Brad Jesness, Psychology Critic, Calls for Improvements in Science of Psychotherapy

NOTE: Click here for Jesness's Scorer, a program for scoring objective tests and personality inventories, including the MMPI, with a Java version available for PC/Linux users and a JavaScript version available for MAC users.

Shortly after adopting this assumed name in May, 2001, J. Wyatt Ehrenfels took to psychology's listserves to announce the launch of his web site, where he was quickly acquainted with the name Brad Jesness. "It would seem I wandered into the wake of another boat," remarked Ehrenfels. "I fielded a handful of posts from listserv participants who fingered 'J. Wyatt Ehrenfels' for an alias of an agitator named Brad Jesness, a master's level counseling and psychology instructor." A Yahoo search on the name 'Brad Jesness' revealed links to a number of posts in which Brad claims to have been harassed by psychologists disturbed by his round indictment of the APA and the science of psychotherapy. Having sampled a hint of this harassment, Ehrenfels contacted Jesness to swap notes, to which Brad Jesness replied by stating that he was willing to help "as long as what you are doing is simply expressing yourself truthfully and trying to exercize your right to free speech." Jesness's Core Psychology web site, which includes his essay Critical Science Problems for the Psychotherapy Field and his Client Advocate's Manifesto, have struck a nerve within the psychological community, and his efforts were rewarded with the support of other prominent sojourners (e.g., Alvin Mahrer, Allen Ivey) toiling at the heart of psyche and on the fringes of Psychology. Jesness reports having been "thrown off the CLINICAL-PSYCHOLOGISTS listserv for no good reason," which Ehrenfels cites as an all-too common consequence of posting creative, critical, or unconventional points of view in a psychology forum. "Ask for evidence of any wrong-doing by me," remarks Jesness, "and they can supply none." A detailed accounting of harassment by psychologists of Jesness and his wife will be made available in an imminent report.

At its broadest-level, the Jesness critique is two-pronged. Therapy is neither guided nor supported by science. "It is arguable that clear, well validated techniques exist only for some anxiety disorders, some depressive conditions, and a few other problem conditions. It is only in these minority cases that some mental health care providers can even be seen as operating reasonably in accord with science...Their time may not be worth the money unless you are unsophisticated and out of control."
Jesness says these are what is lacking:

effective therapies

Typically, therapeutic gains are roughly half the size of gender effects, such that the effects of therapeutic intervention are at best only as large as the difference between the average man and woman on certain personality inventory scales. You could not expect therapy to achieve more than what you would naturally expect in the way of the difference between the average man and woman on relevant traits. "With a hard-to-treat problem like anger, the average shift from therapy will, if you are lucky, be about half the size of the difference between the average man and average woman on an aggressiveness questionnaire!"

standards for validating therapies

They use ill-conceived control groups to avoid meaningful tests of a therapy's validity.

Not unlike Ehrenfels objection to the practice of comparing research "hypotheses" with null results (i.e., null hypothesis testing), Jesness points out that the preponderance of what we know about therapeutic efficacy is based on comparing the effects of therapy against the effects of no treatment (i.e. neglected clients) or placebo treatment (i.e. treatment thought to be inert). Citing research that the efficacy of a therapy can be shown to double (or conversely, halve) when compared to another type of control group, Jesness pines for a class of authentic science-practitioners (or at least some foundation research) willing to pit their preferred therapy against treatment by trained and untrained peers and paraprofessionals. "Neglected clients in waitlist control groups do less than what a person would normally do while waiting, such as seek help," remarked Jesness. "Is it any wonder waitlist control groups are so popular?"

"Professionals" did not prevail in the only three controlled studies to pit them against "other reasonable helpers," prompting Jesness to speculate as to why no similar studies have been performed since 1979. But additional studies would be helpful to identify those problems for which professional therapy (i.e., graduate-trained) is actually needed and those for which professional alternatives or improvements may be necessary.

Jesness used the phrase "mock science" to refer to the behavior of academics and practitioners under tight community controls, a charge consistent with Ehrenfels's various references to psychology as a "terrycloth science," "ADHD science," or "autistic empiricism." "As crude as this metaphor is," remarks Ehrenfels, "I imagine Dr. Frankenstein's next of kin applying cosmetics to the rectilinear skull of Dr. F's deceased monster and attempting to pass that off as a human being. This is an intellectually and inspirationally stifling culture that takes for the soul of psychology the cosmetically rigorous features of finished research coming out of harder disciplines. It expects imitation or lip service from its students, lifetime enslavement from its academics, and from its independent practitioners, well, they're expected to lapse into a pseudo-scientific stupor so lackadaisical as to fail to advance neither real science nor the soul of psychology, the human psyche. At this stage, the only thing the forced feeding of scientific precepts and discipline accomplishes is the stagnation of thought. Jesness reminds us that we can do better. We can do both. He challenges us to do both. And until we do both, we're no more scientific or medical than the woman in the white coat behind the Clinique counter at JC Penny's."

reliable diagnoses

Poor inter-rater reliability (.7) among therapists in determining whether or not a client had a mood disorder.

Poor inter-rater reliability (.7) among therapists in determining whether or not a client had an anxiety disorder.

Not uncommon disagreement as to whether a client's disorder is a mood disorder or an anxiety disorder.

Reliabilities for 13 of 27 specific ICD-10 diagnoses, from which the DSM-IV draws heavily, fail to meet the minimum standard (.60) established by G. Meyer for the coding of client responses to Rorschach inkblots. "We cannot diagnose people as well as we can sometimes agree on what ink blots mean!" chides Jesness. "Is this "okay"? I don't think so!!" (See Jesness's web site for the statistics).

scientific motive

Despite being confronted by poor-to-marginal reliability, the psychological community did "very little" to investigate the inter-rater reliability of individual criteria, generating inter-rater reliability data for only 14 of the top 40 diagnoses in the 15 years between DSM-III and the meeting of the DSM-IV committee to define "new" diagnostic "options."

No attempt has been made to operationalize DSM disorder criteria.

There is an eerie resemblance between the Ehrenfels and Jesness critiques about the DSM.

Jesness on the DSM:

"It displays the lack of appreciation for the grassroots inductive work that, it seems to me, has to be done. True, the 'diagnostic options' decided on by the DSM committees every decade or so are tested after the fact for inter-rater reliability. But, the problem is: Do you wait for rare committee meetings to try to piece together a set of best 'options' on a relatively rare basis or do you strive for better reliabilities for criteria and better criteria more often, on a more local level?? Yes, people must first have 'guesses' about what might be better criteria and then investigate them. But this need not all be done by rare committees alone doing this work. Doing virtually all such diagnostic development work just by committee (meeting every decade or so) is loaded on a hypothetico-deductive side as opposed to a grassroots, more inductive, discovery (and yes, trial and error) approach. One could argue that indeed you do (and must) discover the better criteria, rather than formulate them en masse in our heads during big committee meetings. What our present attitude suggests, and what is done now, is the figuring of nature out in our heads and then (only afterward) testing your limited range of relatively constrained ideas."

Ehrenfels on the DSM:
"The DSM is formulated arbitrarily which is to say it is meted out socially in committee and has no standing in science or nature. It is important to bear in mind that psychologists co-opted a classification scheme from another organization (the DSM is published by the American Psychiatric Association) as part of an effort to imitate just enough of both science and medicine to distract the public from the fact they are incapable or unwilling to do either well. Inasmuch as the DSM drives psychopathology training, organizes NIMH research, and spawns classes of specialists and their manualized treatment protocols, psychologists have become second-rate psychiatrists with no real psychologistic education. No wonder they lobbied for prescription privileges. Surrounded by nails, they are without a hammer. And by canonizing disorders at such a superficial level, they create a status quo difficult to change that can only modestly be adjusted by a post-hoc science that sees the world through the eyes of the DSM. No real exploration is possible within this system. No serendipity and no discovery. Clinical research has become synonymous with the science of the DSM, and whether it be reliability or epidemiology, it is just a process of affirming, denying, or qualifying an ingrained structure."

While Jesness by and large restricts his commentary to empirical research, he occasionally flirts with the kind of broad "cultural" characterization more typical of coalition partner, J Wyatt Ehrenfels, and draws conclusions similar to those of his counterpart. Citing research that an internal locus of control is associated with adaptation (and conversely an external locus of control with depression, anxiety, and underachievement), Jesness capitalized on research that failed to associate an internal locus of control with the psychological community. "Locus of control does not correlate with who becomes a counselor," professed Jesness. "And, locus of control is not correlated with 'effectiveness of counselors-in-training' (and this is an empirical fact), likely because it is not correlated with those that go into the field in the first place (this is certainly a possible and very likely explanation for this finding)." Jesness believes persons who aspire to become therapists are typically outer-directed personalities who exhibit an "elitist or maladapted" dependence in their appreciation for therapy, and he cites unpublished research revealing that on average a licensed therapist will have more therapy than one of their own clients. "This (dependence) also may account for why so little initiative and good work is done in the field by individuals and individual agencies."

Jesness is amused that the students tend to think of empathy as a technique learned at the doctoral levels, and he believes this speaks volumes about their maturation and adjustedness. "Therapists can be (and I believe often are) nasty people when they don't have your utter cooperation (which you pay for). If you're not confused and uneducated you maybe should not even consider a therapist. And if you are inexplicably confused consider psychiatry (drugs). Whether it's physiological or psychogenic you can't be too far gone (confused) for a psychologist. They require everything be optimal for their "magic" to work. Friends may not be as good as some counselors hour for hour, but you can afford more than a few hours with a friend. Research has shown that, for a rather general subgroup of college students-who-felt-they-had-problems, being assigned to a listening professor (in any field) was as good as meeting with a counselor."

Jesness thinks all this poor science makes for poor service and poor business. "You do not know what kind of program they will use typically until after you start. It will therefore take at least a session (possibly $100) to find out. This is neither fair nor therapeutic. Why should they expect business only by reputation? No one else who will earn many hundreds of dollars from you (if you do just what is usual) will not explain what they are going to do. You wouldn't accept this from a carpenter (and don't for a minute try to tell me their skills are not at as high a level)."