Abstract
Substantively as well as symbolically, psychotherapy for depression and addiction repeats the clinical record of post-traumatic stress disorder. The best of the best studies of psychotherapy for depression fails as science, lacking true tests of treatment while routinely exaggerating the effectiveness of psychotherapy. The research does not dispel the likelihood that psychotherapy for depression fails to improve on the processes that account for natural remission. Psychotherapy offers no apparent cure for drug addiction. The variation in reported addiction rates from year to year, suspect in itself, may be due to generational learning and changing fashions in social attitudes to illicit drug use more than to any form of treatment. The small amount of remission and true long-term abstinence reported in psychotherapy trials are likely determined by rare patient motivation and their situations rather than treatment itself.
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Notes
- 1.
Johnson, the lead author of Johnson et al. (2016) was queried by this author for further information: How was intention to treat handled—carrying forward initial or recent scores—and what if any were the scoring differences between the blind rater and the assessor who was not blind. In return, Johnson emailed “No carryforward - used general linear models that accommodate missing data.” A further query was sent: “What were the assumptions of the linear models? What data was used to substitute for the missing data? And the comparison of the blinded and unblinded raters? I could not find the answers in the paper. Did I miss something?” No response. If the undisclosed linear model in any way extrapolated the initial ratings of patients who dropped out, it probably exaggerates the effectiveness of the intervention since many if not most patients in psychotherapy report initial gains. Those gains, probably emerging in large part from the hope of recovery, may be ephemeral especially in those who drop out. Further, it is beyond strange that a study would report differences in blinding but not report an analysis of its effects. The absence leads to two suspicions: first that the differences were real with the blinded rater providing scores that undercut the effectiveness of the intervention and second that both the absent evaluation and the use of a linear model for intention to treat analyses were conscious attempts to enhance the reported effectiveness of the interventions.
- 2.
Note, too, the winter study with Fals-Stewart as coauthor that did not experience any attrition but also scheduled urinanalyses.
- 3.
As an aside, the fact that both objective tests for drug use agreed with subjective reports in Hayes et al. provides no warrant to employ subjective tests without objective corroboration.
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Epstein, W.M. (2019). Psychotherapy for Depression and Addiction. In: Psychotherapy and the Social Clinic in the United States. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-32750-7_4
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