Our Raison Detre

So why should we be concerned about the widening gap between mental health science and practice? We can identify at least four major reasons, which collectively serve as the raison d’être for this new journal.

(1) Unvalidated or scientifically unsupported mental health practices undermine the general public’s confidence in our professions. Once the reputation of the mental health professions has been sullied, many individuals in the general public may understandably be reluctant or unwilling to seek psychological or psychiatric treatments, a number of which may be effective. In addition, after seeing mental health professionals make unwarranted or dubious assertions, many individuals in the general public may accord less weight to psychological advice derived from well-supported research findings.

(2) Unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments. Economists refer to this unfortunate consequence as “opportunity cost.” Many individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either. As a result, they may forfeit the opportunity to obtain treatments that could be more helpful. Thus, even ineffective treatments that are by themselves innocuous can indirectly produce negative consequences.

(3) Unvalidated or scientifically unsupported mental health practices can be harmful. In the field of psychotherapy, the default assumption has often been that “doing something is better than doing nothing.” Although this assumption may well hold true in certain cases, it has been shown to be demonstrably false in others. The growing literature on “deterioration effects” in psychotherapy increasingly suggests that a thankfully small but nevertheless nontrivial proportion of individuals (perhaps 3 to 6%) tend to become worse following treatment (Strupp, Hadley, & Gomez-Schwartz, 1978), although the variables that account for such deterioration remain controversial. Moreover, therapists who use highly suggestive techniques, such as hypnosis, guided imagery, and sodium amytal (the so-called truth serum), to recover purported memories of satanic ritual abuse and alien abductions may be inadvertently inducing analogues or even full-blown variants of posttraumatic stress disorder in their clients (Chu, 1998). The tragic and heartbreaking case of Candace Newmaker, the 10-year-old Colorado girl who was smothered to death in 2000 by therapists practicing rebirthing therapy, an unvalidated technique for treating children with attachment problems, attests to the dangers of implementing methods that are empirically unsupported, untested, or both. Still other techniques, such as facilitated communication for infantile autism (see Herbert, Sharp, & Gaudiano, this issue), have resulted in false—and in some cases terribly destructive—accusations of child abuse against family members.

(4) Unvalidated or scientifically unsupported mental health practices eat away at the scientific foundations of our professions. Richard McFall (1991) has argued persuasively that the scientific basis of clinical psychology is steadily eroding as a consequence of this profession’s collective failure to attend to the threats posed by unsubstantiated treatment and assessment methods. Once we abdicate our responsibility to uphold high scientific standards in administering treatments, our scientific credibility and influence are badly damaged. Moreover, by continuing to ignore the imminent dangers posed by questionable mental health techniques, we send an implicit message to our students that we are not deeply committed to anchoring our discipline in scientific evidence or to combating potentially unscientific practices. Our students will most likely follow in our footsteps and continue to turn a blind eye to the widening gap between scientist and practitioner, and between research evidence and clinical work.