The Use of Novel Unsupported and Empirically Supported Therapies by Licensed Clinical Social ...

130 Pages·2015·0.78 MB·English

by  Monica Pignotti

Florida State University Libraries
Electronic Theses, Treatises and Dissertations The Graduate School
2009
The Use of Novel Unsupported and
Empirically Supported Therapies by
Licensed Clinical Social Workers
Monica Pignotti
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THE FLORIDA STATE UNIVERSITY

COLLEGE OF SOCIAL WORK

THE USE OF NOVEL UNSUPPORTED AND EMPIRICALLY SUPPORTED THERAPIES

BY LICENSED CLINICAL SOCIAL WORKERS

By

MONICA PIGNOTTI

A Dissertation submitted to the
College of Social Work
in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy

Degree Awarded:
Fall Semester, 2009
The members of the committee approve the dissertation of Monica Pignotti defended on June 18,
2009.

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__________________________
Bruce A. Thyer
Professor Directing Dissertation

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_________________________
Kenneth Brummel8Smith
University Representative

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_________________________
Martell Teasley
Committee Member

Approved:

_________________________________
Nicholas Mazza, Dean, College of Social Work

The Graduate School has verified and approved the above8named committee members.
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I dedicate this to my parents, Alfio and Ruth Pignotti, who have
always supported and encouraged me in pursuing my education
and excellence in all I do and who instilled in me the strong work
ethic it takes to complete a doctoral program.

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ACKNOWLEDGEMENTS

I would like to acknowledge and thank all of the people who stimulated and encouraged
my interest in the topics of evidence8based practice, critical thinking, and distinguishing science
from pseudoscience in mental health practice including Drs. Brandon A. Gaudiano, Richard Gist,
James D. Herbert, Scott O. Lilienfeld, Jeffrey M. Lohr, Steven Jay Lynn, Richard J. McNally,
John Riolo, and Gerald Rosen. Dr. Riolo was the first person in the social work profession I had
contact with who expressed concerns and skepticism about unsupported claims being made about
novel interventions on the Internet and I am very grateful for the issues he made me aware of.
The other individuals listed above began as critics of earlier views I held, but through my own
examination of their criticism, I have come to recognize the validity of many of the points they
raised, which I now thank them for raising and for the support and encouragement they gave me
to pursue my studies in this area.
I would also like to thank each of my Committee members. Thanks go to my committee
chair, Bruce Thyer for all of the tremendous support and encouragement he has given me
throughout my doctoral program, not only for the writing of my dissertation but also for giving
me the opportunity to co8author publications and for all the support he has given me with my job
search. I also wish to thank Charles Figley, who was initially part of my committee before his
move to a different faculty position, for all his support and passion for developing effective
interventions for trauma. Dr. Figley was the one who initially encouraged me to apply to and
attend Florida State University’s doctoral program. I also thank Dr. Martell Teasley for stepping
in as a committee member after Dr. Figley’s departure and for all the support he has given me as
a professor, in my job search, and as a committee member. Thanks also go to Dr. Kenneth
Brummel8Smith for being my outside committee member and contributing his expertise and his
excellent feedback that has improved this manuscript.
I am also grateful to Drs. Brandon Gaudiano and Ian Sharp for being my expert reviewers
for classification of the interventions my respondents reported. As published experts in this area,
their expertise was very much valued and appreciated and greatly approved the validity of my
assignment of interventions to categories and thus, the quality of this dissertation.
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TABLE OF CONTENTS

List of Tables vii

Abstract viii

1. CONCEPTUAL OVERVIEW AND PROBLEM STATEMENT 1
1.1 Introduction 1
1.2 Pseudoscience 2
1.3 Antiscience 7
1.4 New Age Therapies 8
1.5 Novel Unsupported Therapies (NUTs) 9
1.6 Evidence8Based Practice and Empirically Supported Therapies 11

2. LITERATURE REVIEW 15
2.1 Inclusion Criteria 15
2.2 Database and Search Terms 15
2.3 Summary of Studies on Social Workers Prior to 1990 16
2.4 In8Depth Review of Studies Conducted since 1990 18
2.5 Summary and Conclusions 27
2.6 Identification of Gaps in the Literature and
Recommendations for Future Research 28

3. RESEARCH QUESTIONS, HYPOTHESES AND METHODS 30
3.1 Research Questions 30
3.2 Hypotheses 31
3.3 Methods 31

4. RESULTS 41
4.1 Sample Description 41
4.2 Practice Characteristics 42
4.3 Analysis of early vs. late responders 45
4.4 Research Question 1 45
4.5 Research Question 2 45
4.6 Research Question 3 49
4.7 Research Question 4 50
4.8 Research Question 5 51
4.9 Research Question 6 51
4.10 Research Question 7 56
4.11 Research Question 8 57
4.12 Hypothesis 1 57
4.13 Hypothesis 2 58
4.14 Hypothesis 3 58
4.15 Hypothesis 4 60
4.16 Hypothesis 5 60

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5. DISCUSSION, CONCLUSIONS AND IMPLICATIONS
FOR SOCIAL WORK PRACTICE 62
5.1 Key Findings 62
5.2 Study Limitations 66
5.3 Recommendations for Future Research 67
5.4 Implications for Social Work Practice 70

APPENDICES 73

A. NOVEL UNSUPPORTED PRACTICES ON THE INTERNET 73

B. SYSTEMATIC LITERATURE REVIEW 76

C. DATA COLLECTION INSTRUMENT 98

D. IRB APPROVAL LETTER 107

REFERENCES 109

BIOGRAPHICAL SKETCH 120
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LIST OF TABLES

Table 1 Sample Description: Demographics 41

Table 2 Practice Description 42

Table 3 Areas of specialization named by participants 44

Table 4 Interventions mentioned most frequently by each particular respondent 46

Table 5 Interventions and assessment procedures respondents reported
currently using in any frequency within the past year and in
the past/discontinued 47

Table 6 Usage of NUTs, CUTs, CNUTs, and ESTs 50

Table 7 Relationship between Demographics and Number of
NUTs, CUTs, CNUTs, and ESTs 51

Table 8 Relationship between Demographics and Usage of NUTs,
CUTs, and CNUTs (dichotomized) 52

Table 9 Relationship between Practice Characteristics and Number of
NUTs, CUTs, CNUTs, and ESTs 53

Table 10 Relationship between Practice Characteristics and Usage of
NUTs, CUTs, and CNUTs (dichotomized) 54

Table 11 Relationship of use of NUTs, CUTS, and ESTs and CBT
Theoretical Orientation to EBPAS scores 56

Table 12 Relationship of reasons for choosing interventions to CBT
theoretical orientation 59

Table 13 Examples of novel unsupported practices by licensed clinical social
workers promoted on the worldwide web 73

Table 14 Summary of studies reviewed on theoretical orientation, therapy
choice, and attitudes towards EBP or ESTs 76

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ABSTRACT

In recent years there has been a growing interest regarding the integration of evidence8
based practice into social work curricula and practice (Howard, McMillen, & Pollio, 2003; Thyer,
2004). However, there has also been a growing concern about the proliferation of novel
interventions that lack empirical support and yet make claims of efficacy in the absence of
evidence (Thyer, 2007) as well as conventional social work interventions that lack empirical
support and yet remain unquestioned (Gambrill, 2006). Although studies have been conducted
that have examined the theoretical orientations and other practice patterns of clinical social
workers, to date, with the exception of the pilot study (Pignotti & Thyer, 2009) that preceded this
dissertation, no study has systematically examined the intervention choices of licensed clinical
social workers (LCSWs) including the use of novel unsupported therapies.
The present dissertation examined the reported usage of novel and conventional
unsupported and empirically supported therapies by 400 LCSWs from 39 different states who
responded to an Internet survey. The purpose of the study was to determine what interventions
were reported currently being used by LCSWs, reasons for choosing interventions, and their
attitudes towards evidence8based practice. Prior to data analysis, the list of the therapies reported
being used by LCSWs was presented to a panel of expert reviewers and therapies were classified
as empirically supported therapies (ESTs), novel unsupported therapies (NUTs) or conventional
unsupported therapies (CUTs). The study hypotheses were that: 1) females would be more likely
than males to use CUTs and NUTs; 2) respondents who report an affiliation with eastern/new
age or nondenominational/spiritual religions would be more likely to use NUTs; 3) clinical
experience would be more highly rated than empirical evidence as a reason for selecting a
therapy; 4) LCSWs with a theoretical orientation of cognitive8behavioral would value evidence
from research more highly than LCSWs of other orientations and 5) LCSWs who use NUTs
and/or CUTs will score higher on the Divergence subscale of the Evidence8Based Practice
Attitudes Scale (EBPAS; Aarons, 2004) than those who did not use such therapies.
The results showed that although an overwhelming majority of the sample reported using
ESTs (98%), three8quarters of participants also reported using at least one NUT and 86% used at
least one CUT. The hypothesis that females were more likely to use NUTs and CUTs was
supported and females also used a higher number of NUTs. The hypothesis that participants
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reporting eastern/new age and nondenominational/spiritual religious beliefs use a higher number
of NUTs was also supported, although they were not more likely to use any NUT. It was found
that participants, as hypothesized, valued clinical experience over research evidence and LCSWs
with a theoretical orientation of cognitive8behavioral were found to value research evidence
more highly than those of other theoretical orientations. The hypothesis that LCSWs who use
NUTs and/or CUTs will score higher on the Divergence subscale of the EBPAS was not
supported.
This study offers preliminary evidence that the use of NUTs is widespread among
LCSWs, although the limitation is noted that the present sample may not necessarily be
representative of all LCSWs. It also appears that given the fact that actuarial judgment has been
shown to be more accurate than clinical judgment (Dawes, Faust & Meehl, 1989) LCSWs may
be under8valuing research evidence. It is also evident that the use of ESTs and NUTs are not
necessarily mutually exclusive and although the EBPAS indicates that overall our sample had a
positive attitude towards EBP, future research needs to examine a fuller definition of the term
that includes their understanding of the term and specific practices.
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