Doctoral dissertation of Ronald van der Maesen, 2006
Studies on the effectiveness and client satisfaction in reincarnation therapy
Since the last 30 years there has been a growing interest in reincarnation or past‑life therapy in the western world among those who hold a philosophical orientation toward health. This orientation can be described as holistic, i.e., believing in the importance of body, mind and spirit in health (Astin, 1998). Past‑life therapy is a form of psychotherapy that can be categorized as a form of complementary and alternative medicine (CAM). The therapy is based on the assumption that actual health problems may have their roots in traumatic events in so‑called former lives or in prenatal or perinatal conditions. The actual problems, being a possible consequence of those former events, maybe treated by regressing the patient to the event that brought about the problems in this life. In past‑life theory a traumatic event usually starts with a panic reaction on a body and/or mind‑threatening situation, followed by shock and dissociation, for fear of physical pain or anxiety for the consequences of the event. Because of the dissociation, the event becomes a traumatic event that cannot be integrated in the personality as a well‑understood and comprehended event and remains unfinished in the unconscious. In past‑life therapy theory, the event, being unfinished, may be brought to the actual life as a scar in the “human soul” in the next incarnation. Reliving the experience and abolishing the dissociation responsible for the traumatic character, helps the client to finish the unfinished event and to accept and to integrate its meaning in the present personality. Consequently, the current symptoms in present‑day life may be reduced or disappear, according to the theory of past‑life therapy.
In his dissertation, the author of this summary describes his 12 years of treatment outcome studies among various populations in the Netherlands and in Surinam, a former colony of the Netherlands in the northern part of South America. After a thirty‑five‑year career in the insurance business his interest in the therapy was raised when his attention was drawn to this form of assistance by a group of people running a school for past‑life therapy (SRN: School for Reincarnation Therapy in the Netherlands). The success they claimed with treatment of psychological and chronic physical problems, as well as their urge for acknowledgement by health‑care organizations enhanced the need for treatment outcome studies on past‑life therapy. These studies are even more of interest because of a worldwide development of CAM therapies and because of the growing interest in CAM care in various countries, e.g., the United States (Astin, 1998, Eisenberg, Davis, Ettner et al.,1998, Konefal, 2002). Moreover, alternative medicine is held in esteem by a number of professionals in the field of psychotherapy (Kelsey, 1973, Cladder, 1983, Edelstien, 1984, Dethlefsen 1987, Weiss, 1988, Moody, 1989, Grof & Bancman, 1990, Neimann & Goldman, 1994, Weiss, 1997). In its Strategy for Traditional Medicine for 2003 ‑ 2005 the World Health Organization (WHO) expresses its objectives ‘to help countries develop national policies on the evaluation and regulation of CAM and create a stronger evidence base on the safety; potency and quality of CAM products and practices’ (Smolkin, 2005). In the study of Unützer, Klap, Sturm et al. (2000) the number of users of CAM care in the United States is estimated at 16.5% of the respondents. In the Netherlands, a study was performed showing that 16% of the examined Dutch people made use of alternative medicine while the expectation was a fast growing number of people using CAM care (Becker, De Hart & Mens, 1997). In their study they found that 77% of the examined people agreed that it was all right that alternative medicine was available.
Since many decades there has been a difference of opinion in psychotherapy about which therapy prevails (compare Luborsky, Rosenthal, Diguer et al., 2002, with Hunsley & Giulio, 2002). A general accepted idea is about the common factors of efficacy that can be found in the so‑called non‑specific factors, like the therapeutic relation, given attention and applied empathic attitude. The theoretical frame of references and the practical application determine the identity of the various forms of psychotherapy (Van Kalmthout & Van der Staak, 1994).
The development of CAM care together with questions about the identity; theoretical frame and practical application of past‑life therapy gave just cause for treatment outcome studies, which the author of this dissertation started in 1991 with a satisfaction research among 400 former clients of past‑life therapists in the Netherlands. To obtain a master degree in clinical psychology in 1995 the author studied the outcome of pastlife therapy among a small group of patients with the syndrome of Gilles de la Tourette, with motor and vocal tics and comorbid symptoms like obsessive-compulsive disorder. In 1997 and 1998 a treatment outcome study on past‑life therapy was performed among patients hearing voices (auditory hallucinations). Most of these patients (67%) had a psychiatric past or received ongoing treatment for schizophrenia, borderline or another psychiatric disorder. In 2002/2003 the fourth treatment outcome study was done in Surinam under the general population treated by past‑life therapists who had received training in past‑life therapy in 1998.
In this dissertation, the treatment outcome studies among people hearing voices and the study in Surinam are presented as the main sources. That is because in these treatment outcome studies a design was used known as the two‑group randomized controlled trial (RCT). This design is also described as an experiment in which the impact of treatment is compared with a control condition, in which no services are provided (a waitlist control group). An RCT enables the researcher to determine the statistical significance of the outcomes of the measured groups as a comparison between therapy and no therapy. Neither in the therapy satisfaction study, nor in the treatment outcome study among Tourette’s patients a statistical analysis has been made. For this reason the reports of those studies are presented in the Annexes.
In this dissertation, written in order to obtain a PhD degree at the University for Humanistics in Utrecht, the Netherlands, four treatment outcome studies are presented. These studies have been done to evaluate the outcome of reincarnation therapy, as it 15 called in the Netherlands, or past‑life therapy as it is called in English‑speaking countries. The central questions in this dissertation are:
1. Is past‑life therapy beneficial for patients with psychological, psychosomatic and chronic physical problems?
2. Does past‑life therapy contain specific techniques that distinguish it from other forms of psychotherapy?
In this summary, a brief recapitulation will be given of the methods used and results obtained in all four studies, done in the past twelve years. The order in which the studies are presented corresponds with the order in the dissertation. In the final paragraph, Discussion, it will be analyzed what conclusions may be drawn on the basis of the results and what answers have been found for the central questions in this dissertation.
Treatment outcome study on past‑life therapy in Surinam
In 2002 and 2003, a treatment outcome study on past‑life therapy was done in Surinam. Eleven past‑life therapists (one psychiatrist and ten paraprofessionals, all but one females), who had been practicing the therapy for four years, participated in this study. Five of them were of Indian origin, two of African origin, while the others were of European (two) or Chinese (two) origin. From their practices, 75 clients (82% females) between 17 and 71 years of age with psychiatric and non‑psychiatric problems, were randomly assigned to either a treatment condition or a waitlist control condition. To offer a limited waitlist period of one month, the protocol provided for only four once‑a‑week individual sessions. The people assigned to the waitlist condition were promised to receive therapy after this one month period.
Participants, 36% of whom originated from India and 27% from Africa, had all kinds of nonpsychiatric complaints, mostly symptoms of fear, depression, relation problems and chronic physical problems. Before and after treatment, as well as before and after the waitlist period, all participants filled out a questionnaire, the Symptom Check List SCL‑90 (Derogatis, Rickels & Rock, 1976, translated by Arrindell & Ettema, 1986, 2003). Moreover, they were all interviewed (semi‑structured interview) by students of the medical school in Paramaribo, the capital of Surinam. As a follow‑up study, the same procedure was repeated with people in the waitlist condition six months after finishing treatment.
Of 75 participants, 13 were excluded because of having another therapy during the period of research, because of incomplete questionnaires or for other reasons. Another 13 were dropouts before therapy started (mainly clients on the waitlist), while eight stopped treatment before completion.
The results refer to the remaining 41 participants, 24 in the treatment condition and 17 in the waitlist condition. On the group scores of the SCL‑90 of the participant in both conditions a statistical analysis (Mann‑Whitney test) was done, which gave very significant result (p = .001) in favor of treatment. Also, a Cohen’s d effect size (ES) of 1.16 was calculated. The individual scores of the participants in the treatment condition showed an average of 187 (sd 71) before treatment and 113 (sd 23) after treatment, while in the waitlist period the average score of the participants in that condition decreased from 216 (sd 93) to 197 (sd 84). Six months after completion of treatment, 34 participants could be traced for a follow‑up interview; 38% of them claimed a total disappearance of their initial complaints, while 56% claimed a reduction of those complaints. Of all participants, 74% told the interviewers they were very satisfied with the past‑life therapy as well as the therapist, while 20% was reasonably satisfied. The average appreciation figure was 8.7 on a scale from 0 to 10. ‑
This result was obtained by paraprofessionals (except one) in an average of four sessions of 155 minutes of therapy. So‑called past lives came up in 60% of the treatments. No racial preference was found of clients of African origin for therapists of Indian origin. Since the participating therapists of African origin (two) only brought in a few clients into this study, no conclusion can be drawn with respect of a possible preference of clients of Indian descent for originally African therapists.
Treatment outcome study on past‑life therapy for people hearing voices
Thirty‑seven females between 12 and 77 years of age and 17 males between 15 and 63, hearing voices (auditory hallucinations), participated in a treatment outcome study on pastlife therapy and were randomly assigned to either a treatment condition or a waitlist control condition. From them, 44 (79%) were in current treatment for a psychiatric disorder, mainly schizophrenia. They were offered 12 sessions after intake with 25 past‑life therapists (all paraprofessionals), who had been trained at the School for Reincarnation Therapy in the Netherlands.
Before and after treatment, as well as before and after the waitlist period, all participants filled out the Symptom Check List SCL‑90. Moreover, they were all interviewed after treatment by a psychiatrist who was responsible for the diagnoses.
Of 27 participants in the treatment condition, seven dropped out before the beginning of therapy, while seven others broke off their treatment. Of 27 participants in the waitlist condition, ten withdrew before the beginning of treatment, while three broke off treatment. The following results refer to 13 participants in the treatment condition and 14 in de waitlist condition.
Like in the treatment outcome study in Surinam, a statistical analysis (Mann-Whitney) was done on the average scores on the SCL‑90 of the participants in both conditions, which showed an identical, very significant result of p = .001 in favor of treatment. A Cohen’s d effect size (ES) of 1.40 was found. The individual scores of the participants in the treatment condition showed an average of 217 (sd 53) before treatment and 169 (sd 52) after treatment, while in the waitlist period the average score of the participants in that condition increased from 236 (sd 69) to 238 (sd 59).
Six months after completion of treatment of all 27 participants, the average SCL score had dropped to 162 (sd 49) for the original treatment group and to 172 (sdS7) for the original waitlist group, which had received treatment after the waitlist period.
14 Participants told the interviewer that the treatment benefited them by reducing the troubling voices or helping them to cope with these; four of them said they were not hearing voices anymore; 21 participants experienced other positive influences from the therapy. The average appreciation figure was 7.8 (scale 0 to 10).
The results of this efficacy study show that past‑life therapy also may be beneficial ambulant psychiatric patients in supporting and enhancing their self‑esteem, as well as in reducing their troublesome voices or in helping them to cope with these voices. According to the reports of the therapists, only a small part of the participants (16 experienced a so‑called past life. These therapists experienced that for people hearing voices, congruency with the ideas of a majority of these patients about the ESP‑l: (extra sensory perception) origin of the voices they claim to hear, is of the utmost importance for the therapeutic relation.
Study on the satisfaction of ex‑clients regarding treatment and results of past‑life therapy
Just over 400 clients (64% women) with non‑psychiatric complaints were treated 1992 by 32 past‑life therapists in the Netherlands. Of them, 393 were asked to fill o a questionnaire with 18 theses on their opinion about intake, treatment and result of the treatment. The questionnaire was composed after the example of a study do among ex‑clients of the RIAGG, an organization for mental health care in the Netherlands. Six specific questions about experiences with past‑life therapy were added. The response rate was 85%. The questionnaires of 327 people were properly filled out and were usable for analysis.
On a scale ranging from 1 (very dissatisfied) to 5 (very satisfied) the average outcome on intake, treatment and therapy result ranged between 4.8 and 4.3. In a follow-up study using a questionnaire six months later, 58% of the treated clients report complete disappearance of their complaints or substantial reduction of those con plaints. An average figure of 7.7 (scale 0 to 10) expressed the level of appreciation of therapist and therapy. A majority of people in this study experienced one or more past lives and reported a probable relation between those experiences and their presenting complaints.
Treatment outcome study on past‑life therapy for patients wit Tourette syndrome
Twenty‑one patients with motor tics and vocal tics, known as Gilles de la Tourette syndrome, participated in a treatment outcome study on past‑life therapy with ten past‑life therapists in the Netherlands in 1995 and 1996. Seventeen patients were mak (seven minors) and four were females, all adults. Nine patients (43%) indicated that their Tourette symptoms were very severe. They were randomly assigned to an experimental group, receiving immediate therapy, and to a waitlist group as controls, receiving therapy after the waitlist period. Five patients dropped out before the beginning o therapy, while five others broke off their treatment. The results refer to 11 patients wit] Tourette symptoms who completed therapy.
One year after treatment, an overall reduction of 46% in motor tics and 48% in vocal tics was reported. The appreciation for the therapy was expressed by an average appreciation figure of 8.9 (scale 0 to 10). According to past‑life therapists, in treating Tourette’s patients, attention should be given to psychological aspects of these patients, with special attention to their prenatal period and to the experiences, thoughts and emotions of their mother in that period.
The studies presented here are treatment outcome studies without comparison with other types of psychotherapy. So the results of the studies are a comparison between therapy and no therapy. For conducting comparative treatment studies the cooperation of therapists from a different therapy school is needed. So far, that has been a problem for therapies that are considered to be complementary and alternative medicine.
In the treatment outcome study with people hearing voices, as well as in the study among the general population in Surinam, the comparison between the treatment condition and the waitlist condition was made with a statistical test (Mann‑Whitney), in both studies with a very significant result (p = .001). For the sake of comparison with effect sizes (ES) in other treatment outcome studies, as can be found in publications on meta analysis in psychotherapy, an ES for past‑life therapy was calculated of 1.40 (study hearing voices) and 1.16 (study in Surinam), which are competitive with effect sizes in other types of psychotherapy. It should be taken into consideration that most people that start past‑life therapy, ranging from 50 to 80%, have been in psychotherapy before.
The initial central question in this dissertation was. does past‑life therapy have a positive effect in the treatment of patients with psychological, psychosomatic and chronic physical problems? The answer may be affirmative on two grounds:
1. In the studies among the general population in Surinam as well as among people hearing voices a comparison of the average scores on the SCL‑90 of both treatment and waitlist conditions show a very significant statistical result in favor of the treatment condition.
2. Sufficient indications of successful treatments and high levels of satisfaction are found in client’s reports about a reduction of individual scores on the SCL‑90 and about reduction or disappearance of their complaints.
The second central question in this dissertation refers to potential specific techniques that distinguish past‑life therapy from other forms of psychotherapy. The best way of tracing specific techniques in any form of psychotherapy that may be responsible for treatment outcomes is by doing process research, giving an answer to the question how a therapy works. In the studies presented here only the question if therapy works can be answered. Past‑life therapists claim that their assistance matches the growing need of many people for a holistic approach that is more congruent with their own values, believes and philosophical orientation toward health and life. This need was also noticed in the USA (Astin, 1998). It seems worthwhile to promote further efficacy and process study on past‑life therapy and the benefits it might have for a growing number of people who need help for their psychological and chronic physical problems.