offices. Professional training, they believe, should teach students empathy and appropriate therapeutic skills. In their view, good therapy depends on the therapist's insight and experience, not on knowledge of statistics, the importance of control groups, and the scientific method.

I agree that therapy often addresses issues on which science is silent: finding courage under adversity, accepting loss, making moral choices. My clinician friends constantly impress me with their deep understanding of the human condition, which is based on seeing the human condition sobbing in their offices many times a week. Nor am I arguing here that psychological scientists, or any other kind, have a special claim to intellectual virtue. They, too, wrangle over data, dispute each other furiously in print and public, and have plenty of vested interests and biases.

It is not that I believe that science gives us ultimate truths about human behavior, whereas clinical insight is always foolish and wrong. Rather, I worry that when psychotherapists fail to keep up with basic research on matters on which they are advising their clients; when they fail to learn which methods are most appropriate for which disorders, and which might be harmful; when they fail to understand their own biases of perception and politics and do not learn how to correct them; when they fail to test their own ideas empirically before running off to promote new therapies or wild claims—then their clients and the larger public pay the price of their ignorance.

For present purposes, I am going to do an end run around the centuries-old debate about defining science, and focus on two core elements of the scientific method. These elements are central to the training of all scientists, but they are almost entirely lacking in the training of most psychotherapists today. The first is skepticism: a willingness to question received wisdom. The second is a reliance on gathering empirical evidence to determine whether a prediction or belief is valid. You don't get to sit in your chair and decide that autism is caused by cold, rejecting “refrigerator” mothers, as Bruno Bettelheim did. But legions of clinicians (and mothers) accepted his cruel and unsubstantiated theory because he was, in fact, Bruno Bettelheim. It took skeptical scientists to compare the mothers of autistic children with those of healthy children, and to find that autism is not caused by anything parents do; it is a neurological disorder.

The scientific method is designed to help investigators overcome the most entrenched human cognitive habit: the confirmation bias, the tendency to notice and remember evidence that confirms our beliefs or decisions, and to ignore, dismiss, or forget evidence that is discrepant. That's why we are all inclined to stick to a hypothesis we believe in. Science is one way of forcing us, kicking and screaming if necessary, to modify our views. Most scientists regard a central, if not defining, characteristic of the scientific method to be what Karl Popper called “the principle of falsifiability”: For a theory to be scientific, it must be falsifiable —you can't just show me observations that confirm it, but also those that might show the theory to be wrong, false. If you can twist any result of your research into a confirmation of your hypothesis, you aren't thinking scientifically. For that reason, many of Sigmund Freud's notions were unfalsifiable. If analysts saw evidence of “castration anxiety” in their male patients, that confirmed Freud's theory of its universality; if analysts didn't see it, Freud wrote, they lacked observational skills and were just too blind or stubborn to see it. With this way of thinking, there is no way to disconfirm the belief in castration anxiety.

Yet many psychotherapists perpetuate ideas based only confirming cases — the people they see in therapy — and do not consider the disconfirming cases. The popular belief in “the cycle of abuse” rests on cases of abusive parents who turn up in jail or therapy and who report that they were themselves victims of abuse as children. But scientists would want to know also about the disconfirming cases: children who were beaten but did not grow up to mistreat their children (and, therefore, did not end up in therapy or jail), and people who were not beaten and then did grow up to be abusive parents. When the researchers Joan Kaufman and Edward Zigler reviewed longitudinal studies of the outcomes of child abuse, they found that although being abused does considerably increase the risk of becoming an abusive parent, more than 70 percent of all abused children do not mistreat their offspring—hardly an inevitable “cycle.”

Practitioners who do not learn about the confirmation bias and ways to counteract it can make devastating judgments in court cases. For example, if they are convinced that a child has been sexually molested, they are often unpersuaded by the child's repeated denials; such denials, they say, are evidence of the depth of the trauma. Sometimes, of course, that is true. But what if it isn't? In the Little Rascals daycare-abuse case in North Carolina, one mother told reporters that it took ten months before her child was able to “reveal” the molestation. No one at the time considered the idea that the child might have been remarkably courageous to persist in telling the truth for so long.

Similarly, most clinicians are not trained to be skeptical of what a client says or to demand corroborating evidence. Why would they be? A client comes to see you complaining that he has a terrible mother; are you going to argue? Ask to meet the mother? Some clinicians, notably those who practice cognitive-behavior therapy, would, indeed, ask you for the evidence that your mother is terrible and also invite you to consider other explanations of her behavior; but most do not. As the psychiatrist Judith Herman explained in a PBS Frontline special on recovered memory: “As a therapist, your job is not to be a detective; your job is not to be a fact finder; your job is not to be a judge or a jury; and your job is also not to make the family feel better. Your job is to help the patient make sense out of her life, make sense out of her symptoms . . . and make meaning out her experience.”

Herman’s remark perfectly summarizes the differing goals of most clinicians and scientists. Clinicians are certainly correct that most of the time it is not possible to corroborate a client's memory anyway, and it isn't their job to find out what “really” happened in the client's past. Scientists, though, have shown that memories are subject to distortion and confabulation and that self-justification often warps the stories we tell to “make sense out of our lives.”  So if the client is going to end up suing a parent for sexual abuse, or if the therapist's intervention ends up causing a devastating family rift, surely a little detective work seems called for. Detective work is the province of scientists, who are trained not to automatically believe what someone says or what someone claims to remember, but to ask, “Where's the evidence?”

For psychological scientists, clinical insight is simply not sufficient evidence. For one thing, the clinician's observations of clients will be inherently limited if the clinician overlooks comparison groups of people who are not in therapy. For example, many clinicians invent “checklists” of “indicators” of some problem or disorder based on children or adults they see in therapy—say, that “excessive” masturbation or bedwetting are signs of sexual abuse or, my favorite, that losing track of time or becoming engrossed in a book is a sign of multiple personality disorder. But before you can say that bedwetting or masturbation is an indicator that a child has been sexually abused, what must you know? Many psychotherapists cannot give you the simple answer: You must know the rate of bedwetting and masturbation among all children, including nonabused ones. In fact, many abused children have no symptoms, and many nonabused children wet their beds, masturbate, and are fearful in new situations.

Throughout the 1980s and 1990s, many therapists routinely testified in court that they could magically tell, with complete certainty, that a child had been sexually abused because of how the child played with anatomically correct dolls, or because of what the child revealed in drawings. The plausible assumption is that very young children may reveal feelings in their play or drawings that they cannot express verbally. But while such tests may have a therapeutic use, again the scientific evidence is overwhelming that they are worthless for assessment or diagnostic purposes. How do we know that? Because when scientists compared the doll play of abused children to that of control groups of nonabused children, they found that such play is not a valid way of determining whether a child has been sexually abused. The doll's genitals are pretty interesting to almost all kids.

Likewise, psychological scientists who study children's cognitive development empirically have examined the belief held by many psychotherapists that “children never lie” about sexual abuse. They have shown in dozens of experiments that children often do tell the truth, but that they also lie, misremember, and can be influenced to make false allegations—just as adults do. Researchers have shown, too, that adults often misunderstand and misinterpret what children say, and they have identified the conditions that increase a child's suggestibility and the interviewing methods virtually guaranteed to assure false reports—and developed better ways of interviewing children that reduce the likelihood of those errors.

But to the public, all this remains an internecine battle that seems to have no direct relevance. That's the danger. Much has been written about America's scientific illiteracy, but social-scientific illiteracy is just as widespread and in some ways even more pernicious. People can deny evolution or fail to learn basic physics, but such ignorance rarely affects their personal lives. The scientific illiteracy of psychotherapists has torn up families, sent innocent defendants to prison, cost people their jobs and custody of their children, and promoted worthless, even harmful, therapies. A public unable to critically assess psychotherapists' claims and methods for scientific credibility will be vulnerable to whatever hysterical epidemic comes along next. And in our psychologically oriented culture, there will be many nexts. Some will be benign; some will merely cost money; and some will cost lives.

Postscript

Out of curiosity, I looked up rebirthing therapy. I thought surely it was dead, especially after the tragedy of Candace Newmaker, but no. Here’s an online description from 2019:

Rebirthing is an alternative therapy technique used to treat “reactive attachment disorder.” This therapy uses a specific kind of breathing meant to help you release emotions. 

Supporters of rebirthing claim that by participating in a “rebirth” as a child or adult, you can resolve negative experiences from birth and infancy that may be preventing you from forming healthy relationships. Some even claim to have memories of their birth during rebirthing. 

In other words, supporters claim that the technique gives you a do-over of your entrance into the world, without the trauma or instability you originally experienced. The goal is to process blocked emotions and energy, leaving you free to form trusting, healthy attachments.

The story concluded: “Rebirthing therapy is controversial because there is little evidence of its merit. In some cases, it has proven to be dangerous.” Well, duh.

Why all the therapies? Has nothing changed? Follow the money. Therapy became a massive growth industry, generating cheap, easy degrees through free-standing therapy mills (separate from credentialed clinical psych programs affiliated with university psych departments) as the service economy exploded. Who wants to spend thousands of dollars and many years of study and having to write a thesis and have supervised training to become a licensed clinical psychologist, when you can go to a therapy or social work program offering an easier, faster way to get a degree and go out to “help people”? Such a kind and lofty goal, and you don’t have to take pesky classes in statistics or methods or evidence-based treatments.

With so many thousands of people speedily earning a degree to call themselves therapists, how does a potential client know how to find a good one?  To answer that question, the Academy of Psychological Clinical Science (PCSAS) was established in 2007. It is an independent, non-profit body that provides rigorous, empirically based accreditation of Ph.D. programs in psychological clinical science. The organization grew out of a conference on “Clinical Science in the 21st Century,” attended by prominent scientists representing numerous graduate training programs in clinical or health psychology and a representative from the National Institute of Mental health and APS. Today there are more than 80 accredited Academy programs. The hope is that one day, when a person chooses a “psychotherapist” or a “clinical psychologist,” they will know what they’re getting.