Have you heard of...

This section is for questions relating to therapy, assessment, formulation and other aspects of working with people in mental health services.

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rustyrebecca
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Have you heard of...

Post by rustyrebecca » Sun Nov 11, 2018 2:36 pm

I hope someone may be able to help me with regards to a relatively new therapy that causes me great concerns, but where I have hit a brick wall to know what to do next.
Have you heard of Brain Working Recursive Therapy (BWRT)? It was created a while ago now by a hypnotherapist called Terrence Watts.
If you search for it, all you will find are claims of immediate cures for a whole host of complex and non complex mental health conditions. Though Terrence Watts says that he doesn't exactly claim to cure anything (through subtle wording) but basically, this is what the websites say. Amazing things will happen pretty quickly. Then there are a huge amount of mostly hypnotherapists who are falling over themselves to sing BWRT quite literally from the rooftops.
There is a group on facebook, where anyone can join, about BWRT, but the rules of the group are to not discuss empirical evidence. If anyone does, they will be hastily removed. And that is because there is no evidence! Absolutely none. There is one study where the results are being awaited (that Terrence refers to proudly) of about 6-8 people in the sample!
I started to research BWRT quite a while ago and was very concerned that so many hypnotherapists were administering it. The training (that is advertised so much, of course, and isn't cheap) is very limited and one can be a proficient in BWRT within a year. Vulnerable people are paying hundreds for this treatment. I have received it myself from 3 different practitioners (over skype) and it didn't do a thing. A moment in time is frozen and then the therapist attempts (with you) to put a new, positive memory in place where a negative/fearful reaction was.
I have written for The Psychologist before (BPS) and approached the editor about writing a piece on new therapies such as this one with regards to a lack of peer reviewed studies, just anecdotal accounts that are evangelical and seem false (if you read what people write to Terrence on the facebook page, it is sycophancy gone mad!). But the editor of the magazine (who is happy to have an article) said that sometimes it is best to be relaxed about new therapies! I argued with him, but gave up (they need a new editor, with a degree in psychology at least would help).
The BPS withdrew BWRT training from the CPD approval list a while ago. So I tried to find out why, and met a complete brick wall. They refuse to say why, totally adamantly. Just keep saying it is an external company and nothing to do with them. They refuse to comment.
Apparently, according to the websites, NHS clinical psychologists are using BWRT in their practices, yet it is not endorsed by the NHS. Other psychologists are using it, even though there is literally no evidence of its efficacy.
I have tried to contact so many different organisations now to ask, what can be done to protect people from charlatans such as Terrence Watts (which I suspect him to be, but obviously wouldn't write that in an article) but all the time, I keep getting people saying they don't wish to comment.
I am not normally of a paranoid disposition but something is very fishy here and my spider senses have been well and truly tweaked :D
I am not sure I can write this article for The Psychologist magazine but I do wonder what I can do or who else I can contact; a body who protects vulnerable people from snake oil psychological treatments. I can't be the only person in this country who is concerned about BWRT.
Maybe it does work for some people and that is good, maybe one day, BWRT will cure all people with mental health problems (I suspect not) but in the meantime, I worry about this cult like following of BWRT and wonder what else I can do...

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miriam
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Re: Have you heard of...

Post by miriam » Sun Nov 11, 2018 3:45 pm

I would report anything that over claims to advertising standards. They can't offer any treatments for health conditions and claim efficacy without evidence. But there is very little regulation. You might want to contact your MP to raise the issue of regulating therapies more widely than the HCPC currently do - which is something I've long campaigned for. But maybe the takeaway lesson is to do your research and apply your scepticism before parting with money in future.

Finally, and I'm really sorry to say this, this is a forum for aspiring clinical psychologists rather than for recipients of psychological (or in this case pseudo-psychological) interventions. Are you aspiring to be a CP? If not, whilst I share your scepticism about these kinds of therapies I'm afraid this isn't the right place to raise this concern.
Miriam

See my blog at http://clinpsyeye.wordpress.com

rustyrebecca
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Re: Have you heard of...

Post by rustyrebecca » Sun Nov 11, 2018 4:21 pm

Thanks Miriam. Oh yes, I am indeed an aspiring CP. I am working in the field of psychology to get training and becoming more qualified to accomplish my dream. But obviously, some aspiring clinical psychologists do sometimes feel the need to receive therapy themselves, to overcome any difficulties. I can see why you assumed I was just a patient but that isn't the case. I often think that people with lived experience do make the best psychologists (provided they have overcome their problems!).
I thought this was a good forum to raise this concern regarding this therapy and to see if other aspiring CPs were aware of it.
In terms of BWRT as a therapy, I have actually contacted advertising standards already. So lets hope something comes from that.
My MP, that could be an idea (but never really expect much to arise from that really). Unfortunately, more vulnerable people are not likely to do extensive research and people do get desperate for help. Which is why I wanted to do more, but fear I may have done the most I can.

hawke
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Re: Have you heard of...

Post by hawke » Sun Nov 11, 2018 5:11 pm

In my previous job working in the third sector, we had a hypnotherapist on the board. I like to think I'm an open minded skeptic, but he totally shot me down when I asked for evidence for what he was claiming hypnotherapy could do. I later looked it up and found evidence contradicting his claims. I think that attitude filtered down throughout the organisation, and I had real concerns when a trainee hypnotherapist on the team emailed all staff and asked us to refer vulnerable clients to them for discounted hypnotherapy sessions, and this was supported by management. I left the job shortly afterwards, and told them my concerns in my exit paperwork. I also posted brief details about it on the local 'Skeptics In The Pub' Facebook group, as they get very involved in local campaigning around things like this.

(To clarify, I'm not totally dismissing hypnotherapy here, just that the service approved the promotion of private unevidenced therapy to very vulnerable people.)

lingua_franca
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Re: Have you heard of...

Post by lingua_franca » Sun Nov 11, 2018 5:35 pm

I teach an undergrad research methods module, and I sometimes use dodgy pseudo-therapies like these as case studies to help students learn to distinguish evidence from anecdote. Many of them are aspiring to be clinical psychologists or at least to work in the mental health field, so I think it's important that they learn these skills from an early stage. Unregulated therapists and counsellors are one thing (and a big problem in their own right) but I feel extra worried when I hear about practitioner psychologists using techniques with little or no evidence behind them, and that may even do some harm. I wonder how they managed to get through doctoral-level research methods training and still not recognise snake oil for what it is.

That said, I've seen one dodgy American website claiming to be "endorsed by the British NHS", which isn't true and never has been true (the NHS makes it plain on its own site that it does not endorse other people's online materials), so it may be that these websites are just making unsubstantiated boasts and this therapy is nowhere nearly as widely used by NHS professionals as the promoters would like people to think. I hope so, anyway.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

rustyrebecca
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Re: Have you heard of...

Post by rustyrebecca » Sun Nov 11, 2018 6:28 pm

This is what worries me Lingua; that psychologists are in fact using it on the NHS.
The NHS have funded this one study that I have referred to which has used 6-8 participants and the person who has conducted the study has actually said; 'Brain Work Recursive Therapy (BWRT) is a new model of psychotherapy that is determinedly solution-focused, promoting rapid resolution of psychological distress. Although not yet subject to full scientific trials, it is currently being used by NHS Psychologists working with diverse conditions such as Posttraumatic Stress, and Depression. The effectiveness and efficiency reported by therapists and patients are so far unanimously positive. However, research is needed to further investigate these effects and better our understanding of why it works.'
This is the only study and yet BWRT seems to be remarkably popular, even though any success is based purely on anecdotal reports.
I know there are psychologists that do use therapies with limited research, or research that many might query such say brainspotting, but BWRT literally has no evidence supporting it. It does seem to me as if it is a way to make a fast buck, but I do hope I am wrong.

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Spatch
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Re: Have you heard of...

Post by Spatch » Mon Nov 12, 2018 3:27 pm

Interesting points, and I hadn't come across BWRT before.
This is what worries me Lingua; that psychologists are in fact using it on the NHS.
The NHS have funded this one study that I have referred to which has used 6-8 participants and the person who has conducted the study has actually said; 'Brain Work Recursive Therapy (BWRT) is a new model of psychotherapy that is determinedly solution-focused, promoting rapid resolution of psychological distress. Although not yet subject to full scientific trials, it is currently being used by NHS Psychologists working with diverse conditions such as Posttraumatic Stress, and Depression. The effectiveness and efficiency reported by therapists and patients are so far unanimously positive. However, research is needed to further investigate these effects and better our understanding of why it works.'
This is the only study and yet BWRT seems to be remarkably popular, even though any success is based purely on anecdotal reports.
I know there are psychologists that do use therapies with limited research, or research that many might query such say brainspotting, but BWRT literally has no evidence supporting it. It does seem to me as if it is a way to make a fast buck, but I do hope I am wrong.
I do think there are a couple of things to tease apart. Firstly, there is something about needing some space to at least develop a new therapy before it can be scrutinised and empirically tested, which applies to all therapies. If a psychologist has a new idea and wants to see if it may work, they will have to have some mechanism to trial it rather than it being shot down immediately. If not, the field won't move forward at all, so I don't blame anyone for starting a new potential therapy or treatment approach. For me, that's an invitation to be circumspect and not make any major claims ("experimental" "Unproven but has potential" "needs to be replicated"). It's also undertaken with the understanding that this will be exposed to scrutiny (ideally externally) and then disseminated via publication before you start to roll it out globally. BWRT is really begging for some kind of randomised control trial where it is put against CBT, EMDR, SFT and Counselling and then evaluated longitudinally.

I think the latter part is where working psychologists often come undone, because a lot of us are game to try something new, but not necessarily up for the laborious process of writing up and trying to publish it, then replicating it. A lot of clinicians are under pressure to produce results with clients who may have tried lots of more conventional evidence based therapies (e.g. CBT, systemic etc) to little success and may end up going down this kind of route out of desperation.
Unregulated therapists and counsellors are one thing (and a big problem in their own right) but I feel extra worried when I hear about practitioner psychologists using techniques with little or no evidence behind them, and that may even do some harm. I wonder how they managed to get through doctoral-level research methods training and still not recognise snake oil for what it is.
Even if you have a DClinPsy or PhD it doesn't inoculate you against approaches that play into your beliefs around the world or "feel" instinctively correct and therefore should work. Most snake oil is sold successfully because it panders at some level to some of our own strongly held beliefs. This can play into a placebo effect, which then reinforces the belief and allegiance to the model. It also makes it harder to hear a critique of it because it can feel like a personal or existential attack.
I have written for The Psychologist before (BPS) and approached the editor about writing a piece on new therapies such as this one with regards to a lack of peer reviewed studies, just anecdotal accounts that are evangelical and seem false (if you read what people write to Terrence on the facebook page, it is sycophancy gone mad!). But the editor of the magazine (who is happy to have an article) said that sometimes it is best to be relaxed about new therapies! I argued with him, but gave up (they need a new editor, with a degree in psychology at least would help).
The BPS withdrew BWRT training from the CPD approval list a while ago. So I tried to find out why, and met a complete brick wall. They refuse to say why, totally adamantly. Just keep saying it is an external company and nothing to do with them. They refuse to comment.
I suspect this is more of a political issue. Most people reading The Psychologist a) not empirically minded clinical psychologists b) not psychologists of any description. It is a magazine that has to have a broad reach and satisfy the softer end of the discipline as well as the hardcore positivists. In fact there are plenty in the field who are against the quantification and the empirical evidence based approach and are far more phenomenological and humanistic in their outlook, and it doesn't do the BPS any favours to alienate them.

I like the Ben Goldacre approach, where you pick up on this sort of thing, dissect it and then use it to make a name for yourself. (Hell, you may have just identified your ticket onto clinical training if you do this correctly).
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http://www.amazon.co.uk/Irrelevant-Expe ... 00EQFE5JW/

rustyrebecca
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Re: Have you heard of...

Post by rustyrebecca » Mon Nov 12, 2018 4:33 pm

I agree with all you are saying Spatch. Of course, on the glowing websites, BWRT is not associated with any words such as 'has potential' or 'requires replication' or anything similar. Instead, it is being 'sold' as an amazing new therapy with a great success rate. And I am a thorn in Terrence Watts side (in one email he said to me that 'this has been played to exhaustion, I will not engage in further communication with you') and he has developed a great dislike of my persistence.
I do agree that a new therapy does need to be developed (and welcomed) but forgive my ignorance here which I am surely about to reveal, why doesn't he conduct a randomised control trial? The cynic in me says it is to do with expense and would most assuredly detract from his time selling the training, where he must be accumulating much profit.
I have Ben Goldacre's book 'Bad Science'. Think I must read it again :D

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Spatch
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Re: Have you heard of...

Post by Spatch » Mon Nov 12, 2018 7:29 pm

I do agree that a new therapy does need to be developed (and welcomed) but forgive my ignorance here which I am surely about to reveal, why doesn't he conduct a randomised control trial? The cynic in me says it is to do with expense and would most assuredly detract from his time selling the training, where he must be accumulating much profit.
Several possible reasons.

The first is that he feels that he has enough evidence and doesn't need to prove anything further ("The results speak for themself"). Anyone that seeks more empirical or robust findings is an inconvenience or applying unnecessary scientific/obstructive scrutiny that stops "people being helped". If you are not grounded in the scientific method, you are not necessarily going to be aware of personal bias, placebo effect, psychologist fallacy etc. - It works goddamn it-and you are like the bureaucrat in Ghostbusters just getting in the way.

Or it could be that at the moment it sells, and anything that threatens this is bad for business. Why explore and find things that you may not necessarily want to hear. If he was to do an RCT at best he gets the situation he is in at the moment -he gets to say it works and it sells, but if not he gets the humiliation of peddling something proven to not work.

Or it could be the "you can't fairly evaluate what I do in the therapy room" argument. It's true that it is hard to measure what is done, and we often have very crude tools, and sometimes postivistic methods don't capture everything. Then again, the answer isn't to say we don't even try to capture the impact or the longer term effect.

On a related note, you may want to read about Paul Salkovskis fight with Charles Linden and the Linden Method as it repeats a lot of what you have experienced. https://psychonoclast.wordpress.com/201 ... en-method/
Shameless plug alert:

Irrelevant Experience: The Secret Diary of an Assistant Psychologist is available at Amazon
http://www.amazon.co.uk/Irrelevant-Expe ... 00EQFE5JW/

lingua_franca
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Re: Have you heard of...

Post by lingua_franca » Fri Nov 16, 2018 8:25 pm

Spatch wrote:
Mon Nov 12, 2018 3:27 pm
Even if you have a DClinPsy or PhD it doesn't inoculate you against approaches that play into your beliefs around the world or "feel" instinctively correct and therefore should work. Most snake oil is sold successfully because it panders at some level to some of our own strongly held beliefs. This can play into a placebo effect, which then reinforces the belief and allegiance to the model. It also makes it harder to hear a critique of it because it can feel like a personal or existential attack.
This is an interesting point, and something I've noticed in discussions about play and arts-based therapies, where practitioners identified so closely with their therapeutic way of working that they interpreted criticism of the evidence base as an attack on their competence and clinical judgement. I agree that we all have our blind spots, but for me this is exactly where a good grasp of research methods and the ability to critically evaluate evidence comes in - I see it as acting as a massive blind spot mirror, to help us peer past our own beliefs and preconceptions. Perhaps I just look at the DClinPsy with rose-coloured spectacles on, but I'd also hoped that a training that equips you with skills in different models should make you less likely to be so partisan about your methods.

That goes for research methods as well. I have a lot of time for phenomenological approaches (I have used IPA a lot myself), and I don't think there has to be dissonance between quantitative and phenomenological research. I see quantitative stuff as like photography with a wide angle lens, whereas qualitative work provides close-ups. I'm definitely not a hardcore positivist by any means, but I don't think we can just ditch the stats when asking how applicable a treatment is likely to be to a large population, and I really struggle to understand why some clinicians are so resistant to the idea.
"Suppose a tree fell down, Pooh, when we were underneath it?"
"Suppose it didn't," said Pooh, after careful thought.
Piglet was comforted by this.
- A.A. Milne.

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