The Scientific Review of Mental Health Practice

Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work

Media Watch

Thought Field Therapy in the Media:
A Critical Analysis of One Exemplar

Author:
Monica Pignotti, MSW - E-mail: pignotti@worldnet.att.net

Acknowledgements:
Thanks go to Brandon Gaudiano and Bruce Thyer for their helpful comments on earlier drafts of this manuscript. I also thank James Herbert and Scott Lilienfeld for reviewing this manuscript and making many excellent suggestions, which greatly improved the final version.

Abstract:
Thought Field Therapy (TFT) is an alternative therapy that instructs the patient to finger tap on a series of acupressure points while being directed to focus on a psychological or physical problem being addressed. TFT has recently been portrayed by the media in a laudatory, uncritical manner on numerous occasions. A recent exemplar was an article published in the trade journal Social Work Today (SWT) which was intended to serve as an introduction to TFT (Robb, 2003). Proponents interviewed claimed an 85–90% success rate for TFT without supplying evidence; made the unsupported assertion that TFT constitutes a paradigm shift in psychology; maintained that only people who had experienced TFT were qualified to judge it; and declared that a new set of theoretical terms were required to explain the putative powerful results they had experienced in their clinical practices. They also claimed that TFT is superior to existing treatments, ignoring the fact that empirically supported treatments are available and the dearth of rigorous evidence for TFT. Proponents further claimed that TFT procedures could identify alleged energy toxins in the diet. All of these claims are made commonly by TFT proponents to the media. The purpose of the present analysis is to challenge these claims and to point out that the burden of proof, which falls on TFT proponents, has not been met.


Thought Field Therapy (TFT) is a controversial therapy for psychological and physical problems that employs stimulation of a specified sequence of acupressure points on the body (usually by finger tapping) while the patient is directed to focus on the emotional problem being addressed (Callahan & Callahan, 2000; Callahan & Trubo, 2001). [1] TFT was formerly known as the Callahan Techniques® and proponents who practice the form of TFT approved by its founder, psychologist Roger Callahan, prefer to call it Callahan Techniques® Thought Field Therapy (CTTFT) to distinguish it from generic TFT. [2]

Overview of TFT Theory and Basic Terminology

According to Callahan, when we think about an experience or thought associated with an emotional problem, we are tuning into a “thought field,” which he describes as “the most fundamental concept in the TFT system” and which “…creates an imaginary, though quite real scaffold, upon which we may erect our explanatory notions” (Callahan & Callahan, p. 143). Perturbations are described as precisely encoded information contained in the thought field, which become activated whenever the emotional problem is thought about. Perturbations are believed to be the root cause of negative emotions and allegedly correspond to acupressure points on the body. In order to eliminate the emotional upset, Callahan believes that a precise sequence of acupressure points must be tapped on. He theorizes that tapping unblocks or balances the flow of Qi, a Chinese term used to describe vital life energy (Callahan & Trubo, 2001).

The process through which these treatment sequences are determined is called causal diagnosis, which has two forms. The first form, TFT Diagnosis (TFT Dx), is derived from a chiropractic assessment procedure called therapy localization, which incorporates a muscle testing procedure known as applied kinesiology (Goodheart, 1975) . In performing therapy localization, a patient is instructed to touch various acupressure points on the body while a muscle is tested, most commonly by the practitioner pushing down on the patient’s arm while asking the patient to resist, to determine if the arm can be pushed down or if it remains strong. It is believed that when each correct treatment point is identified, the muscle will test strong (Durlacher, 1994) and a tapping sequence can be obtained. Callahan maintained that his algorithms were derived through this procedure. He claimed that given sequences were effective on a high percentage of people with the same type of problem (Callahan & Trubo, 2001), although he has not produced data to support these claims. The second form of causal diagnosis is called Voice Technology (VT), which is the most advanced level of TFT training available and is a proprietary procedure through which individualized sequences of TFT treatment points can be obtained and given to a person over the telephone by analyzing the person’s voice. VT is a trade secret, and Callahan requires all VT trainees to sign confidentiality agreements. Nevertheless, the first person to ever train in VT has pointed out that “The core ‘secret’ behind VT is in the public domain . . . Many people reading this use VT routinely without knowing it” (Craig, 1998, p. 1) .

Uncritical Portrayals of TFT in the Media

From the time of its inception, Callahan has consistently made efforts to get Callahan Techniques® into the media. The reason he gave is that due to his highly unconventional approach and bold claims, he did not feel that his colleagues would believe any of his claims had he submitted them to peer review (Callahan, 1985). Instead, he opted to take his therapy directly to the media and to conduct public demonstrations in which (he believed) his cures could be directly observed as self-evident. As a result, CTTFT has been featured numerous times in the media on popular talk shows (Callahan, 1997) and more often than not, presented uncritically in a laudatory manner. This has also been the case with popular print media and trade journals in which articles were published on CTTFT with little or no challenge to the claims, such as a report on CTTFT and other controversial therapies in The Family Therapy Networker (Sykes-Wylie, 1996) and a mostly laudatory article on both generic TFT and CTTFT in the Philadelphia Enquirer (as reported in Lilienfeld, 2002).

There is some recent evidence that this trend is changing. A BBC documentary on phobias (as reported in Gaudiano & Herbert, 2000b) and an article in the Washington Post (Boodman, 2004) offered a more critical perspective on TFT. However, an article appeared in the December 2003 issue of trade journal Social Work Today (SWT) that presented a completely uncritical perspective. In the article, only CTTFT proponents were interviewed, therefore allowing proponents to make their claims unchallenged and to misrepresent the skeptical perspective, making it appear as if critics were closed minded and resistant to new “paradigms.” At a later date, Robb (in press) did write a hard-hitting skeptical piece on CTTFT and its offshoots. Nevertheless, there are claims and assertions made in the original SWT article that need to be more specifically and fully addressed because they are typical of claims CTTFT proponents often make to the media and are likely to make in the future.

Clinical/Personal Experience vs. Controlled Studies

A recurring theme throughout the SWT article was the notion that to be a good judge of TFT’s efficacy, clinicians need to “experience it themselves.” The two conclusions drawn from this premise were that: (1) people who have not studied and experienced TFT are not qualified to evaluate it and (2) claimed successes in clinical practice can take the place of well-designed controlled studies when it comes to judging TFT’s efficacy.

Nevertheless, “success” as ascertained by personal or clinical experience alone is not a valid basis to judge whether a given therapeutic technique is efficacious. Clinicians are subject to the same types of errors and cognitive distortions that all human beings are prone to. As Meehl (1997) pointed out, “Ignoring a skeptic’s request for evidence by invoking the buzzword ‘clinical’ amounts to saying that the patients’ cognitive distortions can be studied, and those of their relatives, but that I, the clinician, am immune from study. This may be convenient for me, but it is irrational and irresponsible” (p. 94). One such distortion is confirmation bias, the tendency we all have to pay attention to information that confirms existing beliefs and to ignore or explain away information that does not. Well controlled studies, subjected to peer review, are needed to counteract this bias. Although this prescription is far from perfect, it is the best we have and is far preferable to anecdotes and public promotional demonstrations by enthusiastic proponents.

It is erroneous to assume that people who have not “experienced” TFT cannot judge whether there is sound evidence for its claims. Anyone acquainted with the scientific method can evaluate the adequacy of research, just as one need not be trained in electroconvulsive therapy (ECT) to evaluate studies on ECT’s efficacy. In the case of TFT, this task is even easier. One need not pay for expensive TFT trainings to recognize that no published randomized controlled studies support the efficacy of TFT.

Is TFT Really A Paradigm Shift in Psychology?

In the SWT article, Robb (2003) quotes TFT proponent Robert L. Bray:

“We’re not talking about a new theory. We’re talking about a completely new way of conceptualizing the human being. TFT is a total paradigm shift.” Bray and his peers liken the therapy to the same revolution in thought that saw the discovery of antibiotics usher forth a dawning age in medical practice. Then as now, skeptics scoffed and charged its proponents with heresy (Robb, 2003, p. 21).

The unsupported assertion that TFT is a “paradigm shift” is not a valid reason to conclude that only proponents are qualified to judge it. This begs the question and sets up a circular argument. One has to assume the premise that TFT is a paradigm shift and performs as claimed to draw this conclusion. The burden of proof, which thus far has not been met, is on TFT proponents to show with well-designed studies that TFT is as efficacious as claimed.

CTTFT proponents claim that this alleged new paradigm requires special terminology, such as “perturbations”, “thought fields” and “tuning the thought field” (Callahan & Callahan, 2000). These terms are not based on sound science, but rather are arbitrary constructs used to explain phenomena that could more parsimoniously be explained by what is already known by psychologists. As a case in point, in an internet listserv discussion with members of the Society for a Science of Clinical Psychology (SSCPNet), a member asked Callahan to explain the concept of a thought field. He described it as whatever a person is thinking about at a given moment, stating that it was not a physical entity. Harvard psychologist Richard J. McNally, Ph.D., joining the discussion, responded: “A ‘thought field’, then, is a synonym for ‘contents of working memory’. Right?” (McNally, 2000, p. 1). Although Callahan did not respond, McNally was essentially correct.

Along the same lines, a perturbation can simply be thought of as the emotional content of a memory. Furthermore, the TFT concept of directing the patient to focus on the problem being addressed and report the emotional distress level (tuning the thought field) as a necessary prerequisite to successful treatment is not Callahan’s unique discovery. Barlow (2002) explained that “…fear and anxiety are behavior programs existing in memory . . . these emotional programs must be fully accessed if any important change is to occur” (p. 56). Callahan would be unlikely to agree to such parsimony because this would undermine his ability to connect “perturbations” with the body’s energy meridian system, as he attempts to do with still more jargon, complicating his theory even further. [3] His specialized terminology does nothing to explain or provide evidence for this putative connection. The use of such obscurationist terminology is one of the hallmark indicators of a pseudoscience (Lilienfeld, Lynn & Lohr, 2003).

Alternative Explanations for Putative TFT ”Successes”

Due to the lack of published controlled studies on TFT, such non-specific influences as placebo effects, regression to the mean, the therapeutic alliance, and demand characteristics cannot be ruled out as explanations for putative TFT treatment successes. It has yet to be established that TFT possesses specific treatment effects. Even if such effects were demonstrated, a new set of terms to explain them could well be unnecessary. There are plausible explanations consistent with already established learning theories, namely, that TFT and other similar therapies can interrupt old habits and provide new ones by means of conditioning, thereby overcoming prior stimulus dominance (e.g., Commons, 2000). These effects, enhanced by such non-specific treatment influences as placebo effects, could make results appear virtually miraculous in some cases.

Misrepresentations

Robert Bray mentioned the special issue of the Oct. 2001 issue of the Journal of Clinical Psychology (JClP) devoted to CTTFT, but Bray did not note that these articles were not subjected to peer review (Beutler, 2001). Alongside these articles were critiques (e.g., Herbert & Gaudiano, 2001) that noted numerous problems with the studies in this issue, such as the failure to control for non-specific treatment effects, the selection of only successful cases, failure to use valid assessment and outcome measures, using an out-of-context physiological measure, and including a heterogeneous array of psychological and physical conditions in the studies. I was the author of one of these studies (Pignotti & Steinberg, 2001) and have authored a retraction of this article (Pignotti, in press) that outlines why I have changed my position.

This is not the first time that research on CTTFT has been misrepresented by proponents. In his book, Tapping the Healer Within (Callahan & Trubo, 2001), Callahan misreported the results of a study performed on TFT and three other controversial therapies (Carbonell & Figley, 1999). Callahan and Trubo incorrectly claimed that “patients using TFT showed significantly more improvement than those using any of the other treatments” (p. 42). Yet Carbonell and Figley stated clearly that their investigation was not well controlled. Assignment was not random, the pre-treatment self-rated distress levels differed between groups, and no statistical significance testing was conducted. Furthermore, visual inspection of the data does not support the claim that TFT stood out from any of the other therapies being tested in terms of changes in self report measures, which do not appear to come close to the claims of dramatic changes reported anecdotally by TFT proponents (Gaudiano & Herbert, 2000a).

Heart Rate Variability Claims

Callahan has made a number of claims regarding Heart Rate Variability (HRV), [4] which is a physiological measure of the degree of fluctuation in the length of the interval between heart beats (Malik & Camm, 1995). HRV is important to CTTFT proponents because they believe that TFT changes in HRV are not attributable to placebo effects and claim that they demonstrated unprecedented changes pre- and post- TFT treatment in uncontrolled case reports (Callahan, 2001a; 2001b; Pignotti & Steinberg, 2001). In the SWT article, Callahan echoed his claims of the HRV measurement being “placebo-free” as further evidence for TFT. The only studies adduced by CTTFT proponents in support of the claim that HRV is not subject to placebo effects were conducted with placebo pills. As Herbert and Gaudiano (2001) pointed out, one study (Kleiger, et al., 1991) was conducted with normal participants who were administered sugar pills. They were not being treated for any psychological or physical condition and the investigators did not lead them to believe the pill would be beneficial. Other studies cited tested the motion sickness drug, scopolamine (e.g., Vybrial et al., 1993), and was irrelevant to psychological conditions. Thus, the possibility of psychological placebo effects cannot be ruled out.

Claims Regarding Voice Technology (VT)

VT was characterized in the SWT article as “unparalleled in resolving or significantly reducing clinical or medical symptoms, with a reported 98% success rate” (Robb, p. 23). The studies Callahan adduced in support of this claim were nothing more than call-ins from participants in radio shows (Callahan, 1987; Leonoff, 1995). These reports used no control groups, included no follow-ups, used no valid assessment measures, and failed to control for obvious demand characteristics (Gaudiano & Herbert, 2000a; Hooke, 1998).

The statement by Robb (2003) that Callahan’s “colleagues concur” (p. 23) with him on VT is misleading, as not all people trained in the VT agree with Callahan. An internet search on the terms “Thought Field Therapy Voice Technology” reveals heated controversy regarding the VT, even among believers in energy therapies (Craig, 1998). Of the 25-30 people Callahan claims to have trained in VT (Robb, 2003), only 12 are listed on the Callahan website as current VT practitioners (Callahan Techniques, 2004a). I was the fifth person to be trained in the VT and conducted a controlled experiment (Pignotti, submitted), which showed that the VT treatment sequences produce exactly the same results as randomly selected sequences requiring no special proprietary “technology.” As a result, I no longer practice VT or any other form of TFT.

Regarding VT, Robb (2003) noted that, “This knowledge comes with a hefty price. Callahan charges $100,000 for VT training.” Callahan responded, “For people who are good at marketing, VT can be quite a good investment” (p. 23). Nevertheless, there is no valid evidence to support that this “good investment” is efficacious. In fact, one VT therapist was sanctioned and placed on probation by the Arizona Board of Psychologist Examiners (1999) for his refusal to disclose the trade secret of VT to the Board and for unsupported claims (i.e., a 95% success rate) in his marketing of VT. Furthermore, the secrecy of VT makes scientific study highly problematic because only believers who are financially invested in the method can collect data concerning its efficacy. As one psychologist put it, “It appears that the Voice Technology is shrouded in secrecy and mystery. Hiding your clinical methods does not comport with advancing psychotherapy research” (Eisner, 2002, p. 5).

Client Perceptions of TFT

CTTFT proponent Mary Sise was quoted in the SWT article as stating that it is only our colleagues who have a problem with TFT, not our clients. But not all clients are forthcoming with their therapists about the treatments they received. In fact, some clients have expressed serious concerns regarding TFT. Examples in the public domain include a documentary by BBC TV in which Callahan failed with a client who had a specific phobia, who was dissatisfied with the results (Gaudiano & Herbert, 2000b) and a letter to the editor in Skeptical Inquirer in response to Gaudiano and Herbert’s (2000a) article “Can We Really Tap Our Problems Away” from a dissatisfied client who agreed with their critique (Rogers, 2000). Although such reports or course purely anecdotal and may be markedly limited in representativeness, they appear to falsify Sise’s assertion that all clients are satisfied with TFT.

TFT vs. Extant Empirically Supported Treatments

Robert Bray stated in the SWT article that mainstream approaches offer little compared with TFT. Moreover, Bray claimed that he was told in his professional training that phobias cannot be eliminated using extant therapeutic methods. Nevertheless, several cognitive-behavioral treatments that have been in existence for decades have sound empirical support for treating panic disorder, specific phobias, social phobia, PTSD, and obsessive compulsive disorder (Barlow, 2002; Foa, Keane & Friedman, 2000; McNally, 1994; Otto, Smits & Reese, 2004). Given that empirically supported treatments are available, it is highly misleading to clients and ethically questionable for TFT therapists to claim superiority over empirically supported treatments when this claim has not been demonstrated in controlled studies.

Individual Energy Toxins (IET) and Potential for Harm

When the results of TFT do not hold up over time, as noted in the SWT article, Callahan has offered the unsupported explanation that this failure is due to what he calls an Individual Energy Toxin [5] (IET; Callahan & Callahan, 2000) in the diet or environment. An IET allegedly adversely impacts the body’s energy system and thereby interferes with treatment. IETs vary from person to person, thus requiring testing. TFT clients at times are advised to abstain from commonly eaten foods that could drastically restrict their diets, eliminating such major food groups as dairy or wheat products. The SWT article (Robb, 2003) incorrectly reported that TFT practitioners treat IETs with tapping sequences when in fact Callahan recommends that people abstain from foods and substances identified as IETs if possible (Callahan, 2000). He has developed a “treatment” (Callahan Techniques, 2004b) for alleged IETs that is different from the usual tapping on meridian points, but he only uses this treatment to deal with IETs to which the client may have inadvertently been exposed or substances that the client cannot avoid (e.g., prescription drugs).

Clinicians should consider the potential adverse effects of such advice, especially with people who are already suffering from such conditions as eating disorders, obsessive compulsive disorder, or panic disorder. For instance, the declaration by a therapist that a common food in the patient’s diet is “toxic” and is causing panic attacks to recur could create new cues and triggers, thereby becoming a self-fulfilling prophecy. There is at least one reported case (Buryani & Takasaki, 1999; Callahan, 1999) in which an anorexic patient was advised by Callahan to stay away from certain foods (although wisely, the attending psychiatrist overruled this advice). The harmful effects of telling an anorexic patient already obsessed with food avoidance that certain foods are “toxic” should be obvious.

It has been my experience and that of many other CTTFT practitioners that most patients do not comply with Callahan’s advice to avoid certain foods. However, a charismatic therapist could persuade the patient to comply, potentially resulting in harmful dietary restriction. I am aware of cases in which clients have become obsessed with finding IETs to the extent that they were checking with their CTTFT therapist before almost every meal. These are examples of potential negative effects, which are inherent dangers of using treatment approaches that have not been adequately studied.

Callahan’s test for IETs is highly questionable, as he has never formally tested his procedures for inter-rater reliability. This omission raises concern about conflicting results and conflicting dietary advice among practitioners (Craig, 1998).

Conclusion

Much of the coverage of TFT in the media has been insufficiently critical, largely because it has not emphasized the limited database concerning TFT’s efficacy. Instead, unsupported claims for efficacy have been made based mostly on anecdotes and have not typically been challenged. Before mental health practitioners practice and promote approaches such as TFT, particularly to vulnerable clients (Singer & Lalich, 1996), they should carefully consider the consequences of doing so, especially without accurate informed consent about existing empirically supported treatments. Even if no explicit harm is done, such clients can be deprived of efficacious treatments (which TFT proponents claim superiority to) and their conditions could deteriorate as a consequence. The burden of proof falls on TFT proponents to provide evidence for their claims. As of this writing, they have not come close to doing so.

Notes:

  1. Originally, an earlier version of this manuscript was submitted to Social Work Today as a response, but the editor rejected the article on the grounds that a “balanced” article, presenting the views of both believers and skeptics, was already being written on “energy” therapies in which TFT skeptics would be given a sidebar to express their views. More recently, the same author (Robb) decided instead to write an entirely skeptical article on TFT. However, because a critical analysis was still needed to correct the numerous errors, misrepresentations, and unwarranted claims by TFT proponents in the original article and address the tendency of the media to portray TFT uncritically, the current article was written to accomplish that purpose.
  2. A distinction between CTTFT and TFT is relevant to note because a court decision ruled that TFT was generic or descriptive and that Callahan had failed to prove that TFT was entitled to a trademark (Nicosia, 1997). Following that decision, Callahan combined the original name for his therapy, Callahan Techniques® with the generic TFT and began formally referring to his brand as Callahan Techniques® Thought Field Therapy (CTTFT) to identify “the originator or source” and to “distinguish the authentic and standardized TFT from the numerous diluted copies.” (Callahan & Callahan, 2000, p. xi). This is important to note in terms of the SWT article because only CTTFT proponents were interviewed and the viewpoints of certain proponents of generic TFT differ from those expressed by CTTFT proponents, such the alleged superiority of the Voice Technology over other forms of TFT (see, e.g., Gallo, 1995). Throughout this article, the term CTTFT will be used when aspects of TFT unique to Callahan are mentioned; otherwise, the term TFT will be used.
  3. Callahan attempts to tie together the notion of the perturbation and energy meridian points on the body with a concept borrowed from mathematics, “isomorphism”, which he defines as “a one-to-one relation onto the map between two sets which preserves the relations existing between elements in its domain; something identical with or similar to something else in form or structure. This term in TFT summarizes and expresses the basic finding that there is a strong one-to-one relationship between perturbations (diagnosed) in the thought field and specific energy meridian points on the body” (Callahan & Callahan, p. 279).
  4. For detailed rebuttals to HRV claims made by Callahan not mentioned in the SWT article, see Kline (2001) and Pignotti (in press).
  5. The term used in the SWT article was “dietary toxicities” but Callahan’s term for this is “Individual Energy Toxin” (IET, Callahan & Callahan, 2000).

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Callahan, R.J. (2001b). Raising and lowering heart rate variability: Some clinical findings of Thought Field Therapy. Journal of Clinical Psychology. 57 (10), 1175-1186.

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Craig, G. (1998). About Voice Technology. Retrieved July 18, 2004, from http://www.emofree.com/articles/about.htm .

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Meehl, P. (1997). Credentialed Persons, Credentialed Knowledge, Clinical Psychology: Science and Practice, 4(2), 91-98. Retrieved May 29, 2004, from http://www.tc.umn.edu/~pemeehl/168CredentialedPersons.pdf

McNally, R.J. (1994). Panic Disorder: A Critical Analysis. New York: Guilford Press.

McNally, R.J. (2000, February 21). Posting to SSPNet List Serv, Society for a Scientific Clinical Psychology.

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Otto, M.W., Smits, J.A., & Reese, H.F. (2004). Cognitive-Behavioral Therapy for the treatment of anxiety disorders. Journal of Clinical Psychiatry, 65(suppl5), 34-41.

Pignotti, M. (in press). Retraction of conclusions in the article “Heart Rate Variability as an Outcome Measure for Thought Field Therapy in Clinical Practice”. Journal of Clinical Psychology.

Pignotti, M. (submitted manuscript). Thought Field Therapy vs. random meridian point sequences: a single-blind controlled experiment.

Pignotti, M. & Steinberg, M. (2001). Heart rate variability as an outcome measure for Thought Field Therapy in clinical practice, Journal of Clinical Psychology, 57(10), 1193-1206.

Robb, M. (2003, December). Thought Field Therapy at your fingertips. Social Work Today, 20-23.

Robb, M. (in press). Thought Field Therapy Reconsidered. Social Work Today.

Rogers, M. (2000, November). Letter to the Editor, Skeptical Inquirer, 24(6). Retrieved May 29, 2004, from http://articles.findarticles.com/p/articles/mi_m2843/is_6_24/ai_66496177

Singer, M.T., Lalich, J. (1996). Crazy Therapies: What are they? How do they work? San Francisco: Jossey-Bass Publishers.

Sykes-Wylie, M. (1996, July-August). Going for the Cure. Family Therapy Networker, p. 20-25.

Vybrial, T., Glaeser, D., Morris, G., Hess, K., Yang, K., Francis, M., & Pratt, C. (1993). Effects of low dose transdermal scopolamine on heart rate variability in acute myocardial infarction. Journal of the American College of Cardiology, 22, 1320 1326.

Recommended Websites with a skeptical perspective on TFT:

Debunking Thought Field Therapy and Related Pseudoscience:
http://www.geocities.com/pseudoscience_2000/


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