David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment
One of the dangers of widespread pseudoscience is that it can give some treatment providers and proponents an excuse to do what they feel like doing or that which is easier. This is often divorced from published scientific support and established best practice. As a result, individuals with autism and their family members are bombarded with messages that include hype, false claims, and promises of outcomes that do not enjoy underlying scientific support. Pseudoscience indeed separates individuals from interventions that we know to be effective based on published, peer reviewed research. The image of an eclipse blocking the sun powerfully captures this sad reality.
As our readers know, the autism community is no stranger to pseudoscience. In fact, the vast majority of the 500+ treatments for autism lack adequate scientific support. When considering leaders in the much-needed effort to counter pseudoscience for a possible interview in Science in Autism Treatment, Dr. Scott Lilienfeld topped my list. Last October, as I began to seek out his contact information, I was saddened to learn that he lost his battle with cancer. The tributes that were published shortly after his death only cemented my deep appreciation for his insights, intellectual humility, and commitment to questioning any and all claims and assertions. I also learned of Dr. Lilienfeld’s efforts to directly challenge pseudoscience spanned decades.
A 2020 article in Psychology Today, written by Dr. Jonathan Stea, 3 Ways That Pseudoscientific Therapies Can Be Harmful, aptly highlighted the published work of Scott Lilienfeld, Steven Jay Lynn, and Jeffrey Lohr and focused on three salient concerns. All of these bore tremendous relevance to autism treatment. I want to briefly highlight these here as they provide an appropriate backdrop for how pseudoscience is deeply entrenched in the landscape of autism treatment and why the autism community will be forever indebted to Scott Lilienfeld.
(1) Pseudoscientific therapies can directly produce harm. From fabricated allegations of sexual abuse in facilitated communication to death related to chelation therapy, the autism community has witnessed far too many cases of harm. Much of this is attributed to unregulated products, under monitored/poorly implemented procedures, or professionals unethically practicing outside their area of expertise and training. Sadly, the hundreds of so-called “treatments” provide a myriad of risks for individuals with autism and the families who are desperately trying to help them realize their fullest potential.
(2) Pseudoscientific therapies can siphon time and financial resources from supported treatments. There is no shortage of ads promising the moon on the internet. With just a few clicks, parents of individuals with autism will encounter skillfully worded pseudoscience and well-packaged marketing material that will distract them from the very best that science has to offer. In the worst cases, it will rob them of precious time, finances, and hope. Collectively, the “try anything and everything” mantra easily leads parents to put quantity over quality with respect to treatment and may compel providers to become a “jack of all trades and a master of none.” Furthermore, the absence of scientific literature for many “treatments” hampers our understanding of potentially negative interactions between scientifically validated treatments with those that are not.
(3) Pseudoscientific therapies can further erode the foundations and trust in scientific professions that employ their use. The ethical codes of most of the disciplines that treat autism mandate evidence-based practice, yet we see abundant examples of individuals violating their scope of practice or scope of expertise. Many individuals are practicing outside their discipline, failing to share the support or lack of support for the interventions implemented or recommended. Many professional organizations, such as state psychological associations, assume the important task of protecting the discipline from poor or otherwise unethical practices but sometimes lack the awareness or the resources to tackle this to the extent that families of individuals with autism deserve.
We can do better. I believe that showcasing a select portion of Scott Lilienfeld’s extensive body of work is a step in that direction. In fact, this issue of Science in Autism Treatment is dedicated to Dr. Lilienfeld and his tremendous body of work. I have invited three individuals to share some thoughts about Scott as a person and colleague. The remainder of this issue will celebrate the indelible imprint he left behind and the marching orders that compel us to indeed do better.
In appreciation and homage to Scott Lilienfeld
Dr. Donald Meichenbaum
The Melissa Institute
I have just celebrated my 81st birthday and 55 years of clinical research, treatment of patients, and clinical training and supervision in a variety of settings. This has provided an occasion to reflect on the state of the art of psychotherapy. Some might characterize this as a moment for reflective WISDOM.
A critical appraisal of the field of psychotherapy which is filled with HYPE and exaggerated claims of efficacy calls for wise counsel. If you wanted to find someone with WISDOM who has been a leader in combating pseudoscience, you would call upon Scott Lilienfeld, which I did. This was a wise choice. We collaborated on the article, How to spot HYPE in the field of psychotherapy: A 19 item Checklist. With Scott’s scholarship and erudition, our article was chosen as the best contribution in the field of psychotherapy by the Journal of Contemporary Psychotherapy. In this article we cautioned therapists and patients alike to watch out for claims of interventions being “truly transformative,” a “breakthrough,” “unique,” endorsed by some GURU, filled with psychobabble and neurobabble, and with slick marketing and commercialism running rampant.
Scott challenged each of us to determine how many of the 19 items that are on our Checklist characterize our current treatment approach? How can we warn our patients from buying into HYPED treatment approaches? If you are likely to be asking yourselves these questions, then you are taking Scott’s voice with you which is his legacy. His life-long mission was combatting pseudoscience and myths in psychology (e.g., Lililenfeld., Lynn, & Lohr, 2014).
As we highlighted in our article, professional healthy self-doubt and self-criticism are strong predictors of both the quality of the therapeutic alliance and of treatment outcomes. Scott often cited the article by Nissen-Lee and his colleagues (2015), Love yourself as a person, doubt yourself as a therapist. Scott’s scholarship and critical-mindedness should be a model for all of us. The next time you see an ad for a psychotherapeutic intervention or attend a workshop, imagine that Scott Lilienfeld is sitting next to you.
References
Lilienfeld, S., Lynn, S., & Lohr, J (2014). Science and pseudoscience in clinical psychology. New York: Guilford Press.
Meichenbaum, D., & Lilienfeld, S. O. (2018). How to spot hype in the field of psychotherapy: A 19-item checklist. Professional Psychology: Research and Practice, 49, 22-30. https://psycnet.apa.org/doi/10.1037/pro0000172
Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2015). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24(1), 48–60. https://doi.org/10.1002/cpp.1977
Dr. Stuart Vyse, Behavioral Scientist and Writer
Scott Lilienfeld’s interests and intellectual pursuits were so expansive that he was able to make important contributions in many areas. One of these areas—and the one for which I knew him best—was among the community of skeptics.
The classic image of a stereotypical skeptic—an image that skepticism has been fighting against for decades—is a somewhat cranky older white man who takes pleasure in sarcastically deriding people who believe in ghosts, astrology, and dousing. Scott was nothing like this. He was an iconoclast, who did not accept the received wisdom on any topic, no matter who held it. This is the core attitude of a true skeptic. He questioned and poked in all directions looking for the weaknesses of logic or evidence in any belief, while at the same time exhibiting unfailing respect for the people who might hold that belief. He never tried to look smart by punching down; he lifted us all up by thinking just a bit more carefully about many important topics. This meant that he sometimes got pushback on his ideas, as was the case in 2017, when he wrote an article questioning the conceptual basis of microaggressions and the adequacy of research on the topic. But he was always searching for the truth and looking for ways to bridge the gaps between people who held different views. He was an advocate for what he called intellectual humility. The last cover story he wrote for Skeptical Inquirer in September of 2020 (co-authored with three of his students) was on this topic, and he and his co-authors urged skeptics to, “seek to become more aware of their cognitive limitations, including their biases, and acknowledge that the evidentiary bases of their beliefs are often fallible.”
In keeping with this philosophy, Scott made a point of taking up questions that people of his own tribe might be hesitant to examine. His 2013 book, coauthored with Sally Satel, Brainwashed: The Seductive Appeal of Mindless Neuroscience took on psychology’s ongoing romance with dazzling technology, suggesting that there may be much less in an fMRI scan than meets the eye. In 2014 Scott and coauthor Rachel Ammirati published an article “Would the World Be Better Off Without Religion?” in Skeptical Inquirer magazine, a publication whose readership is dominated by people who would probably answer “yes” to that question. Ammirati and Lilienfeld said, “Not so fast.” On the one hand, the question is impossible to answer empirically, and furthermore, correlational data suggest that religion has positive effects on wellbeing and moral behavior. The question is more complicated than either side is willing to acknowledge.
By the time I began writing for Skeptical Inquirer magazine, Scott had already been involved in skepticism for several years and was a Fellow of the Committee for Skeptical Inquiry. We were email correspondents for some time before that, and I was lucky enough to share a few dinners with him at CSICon, the annual skeptic’s conference. Later we came together again in the fight against the discredited communication method facilitated communication (FC) and its variants. Scott was a clinical psychologist, and autism was not his particular specialty. But he recognized the danger and persistent appeal of facilitated communication. Many of us assumed that FC had been thoroughly rejected back in the 1990s. A string of studies unequivocally showed that, in a Ouija board-like phenomenon, it was the facilitating helper who was responsible for the typing, not the non-speaking individual, and in 1993, the PBS program Frontline ran a devastating episode called “Prisoners of Silence.” But FC never went away. This therapy claimed to release the intelligent, articulate people locked in non-functioning bodies, and the attraction for parents and many teachers was just too powerful to resist.
In 2015 Scott published a book for general readers and students entitled The Horse That Won’t Go Away: Clever Hans, Facilitated Communication, and the Need for Clear Thinking (with Thomas E. Heinzen and Susan A. Nolan). It used the famous case of Clever Hans to show how unconscious cueing produced a horse that seemed to perform math problems and could also explain how a nonspeaking person with autism could suddenly write poetry. Scott was part of an informal group of professionals and advocates combating FC, and my only coauthored publication with Scott was a brief comment on an article published in the prestigious journal, Behavioral and Brain Sciences. The authors of the article had provided quotes from people with autism to support their theory of the social behavior of people with autism. A group of us recognized that some of the quotes were obtained through FC and, as a result, were unlikely to be the testimony of the person with autism. Given the lack of evidence for FC, it was more likely the statements were authored by the facilitator and the “voices” of the people with autism had been appropriated in a way that we felt was both scientifically unjustified and morally reprehensible.
In part due to Scott’s leadership, the skeptic community has taken up the cause of fighting FC and other pseudoscientific autism therapies. Following his death, he was added to the Pantheon of Skeptics, along with Stephen Jay Gould, Carl Sagan, James Randi, and many other luminaries.
When a person dies—even a remarkably accomplished person—it is often their simple acts of kindness that last longest in our memories, and for many who knew him, I think this will be true of Scott. A couple of years ago, I learned to my great surprise and delight, that I had been elected a fellow of the Association for Psychological Science (APS). This was a completely unexpected happening and something of a mystery because it is not an honor you can apply for. You must be nominated by an APS member, and one or two others have to write letters of support. Apparently, this had all happened for me, but I was completely in the dark until APS informed me of the result. A few weeks later, when he discovered I’d been approved for fellow status, Scott revealed that he had nominated me. I was very appreciative at the time, but I have come to understand that this is probably just one of hundreds of similar stories. Since his death, many colleagues and students have come forward to recount similar acts of selfless generosity and support. Things Scott didn’t have to do. He could have just gone on with his very busy life, and he would still have been a great psychologist and a good person. But he chose to do them because he took pleasure in helping others.
This, too, is a measure of what we have lost with Scott Lilienfeld’s untimely death. May his memory inspire us all to be a bit more humble and a little more generous in our personal and professional lives.
Shauna Bowes, Doctoral Student
Emory University
It was an honor to be one of Scott Lilienfeld’s students. There are few words to capture what it meant and continues to mean for me to know that I am part of his legacy. Scott was a prolific researcher, scholar, and contributor. Few scholars have revolutionized an entire discipline, and Scott was one such academic, permanently changing the way people think about and approach psychological research.
From becoming one of the world’s leading experts on psychopathic personality to challenging how we conceptualize timely and important psychological processes (e.g., microaggressions), he was intellectually courageous, honest, and sincere. He also valued disseminating science to those outside the ivory tower of academia, ensuring that people had access to high-quality and evidence-based information.
Scott’s research was not only pertinent to academics: he generated research that directly applied to peoples’ lives. While academics could spend hours debating which of Scott’s contributions were most meaningful, I contend that some of his most meaningful contributions pertained to defining and advancing evidence-based therapies. His work on this topic influenced training programs which in turn influenced practitioners and clinical scientists. Scott painstakingly detailed psychological treatments that are ineffective and even harmful. For example, he published rather extensively on “fad” treatments for autism, including facilitated communication, shedding light on the limits and dangers of these treatments. In so doing, he was not solely trying to ruffle feathers. Instead, he was deeply passionate about advancing science and ensuring that people in need were receiving the care they deserved.
Scott was also a passionate and dedicated instructor. He approached teaching with the same level of enthusiasm and dedication as he did mentorship. From my perspective, watching Scott teach was watching someone enter into that dream “flow” state most of us can only hope to achieve. He spent considerable time crafting his lectures, pulling in resources, and making his lectures engaging. He would make time to chat with his students and his door was always open to students in his courses.
In his teachings, he emphasized the value and importance of science. He discussed the power of science to do good in the world. But in order for science to do good in the world, we, as scholars and academics, must check our biases at the door. To do good science, and hence have science do good, one must be intellectually humble, meaning that one must be aware of the limitations of their thinking and be open to disconfirmatory evidence. Whether teaching an undergraduate or graduate course, Scott endeavored to teach people how to think rather than what to think.
As Scott himself once said, “the most one can do or hope for as an instructor is to change people’s life in some small way and maybe make them get to think about their life and their worlds just a little bit differently.” I would say wholeheartedly that Scott achieved those goals and then some.
Citation for this tribute:
Celiberti, D., Meichenbaum, D., Vyse, S., & Bowes, S. (2021). Celebrating the diverse and significant contributions of Dr. Scott Lilienfeld. Science in Autism Treatment, 18(9).
Other ASAT Tributes:
