Witchdoctors & Psychotherapists

by Martin and Deidre Bobgan


 We acknowledge that this article was inspired by research psychiatrist E. Fuller Torrey, MD, and his book Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future.1 According to the dictionary, a witchdoctor is “a person in some societies who attempts to cure sickness and to exercise evil spirits by the use of magic.” 2 Torrey says that most witchdoctors, unlike psychotherapists, “treat a wide variety of physical as well as mental and social problems” (p. 9). In addition he says:

Therapists in almost all cultures are closely allied with religious functions. Some of the most successful of the modern African witchdoctors are associated with the Christian sects. In Latin America, the curanderos utilize Catholicism and in Bali the balians utilize Hinduism in their therapeutic techniques. Often the therapists [witchdoctors] and the religious leaders are one and the same person, as are the Buddhist monks in Thailand and the hodjas in Turkey (pp. 8-9).

We are opposed to both witchdoctors and psychotherapists for different reasons, but Torrey does provide a convincing case for why both appear to be successful, which applies to all counseling.

In Chapter 1 of his book Torrey confronts psychotherapeutic “imperialism” where psychotherapy is regarded as scientific and witchdoctoring as prescientific. In a section titled “Magic or Science” (p. 1), Torrey says:

One reason non-Western therapists and their techniques have been ­ignored is that they are automatically relegated to the realm of “mere magic and superstition”.… This is to distinguish them from therapists in our culture, who are thought to employ techniques based on modern science.

The truth is not even close; it is a quantum jump away. The techniques used by Western [psychotherapists] are, with few exceptions, on exactly the same scientific plane as the techniques used by witchdoctors. If one is magic, then so is the other. If one is prescientific, then so is the other (p. 11).

A point Torrey restates later is that the techniques used in witchdoctoring and psychotherapy “are on exactly the same scientific—or prescientific—plane” (p. 79).

In Chapter 6, “Techniques of Therapy,” Torrey convincingly proves the similarity of techniques of psychotherapists and witchdoctors. Torrey says that techniques are supposed to be the trump card of psychotherapists over the witchdoctors. He summarizes

This trump card is the techniques used in psychotherapy, techniques that are thought to be sophisticated and scientific in Western cultures, and to be primitive and magical elsewhere in the world.

In the psychotherapy game, however, there turns out to be no trump card. Techniques of therapy used everywhere in the world are surprisingly similar. Cultures, as will be shown, favor certain types of therapies and techniques because they are more compatible with the customs or values of the culture, but the differences are more quantitative than qualitative (p. 78).

In Part II, “Psychotherapists in Action,” Torrey gives a clear picture of how the various witchdoctors function as psychotherapists and how they are similar to psychotherapists in how they practice their techniques, even though varied throughout the world. We do not need to revisit and rewrite much of what Torrey has done but merely to recommend that those who are interested in the details of the comparisons of techniques and the similarity of practices between witchdoctors and psychotherapists read Torrey’s book.

Four Basic Common Elements

One reason for writing about the subject of witchdoctors and psychotherapists is to reveal that the four  basic common elements used by psychotherapists and witchdoctors worldwide are not exclusive. Torrey says:

Therapists all over the world utilize the same four components of psychotherapy—[1] a shared worldview between therapist and client, [2] personal qualities of the therapist, [3] expectations and emotional arousal, and [4] an emerging sense of mastery in the client (p. 78).

Torrey rightfully puts techniques where they belong, i.e., in a needed but negligible position compared to the four components. He says;

Furthermore, a study of techniques used in therapy strongly suggests that it is not the techniques themselves that are important, but rather the fact that the techniques enhance the four basic components of psychotherapy…. It is not that the techniques have no therapeutic value in and of themselves, but rather that their value is negligible compared with the four basic components (pp. 78-79, italics his).

[1] A Shared World View: “Communication is [psychotherapy’s] essence. And real communication presupposes not only a shared language but a shared worldview as well” (p. 17). “The naming process is one of the most important components of all forms of psychotherapy. It is also one of the most commonly overlooked components” (p. 18).

[2] Personal Qualities: “There is a general consensus that some psychotherapists have personality characteristics which are therapeutic, while others do not have such personality characteristics and are therefore less successful as therapists” (p. 35). “Some of these ­re­searchers have claimed that certain personal qualities of the therapist—accurate empathy, nonpossessive warmth, and genuineness—are of crucial importance in producing effective psychotherapy” (p. 42).

[3] Client Expectations: “Along with a shared worldview and the personal qualities of the therapist, client expectations are a powerful and important part of the therapeutic process” (p. 54). “Since the therapeutic relationship is an interaction between two individuals, the personal qualities of the therapist and expectations of the client reverberate back and forth, producing what is commonly referred to as the “fit” between therapist and client” (p. 58).

[4] Learning and Mastery:

The sense of mastery in a client is inextricably bound up with the other components of psychotherapy. The naming process [shared world view] contributes to the client’s confidence that somebody knows what is wrong. The sense of mastery goes beyond that, however, equipping the client with knowledge about what to do for the future and how to overcome life’s adversities. Similarly, the client’s expectations and emotional arousal contribute significantly to his or her feelings of mastery and control (p. 70).

Torrey gives numerous examples of how the four components of psychotherapy are the major contributors to efficacy (success) in both psychotherapy and witchdoctoring. To clarify and dramatize the case for the impact of cultural differences, Torrey says:

A [psychotherapist] who tells an illiterate African that his phobia is related to a fear of failure and a witchdoctor who tells an American tourist that his phobia is related to possession by an ancestral spirit will be met by equally blank stares. And as therapists they will be equally irrelevant and ineffective (p. 20).

The naming of the mental disorders needing therapy is so discrepant between the American psychotherapist and the witchdoctor as to prevent even a conversation to begin. The cultural differences are so great that therapy could not commence. This dramatizes how the four components postulated by Torrey work together  and are effective and most productive for successful therapy, but only for those who have been acculturated to psychotherapy or witchdoctoring.

While techniques are an essential ingredient in the help given and received, they represent a subordinate role to the four components. Since Torrey’s book was published much more research has been conducted regarding factors outside of techniques that lead to successful outcomes for both psychotherapists and witchdoctors. We now turn our attention to those factors that reveal success rates for both psychotherapists and witchdoctors.

Research Outcomes

Equal Outcomes Phenomenon

There are about 500 different approaches in the field of psychotherapy. Generally when psychotherapies have been tested and compared, it has been found that, with certain exceptions, the research findings add up to the claim that all psychotherapies work and all seem to work equally well no matter how contrary they are to one another. This result is known in the research literature as the “equal outcomes phenomenon.”3

Psychiatrist Jerome Frank says that from the therapists’ view, “little glory derives from showing that the particular method one has mastered with so much effort may be indistinguishable from other methods in its effects.”4 The fact that there are about 500 different, often-conflicting psychotherapeutic approaches and thousands of not-often-compatible techniques with various incompatible underlying psychological theories must raise a huge question mark over why, on average, they all seem to work equally well. The exception to this conclusion is the fact that there are certain types of psychological therapies, such as regressive therapy, that produce up to forty percent detrimental effects.

This equal-outcomes finding, for which we provide research support elsewhere,5 is not believed by those with individual therapeutic approaches, such as cognitive behavioral therapy, the ­effectiveness of which has been seriously questioned.6 However, the fact of the matter is that no one has been able to demonstrate scientifically that there is a best approach when it comes to psychotherapy. If research established that one of the almost 500 approaches to psychotherapy were ­declared the winner, there would be only one psychotherapeutic approach agreed to by all. For every research report that declares one of the approaches to be the best there will be other research reports that will discredit that conclusion and claim equal outcomes.

After reading Torrey’s book we conclude that there are probably as many witchdoctoring approaches throughout the world as psychotherapies. And, while conducting research on the variety of these approaches would probably take a lifetime, we conclude that they would have equal outcomes, not only based upon the four components cited by Torrey, but also based on the research that we will cite shortly.

Common Factors

The equal outcomes phenomenon (all psychotherapies work and all seem to work equally well) naturally raises the question of what factors are common to all therapies. What are some common factors that would, on average, give most therapies and therapists (i.e., psychotherapists and witchdoctors) positive results? Psychotherapy consists of a client, a psychotherapist, and a methodology, which is centered in conversation, whereas the witchdoctor methodologies, as seen in Torrey’s book, generally involve more than just conversation. In most witchdoctor contexts the clients believe that unseen spiritual entities are involved in the process. However, the client, psychotherapist/witchdoctor, and methodology are the three obvious factors to investigate to find what might be common to all therapeutic success. Of these three, and far more important than the other two, is the person being treated, because the client determines the usefulness of the other two factors.

Client

There are various research guesses about exactly how much depends upon the client in the process of change. However, there is no question that the client is the most important and essential element in change, as will be seen shortly.

Rapport

Henri F. Ellenberger gives a detailed history of the background and emergence of psychotherapy in his monumental book The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. He says, “Whatever the psychotherapeutic procedure, it showed the same common basic feature: the presence and utilization of the rapport.”7 If a psychotherapist/witchdoctor is to best assist the client, rapport is both a necessary ingredient and a common factor in all psychotherapy/witchdoctoring. Through rapport a bonding occurs between the psychotherapist/witchdoctor and the client.

The current research stresses the great importance of rapport for success in psychotherapy and calls it the “therapeutic alliance.” This term and its significance in successful psychotherapy is repeatedly seen in the literature.  A Psychology Today article says:

Researchers who compare the success rates of various schools find that by and large, techniques and methods don’t matter. What does matter is the powerful bond between therapist and patient. The strength of this “therapeutic alliance” seems to spell the difference between successful therapy and a washout.8

Dr. Bruce Wampold reveals through his meticulous research that the characteristics of the client and the psychotherapist and their relationship (therapeutic alliance) had a far greater impact than the treatment approaches. Wampold’s research further demonstrates that there are no differences in outcomes when bona-fide treatments (i.e., those that have not demonstrated detrimental effects that would disqualify them) are compared.9

The Harvard Mental Health Letter refers to the therapeutic alliance and says that it is “the working relationship between patient and therapist that is probably the most important influence on the outcome of therapy.”10

Psychotherapy Networker says: “The therapeutic alliance—the ability to engage a client in therapy, to forge and maintain a strong, personal connection with her, convince her that the two of you are on a common path—remains the single most important element of all therapy.”11

Regardless of the approach, psychotherapy or witchdoctoring, the two most important factors for success are the personal qualities and circumstances of the one who comes for help and the rapport that exists between the psychotherapist/witchdoctor and client, which is a judgment the client makes.

Is Psychotherapy/Witchdoctoring a Placebo?

We next reveal the extent of the power of the placebo in the success of psychotherapy and witchdoctoring. Dr. Arthur Shapiro, clinical professor of psychiatry at Mount Sinai School of Medicine, suggests that the power of psychotherapy may be the effect of a placebo. The placebo effect takes place when one has faith in a pill, a person, a process or procedure, and it is this faith that brings about the healing. The pill, person, process, or procedure may all be fake, but the result is real. Shapiro says, “Just as bloodletting was perhaps the massive placebo technique of the past, so psychoanalysis—and its dozens of psychotherapy offshoots—is the most used placebo of our time.”12

If psychotherapy and witchdoctoring indeed operate as placebos, the approach one uses does not matter. The client will interpret what he is receiving as helping him whether it does or not. His thinking will then influence the result.

A number of studies support the idea that mental, emotional, and even physical change may occur simply because of expectations. Simply expecting to improve will often set the stage for improvement. In fact, the authors of a book on the placebo effect say, “It may be that interventions differ in effectiveness because they differentially elicit expectancy of benefit.”13 Dr. David Shapiro calls this the “expectancy arousal hypothesis,” which is that “treatments differ in effectiveness only to the extent that they arouse in clients differing degrees of expectation of benefit”14 (bold added). The greater the expectation, the greater the possibility of effectiveness.

If one out of three individuals finds relief through the use of a medical placebo, what percent of the individuals who see a psychotherapist receive similar relief through a type of mental placebo? A group of researchers at Wesleyan University compared the benefits of psychotherapy with those of placebo treatments. The placebo treatments were activities (such as discussion of current events, group play reading, and listening to records) that attempted to help individuals without the use of psychotherapeutic techniques. The researchers concluded that “after about 500 outcome studies have been reviewed—we are still not aware of a single convincing demonstration that the benefits of psychotherapy exceed those of placebos for real patients.”15

Dr. Arthur Shapiro criticized his professional colleagues at the annual meeting of the American Psychopathological Association for ignoring placebo effects and therefore skewing the results of their research.16 He believes that if placebo effects were considered “there would be no difference between psychotherapy and placebo.”17

The above research on the placebo effects obviously applies to witchdoctoring. Torrey has given us pictures of how witchdoctors practice throughout the world and gives us a glimpse of “expectations” in the client and how they, being one of the four components of success, are played out in witchdoctoring.

Ingredients for Success

John C. Norcross and Marvin R. Goldfield, in their academic text of psychotherapy research and results, estimate that the client and the rapport (therapeutic alliance) if established by the psychotherapist would average about 70 percent of the success with client factors being the greater of the two.18 However, think about it. Who determines whether the rapport or therapeutic alliance is effective? Who believes whether the therapist can be trusted? Who decides whether the client/psychotherapist relationship is a warm, empathic, sympathetic one? Answer: the client does. The psychotherapist may try to establish rapport through various means, but the client is the one who responds or rejects, and thus the estimated figure of 70 percent of any success really has to do with the clients and how they view the relationship. One therapeutic alliance (rapport) researcher says: “When you’re a therapist, you think you know the most important things about your client and therapy; it’s the client’s perceptions about how things are going that have the greatest predictive value of the outcome of therapy.”19

After surveying clients who had recently been in psychotherapy, the authors of the study concluded:

The most powerful alliance-building behaviors turn out to be basic human courtesies and fundamental relationship skills, which have nothing to do with therapists’ techniques or diagnostic abilities. Greeting clients with a smile, making eye contact, sitting still without fidgeting, identifying and reflecting back feelings, making encouraging and positive comments, truthfully sharing negative information, normalizing feelings and experiences, and remembering details from previous sessions turned out to be extremely important factors.20

Allen Frances, MD, reports on “consistent research findings that should make a world of difference to therapists and to the people they treat.” He says: “The major focus of effective therapy—to establish a healing relationship and to inspire hope…. A good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used.”21

This evidence is seen repeatedly in the research: that the clients’ perceptions of the psychotherapist “have the greatest predictive value of the outcome in therapy” and the personal qualities of the psychotherapist that are rapport building will encourage the client to ­receive whatever methodology is ­offered. Nevertheless, the effectiveness of the psychotherapy still depends on the client receiving it. Here again, while there is no research specifically on witchdoctoring throughout the world, nevertheless, the client who comes to a witchdoctor is influenced by the “four common elements” as described extensively by Torrey, plus the research we are currently quoting.

In addition to the 70 percent for the client and psychotherapist, Norcross and Goldfield give 15 percent for the placebo effect as an important factor for success. Remember, the placebo effect is a sham treatment, in this case a psychological treatment that through belief on the part of the client is received and responded to as a valid treatment.22 In other words, no matter what treatment the therapist uses, if the client responds positively to it, there is a therapeutic effect. Notice that it does not matter what the treatment is; the receiving and responding are on the part of the client. Thus the resulting estimate should add up to about 85 percent for how the client receives and responds to the therapy.

If one combines the interpersonal qualities of the psychotherapists, the external factors involved outside the office, and the placebo effect, this may account for much of what may be working to bring about any success in psychotherapy and witchdoctoring. In other words, the particular approach is not what leads to change, nor the theories, training, or techniques: it is the interpersonal environment plus the placebo effect. And all of these, of course, pale in comparison to the individual’s desire to change and his willingness to take the responsibility to do so. Because of the “four common elements” referred to by Torrey and the current research quoted, the 85 percent figure for the client who goes to a witchdoctor would apply.

Finally, in addition to the 15 percent for the placebo effect, Norcross and Goldfield give only 15 percent to the methodology. However, we remind the reader of the equal outcomes phenomenon, which means that no specific methodology or specific technique is necessarily the best and thus required for success. This could apply to witchdoctors, with no specific witchdoctoring and no specific technique necessarily being the best and thus required for success within their common spiritual context. Excluding those psychotherapies that are known to be detrimental, whatever technique or theory is selected has a considerably smaller effect than the therapist/client factors.

In reviewing a book entitled Psychotherapy Research: Methodological and Efficacy Issues, published by the American Psychiatric Association, the Brain/Mind Bulletin says, “Research often fails to demonstrate an unequivocal advantage from psychotherapy.” The following is an interesting example from the book: “An experiment at the All-India Institute of Mental Health in Bangalore found that Western-trained psychiatrists and native healers had a comparable recovery rate. The most notable difference was that the so-called ‘witchdoctors’ released their patients sooner.”23

We repeat, Torrey says that “psychotherapy does work and that its effectiveness is primarily due to four basic components—a shared worldview, personal qualities of the therapist, client expectations, and an emerging sense of mastery” (p. 198, italics his). All of these factors are at play in all effective human relationships. None of these factors require training, techniques, degrees, or licensing. All of these factors may be at work whether a person is in treatment or not. The same factors which lead to improvement inside formal treatment also work outside of formal treatment, or alongside it, which adds more questionability to the whole psychotherapeutic/witchdoctoring mind game.

In summary, the client is the keystone to successful treatment. This fact is the reason for psychotherapies being about equally effective (equal outcomes phenomenon), with the exception of those that produce as much as a 40 percent harm rate mentioned above. In other words, the clients who are motivated to succeed, who engage in the rapport with the psychotherapist (therapeutic alliance), and who believe that they are receiving a valid treatment (placebo effect) will most likely succeed, regardless of the approach and regardless of the therapist being an amateur or professional. Therefore, clients who meet these conditions and are given entirely different types and even contradictory therapies tend to have similar success rates. These ­research results of psychotherapy complement and augment the research results found in Torrey’s book on the success of witchdoctors.

Regardless of the research results, one should not be afraid to minister ­biblically, because the Bible offers what no psychotherapy or witchdoctoring can offer and that is salvation, spiritual growth, and an eternity with Jesus. Ministering biblically would go far beyond the equal outcomes level of change! There is not even one therapeutic theory, technique, or methodology that can trump the biblical care of souls and what God has to offer those suffering from the issues of life.

Endnotes

1   E. Fuller Torrey. Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future, revised ed. of The Mind Game. Northvale, NJ: Jason Aronson Inc., 1986.. Hereafter page references to this book will be in parentheses.

2   Webster’s Encyclopedia Unabridged Dictionary, 1996, p. 2182..

3   Allen E. Bergin and Sol L. Garfield, “Overview, Trends, and Future Issues,” Handbook of Psychotherapy and Behavior Change, Fourth Edition, Allen E. Bergin and Sol L. Garfield, eds. New York: John Wiley & Sons, Inc., 1994, p. 822.

4   Jerome D. Frank, quoted in Handbook, ibid., p. 167.

5   Martin and Deidre Bobgan. PsychoHeresy and The End of “Christian Psychology,” Santa Barbara, CA: EastGate Publishers, 1987, 1997. 2012.

6   “Has CBT Lost Its Mojo?” Psychotherapy Networker, Vol. 39, No. 6, p. 11.

7   Henri F. Ellenberger. Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books/HarperCollins Publishers, 1970, p. 152.

8   Kathleen McGowan, “The Power Couple,” Psychology Today, November/December, 2004, p. 20.

9   Jay Lebow, “Big Squeeze: No Research? No Treatment,” Psychotherapy Networker, Vol. 34, No. 1, p. 33.

10 “Therapeutic Alliance and Treatment Preference,” Harvard Mental Health Letter, Vol. 24, No. 1, p. 7.

11 Psychotherapy Networker, Vol. 31, No. 6, p. 2.

12 Arthur Shapiro interview by Martin Gross. The Psychological Society. New York: Random House, 1978, p. 230.

13 Leonard White, Bernard Tursky, and Gary E. Schwartz. Placebo: Theory, Research, and Mechanisms. New York: The Guilford Press, 1985, p. 204.

14 David A. Shapiro quoted in ibid.

15 Leslie Prioleau, Martha Murdock, and Nathan Brody, “An Analysis of Psychotherapy Versus Placebo Studies,” The Behavioral and Brain Sciences, June 1983, p. 284.

16 Arthur Shapiro, “Opening Comments,” Psychotherapy Research, Janet B. W Williams and Robert L. Spitzer, eds. New York: The Guilford Press, 1984, p. 106.

17 Ibid., p. 107.

18 John C. Norcross and Marvin R. Goldfield, eds. Handbook of Psychotherapy Integration, Second Edition. Oxford: Oxford University Press, 2005, p. 87.

19 “Clinician’s Digest,” Psychotherapy Networker, Vol. 34, No. 5, pp 10-11.

20 Ibid., p. 11.

21 Allen Frances, “The Magical Healing Powr of Caring and Hope in Psychotherapy,” Psychiatric Times, 7/7/2015, www.psychiatrictimes.com.

22  Marilynn Marchione, “Experts: Placebo effect behind many natural cures,” Santa Barbara News-Press, November 11, 2009, p. B1.

23 “Ambiguity Pervades Research on Effectiveness of Psychotherapy,” Brain/Mind Bulletin, 4 October 1982, p. 2.

 
(PsychoHeresy Awareness Letter, May-June 2016, Vol. 24, No. 3)

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