Controversies in Energy Psychology

In the quarter century since tapping on acupuncture points was introduced as a method psychotherapists could use in the treatment of anxiety disorders and other emotional concerns, more than 30 variations of the approach have emerged. Collectively referred to as energy psychology (EP), reports of extraordinary speed, range, and durability of clinical outcomes have been provocative. Enthusiasts believe EP to be a major breakthrough while skeptics believe the claims are improbable and certainly have not been substantiated with adequate data or explanatory models. Additional controversies exist among EP practitioners. This paper addresses the fields credibility problems among mental health professionals as well as controversies within EP regarding a) its most viable explanatory models, b) its most effective protocols, c) how the approach interfaces with other forms of clinical practice, d) the conditions it can treat effectively, e) what should be done when the method does not seem to work, and f) how the professional community should respond to the plethora of practitioners who do not have mental health credentials. Controversies in Energy Psychology David Feinstein, Ph.D. Ashland, Oregon In the first randomized controlled trial using energy psychology (EP) with post-traumatic stress disorder (PTSD), 16 of 19 veterans, all of whom exceeded the PTSD cutoff score on the military version of the Post-Traumatic Stress Checklist before treatment, were no longer within the PTSD range after 6 one-hour sessions (Church et al., 2009). Mean scores decreased from 60.5 to 36.8 (the PTSD cutoff is 50) while scores for a waitlist control group remained essentially unchanged. These findings are corroborated by earlier outcome studies with both veterans (Church, in press; Church, Geronilla, & Dinter, 2009) and with disaster victims (Feinstein, 2008b). Preliminary findings with adolescents have been even more encouraging, with a single session of EP reliably reducing scores on standardized tests from above to below PTSD cutoffs in two independent studies (Church, Piña, & Reategui, 2009, p < .05 with 8 subjects; Sakai, 2007, p < .0001 with 50 subjects). Meanwhile, in one of the strongest studies demonstrating the efficacy of Cognitive Behavior Therapy (CBT), widely considered the treatment of choice for PTSD (Bryant, 2008, p. 555), 60 percent of subjects still met the criteria for PTSD after 12 sessions and 50 percent showed no symptom relief at all (Monson et al. 2006), a finding that is consistent with other CBT studies (Barlow, Allen, & Choate, 2004; Bryant, 2008). Noting such contrasts, a small but growing number of clinicians have enthusiastically embraced EP, and the approach has also become somewhat of a pop psych phenomenon. More than 1.2 million people have downloaded The EFT Manual (http://emofree.com), a guide for the back-home application of the Emotional Freedom Techniques (a popular form of EP), an additional 30,000 to 40,000 download it each month, and nearly half a million people actively subscribe to the twice-weekly EFT Insights eletter (G. Craig, personal communication, September 17, 2009). Nonetheless, most psychologists do not view EP as a viable treatment option (Norcross, Koocher, & Garofalo, 2006). Even though empirical evidence for EP is accumulating and has arguably already reached the threshold for what the Society of Clinical Psychology (Division 12 of the American Psychological Association) considers a probably efficacious treatment for specified conditions (Feinstein, 2008a), its efficacy has not yet been firmly established scientifically. The approach has, in fact, been denigrated in prestigious clinical journals as an unsubstantiated treatment about which psychologists are not obliged to pay any attention (McNally, 2001, p. 1173) and even as a source of possible threats to the science of psychology and psychiatry (Devilly, 2005, p. 437). In 1999, the American Psychological Association took the unprecedented step of censuring the approach, notifying its CE sponsors by a memo that they risked losing their sponsorship status if they offered APA CE credit for courses in the earliest established form of EP, Thought Field Therapy (Murray, 1999), and this restriction has now been generalized to all forms of EP. In addressing the controversies surrounding EP, we will begin with reasons the approach has become such a strong area of contention within the mental health profession. The bulk of the paper, however, will focus on controversies among EP practitioners, such as a) the fields most viable explanatory models, b) its most effective protocols, c) how the approach interfaces with other forms of clinical practice, d) conditions it can treat, e) what should be done when the method does not seem to work, and f) how the professional community should respond to the plethora of practitioners who do not have mental health credentials. Acceptance within the Mental Health Field Like most biological mutations, the vast majority of clinical innovations do not bring benefits that result in their ultimately being passed along to future generations. Practitioners are wise to be skeptical of enthusiastic claims and aggressively promulgated therapies. Nonetheless, just as some mutations do benefit a species, some clinical innovations move a field forward. Systemic resistance to innovation serves to keep conventional procedures neatly ordered while inhibiting progress. The medical field, for instance, has an embarrassing history that extends from ridiculing the notion that physicians should wash their hands before performing surgery to ignoring a known cure for scurvy as thousands of sailors died. To briefly characterize the situation with EP, enthusiasts for the approach believe it to be the psychotherapeutic equivalent of penicillin while its detractors believe it has no more new active ingredients than sugar water injections. Although I was immediately impressed by the results I witnessed watching EP demonstrations and hearing about treatment outcomes, I was intellectually flummoxed by the wide range of approaches and explanations being proposed. To try to make some sense of the strange mix, I gathered a team 27 of the fields most well-known pioneers and leaders proponents of a divergent range of EP approachesand posed a challenge: Can we develop a professional training program that represents a consensus regarding the methods and principles an experienced clinician new to EP should master before introducing EP into his or her clinical practice.  This resulted in the book/CD-ROM training program Energy Psychology Interactive (Feinstein, 2004). I learned a great deal in the process. Asking the team to speculate on causes for the slow acceptance of EP, the reasons given by these key players ranged from reliance on concepts that cannot be measured, such as subtle energies and thought fields, to the lack of empirical research, to uncertainty about the mechanisms of action, to the inherent paradigm clash between ancient healing systems and conventional psychological explanations for therapeutic change. A more fundamental credibility problem, however, was also frequently mentioned in those discussions. And that is cognitive dissonance. There is nothing in the training or background of most clinicians or researchers that prepares them to understand how tapping on the skin can help overcome severe psychological disorders, no less to account for the speed and power with which positive clinical results are being reported for challenging conditions In fact, every therapist I have interviewed who has adopted EP reports some version of the following trajectory in coming to accept EP as a viable treatment approach: (a) disbelief upon hearing it described, (b) cognitive dissonance upon seeing it performed, (c) puzzlement mixed with relief and appreciation as the method helped resolve a tricky personal issue, (d) tentative application with others leading to surprisingly favorable outcomes, (e) frequent and confident application in clinical situations with, nonetheless, (f) a consistent sense of inner surprise in the sense of, Wow, it worked again!  This journey from doubter to believer causes suspicion in colleagues looking on yet cements the certainty of the practitioner. Therapists who have moved through these stages represent a broad spectrum of professional orientations and backgrounds, and they describe the approach with enthusiasm, but practitioner exuberance is not known to be reliable evidence of efficacy. The psychotherapy field has, in fact, a long historydating back to phrenology and Anton Mesmers magnetic rodsof diagnostic and therapeutic approaches that were once widely touted and embraced but ultimately proved ineffective and sometimes deceptive. Even the most sincerely promulgated methods are frequently shown to have less therapeutic benefit than initially reported when their use by practitioners who did not develop them are investigated over time. Is EP another highly publicized therapy that will soon be universally recognized as being clinically hollow; is it old wine in new skin, producing positive results by repackaging established therapeutic modalities; or do its methods represent genuine and significant innovation? Definitive answers to these questions will emerge only from further empirical investigation. Efficacy research on EP is promising (Feinstein, 2008a), but it is still in a relatively early stage. Well-controlled comparison studies between EP and treatment approaches whose efficacy have been scientifically established are yet to be conducted, so the favorable comparisons of EP in relation to CBT that can be made based on preliminary studies (discussed above) might not hold up to more rigorous scrutiny. Dismantling studies are also needed to identify the active ingredients of the various EP components and approaches. It could, however, be another decade before such questions have b