Mar 28 2007

Neurolinguistic Programming and other Nonsense

There is an episode of Spongebob (one of those few cartoons accessible to both young children and adults) where Patrick, upset that his friend Spongebob has won so many awards and he has won none, decides to copy everything Spongebob does. Patrick is a lazy, dumb, pathetic, (but charming) do-nothing, and he is no less so by simply mimicking Spongebob’s every move – hence the comic irony my four-year-old can appreciate. Neurolinguistic programming (NLP), at its core, takes the Patrick approach to success and counseling.

The wikipedia entry on NLP is fairly factually thorough, and I won’t waste time here reproducing it, so for background I suggest reading the entry. Also, this recent blog post by Donald Clark is a good summary of the scientific reviews of NLP – all damning. Briefly, NLP was developed in the 1970’s and is based upon the notion that success can be achieved by simply modeling the language, behavior, and thought patterns of successful people. Various versions of this have been applied to counseling by simply modeling the language and behavior of supposedly successful counselors.

When first proposed there was nothing overtly pseudoscientific about NLP. It was a bit simplistic and naïve, but may have had some merit. But it turns out that the assumptions of NLP, namely that our cognition, behavior and emotions can be “programmed” by mimicking the more superficial aspects of those with desirable attributes (for example posture and mannerism) are wrong. The last thirty years of research have simply shown that NLP is bunk.

New ideas in applied science (like health care or counseling) are evaluated in two ways – are the basic science premises of the idea valid, and does it work. Although the latter trumps the former, both are important to consider because evidence of efficacy is often less than definitive, and the threshold of evidence necessary to accept a new therapy should be modified by it’s plausibility (in contrast to the precepts of evidence-based medicine, but that’s another blog entry).

In the case of NLP it has failed every test of both its underlying theories and empirical tests of its efficacy. So, in short, NLP does not make sense and it doesn’t work. In science you don’t get three strikes, those two and you’re out. It turns out that improving one’s cognitive ability and emotional stability is hard work – there’s no quick short cut. The brain is not infinitely reprogrammable – it can learn and change, but there is an underlying structure and function that is pretty resistant to change, and this resistance increases as we age. Change is possible, but it’s hard work. You can’t just download a new personality.

So why, then, has NLP persisted for 30 years despite all the evidence against it? I think this reflects an endemic problem within the mental health field. Part of the problem is that the field is very broad, with multiple parallel professions, including psychiatry, clinical psychology, social work, and counseling. Also, within each profession there are multiple theories and traditions, many mutually exclusive. The degree of dedication to science and evidence-based practice is also highly variable. The bottom line is that, although there is a great deal of legitimate science within the mental health field, in practice it is rife with pseudoscience and nonsense.

This results from the fact that new ideas and practices may go from inception to application without taking a detour through the trials of experiment and review. It is not uncommon for a practitioner to get a new idea about how to approach counseling, they then start doing it in their practice, then write a book, teach classes and seminars, if successful they create an institute, and before you know it there is a thriving infrastructure dedicated to this new method within the mental health field. At some point after this process is already under way someone may bother to do some scientific studies, but by then it’s too late. There is already too much invested in the technique, and too many practitioners who “know” that it works because they have seen in work with their clients. This is the story of NLP, and many other methods – like repressed memory therapy, eye movement desensitization therapy, and countless others.

The introduction of new pseudoscientific counseling techniques is driven by market forces, which demands easy answers to complex questions. Everyone would like the quick and magical fix for their complex psychological issues. NLP fits this mold perfectly – just program the brain to model after a successful person, and you will magically become successful.

There are also numerous reasons why any psychotherapy method may seem to work. There is generic benefit from just sitting and talking with another person. The introduction of a novel method into therapy creates the expectation that something should happen. Both the counselor and the client want the sessions to be successful, so there is a motivation to perceive success. So any counseling method will have both non-specific benefits and a large false perception of benefit – even if the technique itself is worthless and the underlying principles absurd.

There doesn’t appear to be an easy fix for these problems either. Ideally, an academic and scientifically grounded group with grab the reigns of the therapy professions and instill quality control by setting practice standards based upon scientific plausibility and evidence for efficacy. New ideas will be tested before they are widely disseminated. It’s hard to imagine this happening, however, because the field is comprised of so many independent and often competing professions. There is no one set of reigns to grab. Infatuation with alternative medicine ideology has also made this more difficult, as efforts to impose scientific standards are dismissed by some as male western demagoguery.

Those who advocate for more science and reason within the mental health field will keep plugging away, and I will cheer them on. But we will likely need either a cultural revolution or a massive overhaul of the system before we will see significant progress. Until then NLP and other counseling nonsense will endure.

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