Psychotherapy as Religion

In Psychotherapy as Religion, author William M. Epstein seeks to demonstrate that the entire field of psychotherapy is based upon unscientific concepts and has never been shown to effectively treat any mental disorder. Dr. Epstein, a professor of social work at the University of Nevada, reports that the basis of his premises are derived from reviewing randomized controlled trials that addressed effectiveness and were published within the past decade in either the American Journal of Psychiatry, Archives of General Psychiatry, or the Journal of Consulting and Clinical Psychology. The introduction presents the author's conclusion that psychotherapy, while lacking in efficacy, is widely accepted in America because it is in concordance with the nation's “heroic individualism” and belief in personal responsibility for social ills. He argues that psychotherapy has taken on the role of social religion, and finds similarities with Christian Science. The major portion of the book is devoted to criticism of individual studies and meta-analyses. Specific topics include depression, anxiety, eating disorders, addictions, testing methodology, psychodynamic psychotherapy, and cognitive-behavioral therapy. In each chapter, the author identifies apparent limitations in every study he encounters. Many of his arguments appear articulate and well crafted, such as rejecting studies with high attrition rates or lack of an adequate comparison arm. In other instances, he discounts studies on the basis of the argument that psychologists have an inherent conflict of interest when evaluating the validity of their own field, and therefore might not be able to objectively report upon the patients they evaluate. The author's use of complicated sentence structure and obscure vocabulary impairs the readability of the text. Likewise, redundant editorializing detracts from what would otherwise be a straightforward and logical presentation. The book may appeal most to those with an interest in evidence-based medicine and to those true believers in psychotherapy who enjoy having their faith challenged.