Thursday, March 02, 2006

Clinical Trials of Psychotherapy:

The New York Times recently discussed psychotherapy, snd they are now fielding letters about it. One writer, Ed Erwin, a professor at the University of Miami, wrote today to say that "The cure for this epistemolgical sickness is to insist on the use of randomized clinical trials before a therapy is judged to be effective. There is no other way."
Now the Virtual Tourist once observed that it is extremely difficult to design a psychology experiment to test only what you really want to test, but bear with me here. I've got a few modest ideas.

First let's consider Blind Trials: People who sign up for psychotherapy will not know whether they are going to see a real therapist, or someone who is specially trained - for this experiment - to appear to be a therapist while actually doing nothing. (Now don't waste my time asking me how to tell the difference, we're trying to be serious here!) Then we can try to determine the relative efficacy of the real and fake therapists in actually helping and curing people. But this, as I'm sure you know, is inadequate. We need Double Blind Trials.

Here's how the double blind trial works. Certain people enter an education program to become psycotherapists, but on a random basis, some are assigned to a program that, while appearing to teach psychotherapy, actually teaches them to do nothing at all. (I said Don't waste my time with your stupid question ...) Then we assign patients randomly to real or placebo therapists, and compare the results.

Now I'm sure you agree there's a stupendous cost in running this experiment, but if we can just end the Iraqi war a few days early, that ought to cover the cost. We have to bear the immense expense of training the placebo therapists, and then, if it turns out that psychotherapy really works, recompensing them for the lost years of their lives and training them again, properly this time.

But there is always that silver lining! Suppose it turns out that placebo therapy is just about as good as the real thing. Then the placebo therapists can hang out their singles, charge a little less perhaps, and go off happily curing people.
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