|The following is a response written to a paper published in the journal Clinical Psychology Review. It was submitted to that journal, but was rejected for publication because, the editor stated, it is not the policy of that journal to publish responses to its articles. While much has been written on EMDR since the Herbert et al. paper was published and my response was submitted, I have not edited my response to include the new material.
An Alternative Opinion on Science, Pseudoscience and EMDR:
A response to Herbert et al.
Howard Lipke PhD
DVAMC, North Chicago
Herbert, Lilienfeld, Lohr, Montgomery, O’Donohue, Rosen, & Tolin (2000) in their paper on science, pseudoscience and EMDR make a number of assertions about EMDR and its dissemination that are contrary to the scientific principles those authors claim to support. This is my response.
EMDR is a method of psychotherapy which has been repeatedly shown to help people who have psychological problems following trauma, as demonstrated by several studies (e.g. Carlson et al. 1998; Rothbaum et al., 1997; S. Wilson, et al.1997). Therapeutic response has often been faster than that expected, or demonstrated by other methods (e.g. Marcus et al., 1997; Rothbaum et al., 1997; van Etten and Taylor, 1998). Several studies have supported, or suggested, the therapeutic value of the eye movement component. (e.g. Feske and Goldstein, 1997; Montgomery and Allyon, 1994; D. Wilson, 1996) Empirically supported rationales for mechanism of action for the eye movement component, and potentially for eye movement substitutes, have been experimentally demonstrated by research psychologists. (Andrade et al. 1997; Becker et al., 1999) In addition, the position that EMDR is not a unique method of treatment, that it only succeeds because of the exposure component, is inconsistent with behavioral explanations, as the interruptions for eye movement or other activity, violate the established principles for psychotherapeutic effect (see Rodriguez & Craske, 1993). All of the above statements are supported by the cited and other references, however they can all be scientifically debated.
Likewise the position that the dissemination of EMDR has taken place in a professionally responsible manner is well supported. Shapiro did not offer public training in EMDR until she had completed a controlled study of the method's effectiveness, a standard that far exceeded the conventional practice of that time. And, until other researchers reported positive results for EMDR treatment, she continued to label the method as experimental. Her initial expectation was that her method could be used effectively by following published brief instructions, and therefore was easily transferable. It was not until she began to receive contrary feedback, by hearing what her trainees had taught others, thinking their misunderstandings were actual EMDR, that she initiated the requirement that participants in her training agree not to represent themselves as being able, based on that experience, to teach others. When her text was published, in 1995, and there was a detailed authoritative description of EMDR she dropped that requirement. She always required that participants be licensed to provide psychotherapy in order to take her training- the exception was for supervised students in a licensing track. (EMDR Institute trainings have turned away applicants with medical degrees who were not psychiatrists, as well as licensed substance abuse counselors and others who were not specifically licensed to be psychotherapists.) Training always included an intensive practicum component with close supervision. Training has been offered for free or token cost to many researchers, as well as to students or therapists working with underserved populations. Despite the added expenses of closely supervised practica, the full training price is commensurate with fees paid for other trainings that do not offer practicum experience. Thus, it can be strongly asserted that EMDR training has been run on sound teaching principles, and not to maximize income. All of these points are supported by the historical record, but they all can be questioned and explored in reasoned discourse.
As to claims of "breakthrough" and "paradigm shift", although I would have rather Shapiro’s second book not have "breakthrough" in the subtitle, I believe these terms are supportable by data referred to in the second paragraph of this paper. The empirically supported finding that substantial relief of many PTSD symptoms often occurs in as few as one to three sessions makes EMDR a breakthrough. The fact that the treatment effects occur rapidly despite interruption of "exposure" would call for a shift in paradigm from the conventional learning theory paradigm, which relies on prolonged exposure to explain desensitization. Again these claims have been well supported, but they are also legitimately debatable.
Unfortunately, rather than engage in scientific discussion of the above issues a number of established and junior academic psychologists have, in the name of protecting "science”, written, and in their capacity as editors, accepted for publication, papers that claim to be scientific discussion or disagreement on the subject, but in fact are attacks on EMDR that employ misrepresentation, errors of omission and rhetorical styles that are so inflammatory that they debase the very principles they claim to defend.
Posing as a scientific exploration of the issues, the paper by Herbert et al., published first on the Science and Pseudoscience Web Site, and later by the Clinical Psychology Review, is one of the latest in this series of attacks on EMDR. Although my own comments at this point may appear too strong for academic discussion- compare them to the Herbert et al. accusations that EMDR is "pseudoscience”, the satirical remark that practitioners of EMDR are like members of a "granfallon" (a derogatory term invented by Kurt Vonnegut), and that the kind of open mindedness that would accept EMDR is the kind that would lead " one's brains to fall out." The virulence of this attack is such that to try to rebut may be self defeating, in that repetition even to disagree, has the potential of making the association between the false accusations and EMDR stronger. Unfortunately bowing to this concern would then leave the field to those who believe that this is a situation in which the ends justify the means, which ironically enough, in this case, entails their using anti-scientific methods to save the what they appear to think is the scientific method
While I dispute the scientific integrity of the Herbert et al. authors attack I do not begrudge the Herbert authors their rhetorical skill. In citing Hume they declare strong claims demand strong evidence, likewise strong condemnation (e.g. pseudoscience, etc.) demands not only strong evidence but strict adherence to scientific principles in making the attack. In this protest I will present several examples of the violation of scientific principle, chosen among a number of possibilities, that are sufficiently compelling to justify my own strong
1. The Herbert et al. paper proclaims EMDR to be pseudoscience partly because EMDR proponents are said to attack the competency of researchers who have done critical work. The list of supposed victims of purely personal attack includes Jensen, as the author of a 1994 study, to which I was a consultant. In their effort to condemn EMDR they ignore the fact that criticisms of the Jensen study are well founded. Among other errors, the Jensen therapists failed to allot prescribed time for treatment, and terminated sessions in the midst of subjects showing decreasing distress. As EMDR has been taught from Shapiro's earliest trainings, the sets of eye movements are to continue to be offered as the client reports decreasing distress. Jensen did not continue to offer sets of eye movement as client distress dropped- this is a fundamental error in application. In that the sessions were terminated well before the prescribed expected treatment time this error was especially mystifying. So while Jensen applied the method well enough for his subjects to gain some initial improvement, the aforementioned errors would be expected to limit his results. Furthermore, it would be very unlikely, and well outside claims for EMDR, that Jensen's subjects would show global changes in their chronic war related PTSD based on two sessions, even if he had applied the method expertly.
The observations concerning fidelity to standard practice were shared with Dr. Jensen as his work was in progress, were alluded to in Jensen’s original paper, and were published in the Behavior Therapist (Lipke, 1999), a paper of which some of the Herbert et al. authors are self-admittedly (Lohr, et al.1999) aware. Nevertheless, never do the Herbert et al. authors refer to the fact that there are specific well founded criticisms of Jensen's work, rather they give the misleading impression that criticism of Jensen is purely ad hominem.
2. The habit of misrepresenting EMDR research, including their own studies, is
longstanding for some of the Herbert et al. authors. One example of self-misrepresentation in the Herbert et al. paper is the reference to a 1998 review of EMDR, written by three of the co-authors, as a credible summarization of EMDR. In that paper the co-authors wrote: "Early experimental research with single subject designs suggested that eye movements are not necessary for reduction of verbal reports of symptoms.” (Lohr, Tolin and Lilienfeld, 1998, p 145) In fact, four of the single subject design studies they cite as references suggested just the opposite. In the abstract of one of the five studies these same authors wrote (and later cited as unsupportive of the eye movement): "Both subjects' verbal reports of fear changed substantially when eye movements were added to the general treatment protocol. It was concluded that the addition of eye movement was necessary to reduce the aversiveness of some phobic imagery."(Lohr, Tolin, & Kleinknecht, 1996 p 73). Perhaps it will be difficult to believe that co-authors of a paper that so boldly impugns the scientific integrity of others would so misrepresent their own conclusions, and then repeat that misrepresentation after it had been publicly called to their attention. You can look up the original articles, just to be sure.
3. As an example of a supposed exaggerated claim by and for EMDR, Herbert et al. state "the original published account of EMDR (Shapiro, 1989, p. 216, 221), touted this intervention as a single session treatment of PTSD. Such claims are often made on the basis of clinician testimony (workshop training and word-of-mouth) and published case studies." How odd it must be to those who rely on the integrity of the scholarship of Herbert et al. that Shapiro reports not on case studies, but on an experiment, with subjects randomly placed in treatment and delayed treatment conditions. And, even more saliently, not only does Shapiro not claim a "one session treatment, but rather on the same page 221 to which Herbert et al. refer she states: "In addition it must be emphasized that the EMD procedure, as presented here, serves to desensitize the anxiety related to traumatic memories, not to eliminate all PTSD-related symptomotology, and complications, nor to provide coping strategies to victims" Thus mount the examples of Herbert et al. exhibiting the same methods of which they falsely accuse another.
4. Finally, on a relatively minor matter, though still a troublesome example of at least poor scholarship, I wish to put on record correction of an error in the Herbert et al characterization of my own research. In trying to make a point about a "rationalization trap" Herbert et al. summarize a research report of mine (published in Shapiro, 1995, but which they cite from a 1994 APA presentation) as thus: " ...Lipke (1994) reported that 77% of the most highly trained participants (Level 2) surveyed after completion of training agreed that extensive training was a vital step in using the technique." The Herbert et al statement is false - I did not separately considered the survey responses of level 1 and level 2 participants. This is relevant because it appears that Herbert et al are trying to argue that
level 2 respondents would endorse the need for extensive training, because of a stronger investment than level 1 participants, and therefore opinions of the survey responders can be discounted. There are other problems with the Herbert et al description and interpretation of this survey, however it is not necessary to belabor this point.
Herbert et al. quote many of our illustrious predecessors on the nature of true science, and the true scientist- they invoke Paul Meehl and Bertrand Russell, saying the true scientist has a passion "not to be fooled and not to fool anybody else." Unfortunately, they have personally failed to meet that standard. When Herbert et al. can make the false accusations and omissions about EMDR prevalent in their paper, after having already received feedback about the inaccuracy of much of their evidence, they are clearly trying to fool somebody. Continued publication and re-publication of these, while they may somehow promote the careers of the authors, can only sabotage efforts to promote science in psychology. This is especially grievous, in that so many of the Herbert et al. authors are faculty members, whose views may be given credence by impressionable students, whose careers depend on their teachers' approval and whose investment in their post graduate education far exceeds the investment of EMDR workshop participants in that activity. Talk about a "rationalization trap".
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