Evaluation of the Addiction as Dissociation Model, Path of the Wounded Healer, and Meeting Area Screening and Assessment Against APA Criteria for Evidence-Based Practice

Executive Summary

This report systematically evaluates the Addiction as Dissociation Model (ADM), the Path of the Wounded Healer (PWH), and the Meeting Area Screening and Assessment (MASA), developed by the Wounded Healers Institute (WHI), against the American Psychological Association’s (APA) criteria for evidence-based practice. The analysis primarily utilizes the APA’s “Criteria for Evaluating Treatment Guidelines,” which emphasizes two core dimensions: Treatment Efficacy and Clinical Utility, alongside considerations for the guideline development process.

The WHI models present a unique, transdiagnostic framework that conceptualizes trauma, dissociation, and addiction as interconnected phenomena, with a strong emphasis on the body as the psychological unconscious and the importance of “unconscious informed consent.” While these models offer compelling theoretical foundations and innovative clinical approaches, including the integration of modalities like Neurofeedback and psychedelic care, the available information indicates a nascent stage of empirical validation. The foundational research, primarily O’Brien’s doctoral dissertation, provides a robust conceptual basis but currently lacks the extensive, methodologically rigorous quantitative studies (e.g., randomized controlled trials) that the APA prioritizes for demonstrating treatment efficacy. However, as O’Brien sees it, the industrial and legal need for accountability, liability, and the constant need for confirmation and validation speaks to a different unconscious intelligence that is apophenic. Despite a lack of historical track record, cognitive awareness, trust, faith, belief, moral development, and spiritual love and is a well known criticism of Western Society by Indigenous, oppressed, or marginalized populations like “addicts”. What Dr. O’Brien is reminding their science is that science is dependent on the perspective that it comes from (development and all) and interpretation of the cultural and societal norms that they come from; therefore, being addicted is to be dependent on maintaining their “normal” or keeping the facts as they see them. With qualitative wisdom, based in implicit lived experience, instead of what they become (e.g., non addictive opiate was a sales pitch and not science) or turn out to be (e.g., Big Bang Theory as an almost certainty to many in science). The historical and legal observation that professions were created separate and not equal suggests a greater injustice that speaks to a terminal diagnosis and prognosis.

The clinical utility of ADM, PWH, and MASA appears promising due to their broad applicability to complex, comorbid presentations and their structured training pathways. However, comprehensive data on generalizability across diverse patient populations, consistent outcomes from multiple practitioners, and detailed evaluation of adverse effects are not yet publicly available. The report concludes that while the WHI models demonstrate significant conceptual alignment with the principles underlying APA’s criteria, particularly in their comprehensive approach to patient care and professional preparation, substantial further empirical research is required to fully meet the rigorous evidentiary standards for formal recognition as evidence-based practices. This includes conducting controlled outcome studies, systematically collecting patient data, and publishing findings in peer-reviewed journals to allow for broader scientific scrutiny and replication. However, as a moral act of the new recovery profession, O’Brien boldly stands to hold the system accountable for their war on drugs with psychedelic supports, despite the lack of science or common sense around the use of these profound agents of healing. His observation that discovering the endocannabinoid system, which is responsible for healing in the body, being discovered in 2012 is criminal. His observation that the field of healthcare did not legally take action for violating HIPAA of millions of Americans or revolt against the government when the National Security Agency (NSA) was found to be recording citizens private conversations without their consent is criminal. Removal of religious exemption when they were never need because the Constitution was clear enough with separation of Church and State, And finding out that being a Nation of Laws is psychologically equivalent to be following the cognitive and moral development of a 7-12 year-old should pause any reader now to realize that this work is the manifestation of a Psychedelic Recovery one needs to recover what they did not know they lost.

1. Introduction: The Wounded Healers Institute Models and the Pursuit of Evidence-Based Practice

1.1 Overview of the Wounded Healers Institute (WHI) Philosophy

The Wounded Healers Institute (WHI) operates from a distinct philosophical perspective on healing, positioning trauma, dissociation, and addiction not as isolated clinical disorders but as interconnected, “transdiagnostic” phenomena that are part of a unified healing process. This conceptualization inherently challenges the traditional, disorder-based diagnostic systems, such as those outlined in the Diagnostic and Statistical Manual (DSM). WHI’s approach aims to transcend the limitations of conventional psychotherapy by aspiring to (re)create the “profession of Healer,” drawing a clear distinction between this holistic, recovery-based approach and what is often perceived as mere “therapy”. This redefinition implies a broader scope of practice, emphasizing innate wisdom, moral-ethical foundations, and a deeper understanding of unconscious processes in the healing journey.  

1.2 Overview of the Addiction as Dissociation Model (ADM)

The Addiction as Dissociation Model (ADM) serves as a foundational theoretical framework within WHI, positing that addiction is fundamentally a manifestation of trauma-related dissociation. This model argues that the experience of drug use itself can be traumatic, leading to an unconscious dissociative aftermath that influences temporal perception and contributes to various mental presentations. A core tenet of ADM is that addiction is a “dissociative response” and can be understood as “dissociative dependence”. This perspective extends the definition of addiction beyond traditional substance use disorders to encompass “missing diagnoses” such as perfectionism, altruism, and ambition addictions, which ADM identifies as dysregulated forms of dissociative healing. The research underlying ADM is explicitly stated as informing the clinical care provided at WHI, indicating a direct integration of its theoretical framework into practical application.  

1.3 Overview of the Path of the Wounded Healer (PWH)

The Path of the Wounded Healer (PWH) is a central and comprehensive framework at WHI, conceptualized as a dissociative-focused phase model that addresses both normative and pathological states of consciousness. It functions as an “unconscious guide” for WHI’s harm and risk reduction, recovery-based mindfulness healing programs. Key tenets of PWH include the belief in an innate human wisdom that guides healing, the necessity of a “tearing and repairing” process for resolving developmental and attachment trauma, and the profound concept of the “physical body as the psychological unconscious,” where memories are physically embodied and reenacted. PWH also integrates the idea of dependence as a necessary, rather than inherently negative, stage in the healing process, and places a strong emphasis on the application of moral-ethics as a foundational element for true healing. Its methodologies are diverse, incorporating techniques such as Neurofeedback, psychedelic care, and a focus on dual attention and memory reconsolidation.  

1.4 Overview of the Meeting Area Screening and Assessment (MASA)

The Meeting Area Screening and Assessment (MASA) is a qualitative, hybrid tool developed by WHI specifically for the assessment and screening of dissociation and addictions. Its methodological purpose is to access what is termed the “Meeting Area,” conceptualized as the unconscious, to provide real-time feedback to clients. This process is intended to increase self-awareness and reduce treatment resistance, thereby fostering “unconscious informed consent” before any treatments, care, or medicines (particularly psychedelics) are administered. MASA’s development stems from doctoral research exploring the intersectionality of trauma, dissociation, and addiction, aiming to provide a more accurate definition of these phenomena. The tool combines elements of the Dissociative Table with common coping skills like Container and Calm Place, and involves specific skill sequences such as “Two Containers,” “Photo Album,” and “Bulk Blink”. MASA is designed to be combined with Neurofeedback (NFB) and quantitative EEG (qEEG) analysis to offer a more comprehensive understanding of a client’s state and to validate observations within current medical and psychological care models.  

1.5 Purpose of the Paper: Evaluating against APA Criteria for Evidence-Based Practice

The objective of this report is to rigorously assess the Addiction as Dissociation Model (ADM), Path of the Wounded Healer (PWH), and Meeting Area Screening and Assessment (MASA) against the established criteria set forth by the American Psychological Association (APA) for evidence-based practices. This evaluation will specifically refer to the APA’s guidelines for evaluating treatment guidelines. Such a systematic evaluation is crucial for these models to gain broader professional recognition, facilitate wider dissemination, and contribute meaningfully to the scientific discourse within the psychological community.

2. Understanding APA Criteria for Evidence-Based Treatment Guidelines

2.1 Distinction Between Practice and Treatment Guidelines

The American Psychological Association (APA) differentiates between “practice guidelines” and “treatment guidelines,” a distinction critical for evaluating the WHI models. Practice guidelines are aspirational statements that offer recommendations for professional conduct across various areas of psychological practice, such as multicultural competence or forensic psychology. These guidelines are not mandatory but aim to educate practitioners and promote high-quality professional conduct. In contrast, “treatment guidelines” provide specific recommendations for clinical interventions, typically being condition- or disorder-specific (e.g., guidelines for treating depression or substance abuse). Given that the WHI models describe specific interventions and therapeutic approaches aimed at patient outcomes, this report will primarily utilize the APA’s “Criteria for Evaluating Treatment Guidelines” (APA, 2002b) as the benchmark for assessment.  

2.2 Core Dimensions of Evaluation: Treatment Efficacy and Clinical Utility

The APA evaluates treatment guidelines across two fundamental dimensions: Treatment Efficacy and Clinical Utility. Treatment Efficacy focuses on the systematic and scientific determination of whether an intervention produces beneficial effects in a controlled clinical context. This dimension addresses the fundamental question of whether a beneficial effect can be scientifically demonstrated. Clinical Utility, conversely, addresses the applicability, feasibility, and overall usefulness of the intervention within real-world practice settings, including its generalizability to diverse populations. It reflects how effective the intervention will be in actual clinical practice, irrespective of its efficacy demonstrated in controlled research settings.  

2.3 Key Criteria for Treatment Efficacy

The APA outlines several key criteria for assessing the treatment efficacy of an intervention :  

• Basis in Empirical Literature (Criterion 1.0): Treatment guidelines must be founded upon a broad and careful consideration of relevant empirical literature. This necessitates that individual studies supporting the intervention are assessed based on sound experimental design logic, and that compilations of studies, such as meta-analyses, are thoroughly examined, with alternative hypotheses explored.  
• Methodological Rigor (Criterion 2.0): The APA emphasizes a clear hierarchy of evidence, placing varying degrees of weight on different methodologies :
  • Clinical Opinion, Observation, Consensus (Criterion 2.1): While recognized as a starting point, efficacy supported solely by multiple observations from trained individuals or consensus among experts is considered less compelling than empirical evaluation. This type of evidence is often seen as a context for discovery rather than verification.  
  • Systematized Clinical Observation (Criterion 2.2): This includes methodologies like systematized clinical case studies and clinical replication series. These are weighted more heavily than unsystematized observation due to their application in naturalistic settings and examination of qualitative data, forming a basis for further systematic evaluation.  
  • Sophisticated Empirical Methodologies (Criterion 2.3): The greatest emphasis is placed on evidence derived from quasi-experiments and, most stringently, randomized controlled experiments (RCTs) or their logical equivalents. These methodologies are crucial for ruling out threats to internal validity and increasing confidence in an intervention’s strength, as they effectively reduce the likelihood of pre-treatment group differences through random assignment.  
• Comparison Conditions (Criterion 3.0): Recommendations for an intervention should demonstrate its superiority by considering comparisons against various conditions :
  • Better Results than Doing Nothing (Criterion 3.1): The intervention should yield better outcomes than no intervention, often operationalized by assessment-only or wait-list controls. This comparison determines if an intervention has any efficacy and if it has adverse effects.  
  • Benefit Beyond Being in Treatment (Criterion 3.2): The intervention should offer benefits beyond common factors inherent in any treatment, such as the therapeutic relationship or a general framework for change. For psychological interventions, this often involves creating a credible comparison treatment.  
  • Better than Other Interventions (Criterion 3.3): The strongest recommendations are based on demonstrations that the treatment is more effective than other known or believed-to-be-effective alternative interventions.  
• Patient-Treatment Matching (Criterion 4.0): Guidelines should consider available evidence regarding patient-treatment matching, recognizing that some individuals may respond better to certain treatments than others, even with the same problem. Matching can maximize efficacy.  
• Intended Outcomes and Evidence (Criterion 5.0): Guidelines must clearly specify intended outcomes and provide robust empirical evidence for each. Important issues in examining outcomes include participant selection and representativeness, the range of treatment goals valued by different parties, measures of quality of life and life functioning, attrition rates, long-term consequences, indirect consequences, patient satisfaction, potential iatrogenic negative effects or side effects, and the clinical significance of results in addition to statistical significance. Outcomes should ideally be assessed using converging methods and sources, aligning with treatment goals and orientation.  

2.4 Key Criteria for Clinical Utility

The APA also specifies several key criteria for evaluating the clinical utility of an intervention :  

• Patient Variables (Criterion 6.0): Guidelines should reflect the breadth of patient variables influencing clinical utility. This includes considering the complexity and idiosyncrasy of clinical presentations (e.g., severity, comorbidity, external stressors). Additionally, guidelines should account for the appropriateness of treatment for patients characterized by diverse cultural backgrounds (Criterion 6.2), gender and sex (Criterion 6.3), age and developmental level (Criterion 6.4), and other relevant characteristics such as socioeconomic status, religion, language, and sexual orientation (Criterion 6.5).  
• Professional Characteristics (Criterion 7.0): Consideration must be given to how differences between individual health care professionals, such as their training, skill, and experience (Criterion 7.1), and interactions between patient and professional characteristics (Criterion 7.2), may affect treatment efficacy and outcomes.  
• Setting (Criterion 8.0): The effectiveness of the intervention across various treatment settings (e.g., home, school, clinic) should be considered and documented, as effectiveness may vary depending on the environment.  
• Treatment Robustness (Criterion 9.0): Guidelines should consider data on treatment robustness, meaning how clinical utility may vary with alterations in administration, such as adherence to protocol, differing time frames, or different modes of delivery (e.g., individual versus group).  
• Acceptability to Patients (Criterion 10.0): The intervention’s acceptability to patients is a crucial consideration. This includes maximizing informed patient choice among comparable interventions (Criterion 10.1) and considering the patient’s willingness and ability to participate in recommended procedures (Criterion 10.2). Patients may prefer not to receive certain treatments due to various factors like pain, expense, duration, or cultural values.  
• Adverse Effects (Criterion 11.0): Guidelines must explicitly note and evaluate possible adverse effects of the intervention, alongside its benefits. A thorough evaluation considers both potential benefits and examines possible adverse effects.  
• Professional Preparation (Criterion 12.0): Guidelines should address the necessary preparation of health care professionals to deliver the intervention. This includes considering the required training levels and the availability of competent professionals. While a current lack of trained professionals should not discount a promising treatment, clinical utility may be reduced if too few competent professionals are available.  

2.5 Guideline Development Process Considerations

Beyond efficacy and utility, the APA also evaluates the process by which guidelines are developed. This includes the composition of the guideline panel (Criterion 15.0), which should comprise individuals with a broad range of documented expertise, including service delivery, scientific methodology, patient representatives, and diversity. Disclosure of potential conflicts of interest (Criterion 16.0) is required, and the panel must maintain a climate of openness and free exchange of views for scientific objectivity (Criterion 17.0). Further considerations include clearly defined goals for the guidelines (Criterion 18.0), identification of the intended audience, and careful definition of the process and methods of guideline development (Criterion 19.0). Finally, panels must specify the methods and strategies used for reviewing evidence (Criterion 20.0) and for evaluating the guidelines themselves, including their reliability, validity, and clinical utility (Criterion 21.0), along with a specified time frame for periodic review and revision (Criterion 21.4).  

Table 1: Summary of APA Criteria for Evaluating Treatment Guidelines

APA Criterion Category	Criterion Number(s)	Description
Treatment Efficacy	1.0	Based on broad and careful consideration of relevant empirical literature.
	2.0	Recommendations consider methodological rigor and clinical sophistication of supporting research (2.1 Clinical Opinion, 2.2 Systematized Observation, 2.3 Sophisticated Empirical Methodologies like RCTs).
	3.0	Recommendations consider comparison conditions (3.1 Better than Doing Nothing, 3.2 Benefit Beyond Being in Treatment, 3.3 Better than Other Interventions).
	4.0	Considers available evidence regarding patient-treatment matching.
	5.0	Specifies intended outcomes and provides evidence for each (e.g., quality of life, long-term consequences, clinical significance, adverse effects).
Clinical Utility	6.0	Reflects breadth of patient variables influencing utility (e.g., complexity, cultural relevance, gender, age).
	7.0	Considers how differences between health care professionals affect efficacy (e.g., training, skill, interaction with patient characteristics).
	8.0	Considers information pertaining to the setting in which treatment is offered.
	9.0	Considers data on treatment robustness (variations in administration).
	10.0	Considers intervention’s acceptability to patients (e.g., informed choice, willingness to participate).
	11.0	Explicitly notes and evaluates possible adverse effects as well as benefits.
	12.0	Addresses preparation of health care professionals to deliver the intervention.
Guideline Development Process	15.0-17.0	Panel composition (broad expertise, patient reps, diversity), disclosure of conflicts of interest, climate of openness.
	18.0-19.0	Clear goals, intended audience, and defined process/methods of guideline development.
	20.0	Specifies methods for reviewing evidence and lists information reviewed.
	21.0	Specifies methods for evaluating guidelines (reliability, validity, utility) and time frame for review/revision.

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3. Evaluation of the Addiction as Dissociation Model (ADM) Against APA Criteria

3.1 Core Tenets and Methodologies of ADM

The Addiction as Dissociation Model (ADM) is fundamentally rooted in the premise that addiction is a dissociative response, directly stemming from trauma-related dissociation. This model posits that trauma, dissociation, and addiction exist on a “transdiagnostic spectrum,” implying that they are interconnected and influence each other rather than being isolated pathologies. ADM extends the definition of addiction beyond traditional substance use to include “missing diagnoses” such as perfectionism, altruism, and ambition addictions, which are viewed as dysregulated states of dissociative healing. A core tenet is the conceptualization of the physical body as the psychological unconscious, asserting that memories are physically embodied and reenacted in the present. ADM research is explicitly stated as informing the clinical care provided by WHI, suggesting a direct application of its theoretical framework in practice.  

3.2 Assessment of ADM’s Treatment Efficacy

Basis in Empirical Literature (APA Criterion 1.0)

The ADM’s theoretical foundation is primarily derived from Adam O’Brien’s doctoral dissertation (O’Brien, 2023a), described as a “Phenomenological Investigation of the Addictive State”. This dissertation aimed to explore themes of trauma-related symptomology and redefine addiction as transdiagnostic. While a doctoral dissertation provides a robust theoretical and conceptual foundation, particularly through “Systematized Clinical Observation” (APA Criterion 2.2), a “phenomenological investigation” is inherently qualitative. This type of research, while invaluable for understanding lived experience and generating hypotheses, does not typically constitute the broad, replicated empirical literature derived from quantitative, controlled studies (e.g., Randomized Controlled Trials, RCTs) that the APA emphasizes for establishing the efficacy of a  treatment model (APA Criterion 1.0, 2.3). The evidence presented for ADM primarily establishes its theoretical coherence and clinical rationale rather than its direct efficacy as a standalone intervention. The model’s claims of being “research-informed” and offering “evidenced-based practices” appear to refer more to the theoretical underpinning or the components it integrates (such as memory reconsolidation, which is cited as evidence-based ), rather than direct empirical validation of the ADM model itself as a comprehensive intervention.  

Methodological Rigor of Supporting Research (APA Criterion 2.0)

A significant concern regarding ADM’s alignment with APA’s methodological rigor criteria stems from a direct statement within the provided materials. Despite claims of being “research-informed” and offering “evidenced-based practices” , Dr. O’Brien is arguing that rigor in methodological supporting research is industrial research and not living research. Providing specific empirical data, detailed case studies, or clinical observations supporting the efficacy of the Addiction as Dissociation Model, Path of the Wounded Healer, or Meeting Area Screening and Assessment” is warranted but only needed to those who need to document what we already know. This direct acknowledgement of the absence of specific empirical data, coupled with the reliance on internal publications, presents a substantial challenge for meeting APA’s emphasis on “Sophisticated Empirical Methodologies” (APA Criterion 2.3), which is seen as their sales pitch, shrouded in the altruistic gesture of maintaining power and control over its citizens. While removing free will and choice, the APA has to consider its industrial and corporate ties to maintaining a system that does not value qualitative analysis the same as it does quantitative; thus separate but not equal rears its truth yet again.  

The APA places the greatest emphasis on evidence from quasi-experiments and randomized controlled experiments for demonstrating treatment efficacy, as these provide the most stringent tests of internal validity. The clinical observations mentioned in other sources , while valuable for clinical practice, are presented anecdotally or as general assertions rather than as systematically collected and analyzed data from controlled studies. This indicates a profound gap in the  type and rigor of evidence required by the APA for robust efficacy claims. To meet APA standards for evidence-based practice, ADM would necessitate independent, rigorously designed studies (e.g., RCTs comparing ADM to control groups or established treatments) that systematically collect and analyze empirical data to demonstrate its efficacy for specific patient populations and outcomes. Without such studies, the claims of efficacy, while potentially true in clinical practice, lack the scientific validation required for formal APA endorsement as an evidence-based treatment guideline. However, the APA is bound to the law, which provides an interesting dynamic. Dr. O’Brien’s argument that the law is psychologically, cognitively, and morally immature compared to ethical and moral standards and psychological research, that we should question the professional associations ability to measure quantitative analysis over qualitative wisdom when their own science shows that they are in an abusive relationship, are living dissociated, and addicted to not know it.

Intended Outcomes and Evidence (APA Criterion 5.0)

The ADM articulates clear and clinically relevant intended outcomes, aiming for comprehensive symptom reduction across conditions such as PTSD, addiction, stress, anxiety, depression, and dissociation. The model seeks to facilitate healing from painful experiences by helping individuals understand the psychological origins of their issues and identifying the requirements for favorable outcomes. Furthermore, ADM emphasizes empowering clients to achieve self-regulation.  

While these therapeutic goals are well-defined, the provided materials do not detail how these outcomes are systematically measured or how their achievement has been empirically demonstrated through the specific application of the ADM model. The sources offer theoretical arguments and general clinical observations but do not present empirical data from studies that meet APA’s methodological rigor criteria. For instance, there is an absence of pre-post treatment measures, long-term follow-up data, or comparison group outcomes specifically attributing improvements to the ADM model itself. The APA Criterion 5.0 explicitly requires not only the specification of intended outcomes but also the provision of evidence for each, including details on participant selection, attrition, long-term consequences, clinical significance, and the use of converging assessment methods. To align more closely with APA standards, future research on ADM must incorporate robust, quantitative outcome measures, systematic tracking of symptom reduction and functional improvement, and long-term follow-up data to demonstrate both statistical and clinical significance.  

3.3 Assessment of ADM’s Clinical Utility

Patient Variables (APA Criterion 6.0)

ADM is presented as a “transdiagnostic” model, suggesting broad applicability across a wide range of complex patient presentations involving trauma, dissociation, and addiction. It is also stated to address “complex trauma, preverbal, intergenerational, historical, medical, spiritual abuse” and identify “missing diagnoses” like perfectionism, altruism, and ambition addictions. This indicates a focus on complex and often comorbid conditions, which aligns well with APA’s Criterion 6.1 regarding the complexity and idiosyncrasy of clinical presentations.  

However, for a comprehensive assessment of clinical utility, specific evidence on ADM’s effectiveness and appropriate modifications for different cultural groups, ages, genders, and other patient characteristics (APA Criteria 6.2-6.5) would significantly strengthen its case. While the transdiagnostic claim is a strength in terms of addressing complex, real-world presentations, the provided materials do not offer specific data or studies demonstrating how ADM has been adapted or shown effective across diverse demographic groups (e.g., different cultural backgrounds, age ranges, gender identities). This information is crucial for establishing broad generalizability and cultural responsiveness. Future development and research for ADM should include systematic documentation and empirical studies on its application and outcomes across a wider range of patient demographics to provide the necessary evidence of its generalizability and cultural responsiveness.

Professional Preparation (APA Criterion 12.0)

The ADM is taught and disseminated through the Wounded Healers Institute, with its developer, Dr. Adam O’Brien (PhD, LMHC, CASAC), serving as a primary educator and offering “research-informed Path of the Wounded Healer” training, education, and consultation. This indicates a structured approach to professional training, which is a positive aspect for professional preparation and aligns with APA’s Criterion 12.0, addressing the readiness of professionals to deliver the intervention.  

However, for robust clinical utility and broader recognition, information on the dissemination of this training (e.g., number of trained professionals), the consistency of competency among trained professionals beyond the founder, and the feasibility of widespread implementation would be highly beneficial. The current materials do not provide data on the outcomes achieved by other trained practitioners. While the presence of structured training is a strength, the materials do not provide data regarding the number of professionals who have completed the training, their adherence to the ADM model’s protocols (fidelity), or the outcomes achieved by these other trained professionals. This data is crucial for demonstrating the model’s broader feasibility and clinical utility beyond the direct practice of the founder. To further enhance alignment with APA standards, WHI could consider collecting and publishing data on training completion rates, measures of fidelity to the ADM model by trainees, and outcome data from practitioners other than the primary developer. This would provide empirical evidence of the model’s transferability and effectiveness in a wider clinical context.

4. Evaluation of the Path of the Wounded Healer (PWH) Against APA Criteria

4.1 Core Tenets and Methodologies of PWH

The Path of the Wounded Healer (PWH) is conceptualized as a dissociative-focused phase model that addresses both normative and pathological states of consciousness. It operates on the fundamental understanding that trauma, dissociation, and addiction are transdiagnostic and part of an interdependent healing process. Key tenets include the belief in innate human wisdom, the necessity of a “tearing and repairing” process for healing from developmental and attachment trauma, and the central concept of the “body as the psychological unconscious”. PWH also integrates the idea of dependence as a necessary stage in healing and emphasizes the critical importance of a moral-ethical foundation for true healing.  

Methodologies within PWH are diverse and integrated:

• It involves a critical assessment of the client’s narrative, distinguishing between “following the ‘tail of the comet'” (reprocessing) and aligning with the “tale of the comet” (narrative alignment with psychological healing principles like memory reconsolidation).  
• A crucial methodological step is obtaining “unconscious informed consent” before applying any treatment, recognizing that clients may not consciously understand the underlying drivers of their symptoms.  
• The Meeting Area Screening and Assessment (MASA) is a standard screening tool used within PWH, often combined with Neurofeedback (NFB) and quantitative EEG analysis for comprehensive understanding. NFB is a key methodology, aiming to help clients achieve self-regulation by training the body, which is seen as the psychological unconscious.  
• PWH incorporates psychedelic care, recognizing its potential for memory reconsolidation and turning off the default mode network, but emphasizes prior screening for dissociation and addiction.  
• Dual attention and memory reconsolidation are central to the healing process within PWH, viewed as evidence-based for promoting healing.  
• The model differentiates between “therapy” (applying interventions to someone) and “healing” (doing it with or for someone), aiming to establish a healing profession based on adaptive dissociative experiences.  
• PWH also focuses on relational dynamics and questions professional dependence, particularly for non-diagnostic conditions like attachment trauma, to empower client self-regulation.  

4.2 Assessment of PWH’s Treatment Efficacy

Basis in Empirical Literature (APA Criterion 1.0)

The PWH is presented as a “research-informed phase model of care” and is derived from the foundational Addiction as Dissociation Model (ADM) research, which itself stems from a doctoral dissertation. The PWH integrates concepts like memory reconsolidation, which is acknowledged as an “evidenced-based psychological algorithm” , and incorporates modalities such as EMDR, Brainspotting (BSP), Neurofeedback, and psychedelic healing, all of which are stated to “turn off the default mode network, promote states of healing with dual attention, and perform memory reconsolidation, thus being evidence-based”.  

While the PWH integrates elements from established evidence-based practices (EMDR, BSP, Neurofeedback, psychedelic care), the evidence for the PWH framework itself as a unified, comprehensive treatment model meeting APA Criterion 1.0 is less clear. The provided information primarily describes the theoretical underpinnings and the applications of PWH , rather than presenting empirical studies that specifically validate the PWH as a distinct, integrated intervention. The reliance on O’Brien’s doctoral work and internal publications means that while there is a conceptual basis, the broad, replicated empirical literature from independent, quantitative studies specifically on PWH’s efficacy is not detailed. As Dr. O’Brien explicitly notes, WHI “do not need to provide what we already know or what is already evidenced based like EMDR. This indicates a need for more direct empirical support for the PWH as a distinct model is a marketing tool of those in power to remain in power and in control. To see how obtaining an APA approved certificate (close to$ 80,000) that says that this approach is “evidence-based practice” is really to systems level tollbooth to gaining the approval of those who are not qualified to interpret (by their own standards (e.g., the law), to do the busy work that AI can now do, seems dumb. Requiring documentation for what is meditation-based is the ridiculously that Dr. O’Brien is pointing out in his interpretation of industrialized psychology, namely governed by the APA, who is reliant on the law to exist. Hence, separate but not equal peeks through again. If meditation is not already evidence-based, then what and who is the APA really for?

Methodological Rigor of Supporting Research (APA Criterion 2.0)

The available information regarding PWH’s efficacy relies heavily on clinical observations and the theoretical integration of concepts from other modalities. For instance, the “tearing and repairing” process is supported by O’Brien’s doctoral research. While the PWH framework utilizes modalities like EMDR and Brainspotting, which have their own bodies of evidence, the methodological rigor for the integrated PWH model itself is not demonstrated through the highest levels of evidence prioritized by the APA, such as quasi-experiments or randomized controlled trials (APA Criterion 2.3).  

The description of “Mindful Dissociation” promoting states of dual attention, dual attunement, and memory reconsolidation, and being “evidence-based” , points to the theoretical mechanisms. However, the absence of specific empirical data, detailed case studies, or clinical observations directly supporting the efficacy of the PWH model as a whole is explicitly stated. This creates a significant gap (to the perfectionistic APA) in meeting APA’s expectations for methodological rigor, particularly for demonstrating the unique contribution and effectiveness of the PWH as an integrated model beyond its constituent parts. To fully align with APA standards, the PWH would require systematic empirical studies that evaluate its outcomes through controlled methodologies, providing quantifiable evidence of its effectiveness.  But what is also happening is that Dr. O’Brien is opening the doorway for the new Recovery-based profession of Healer to be who settles the score between the body and mind.

Intended Outcomes and Evidence (APA Criterion 5.0)

The PWH aims to help individuals understand unconscious informed consent before treatment , facilitate healing as an act of “being with and there for each other and sharing our experiences” , and empower clients to achieve self-regulation. It also seeks to redefine healing as a profession based on adaptive dissociative experiences and natural abilities. The model integrates elements that target memory reconsolidation, which is associated with reducing emotional content of memories.  

While these are clearly articulated goals, the provided materials do not present systematically collected empirical evidence that demonstrates the achievement of these outcomes specifically through the PWH model. For example, there is no data on the proportion of clients achieving self-regulation, the long-term impact of the “tearing and repairing” process, or the measured effectiveness of “unconscious informed consent” on treatment outcomes. The APA’s Criterion 5.0 requires not only the specification of intended outcomes but also robust empirical evidence for each, including details on participant selection, attrition, long-term consequences, and clinical significance. Without such data, the claims of efficacy, while conceptually compelling, lack the empirical validation necessary for full APA endorsement.  

4.3 Assessment of PWH’s Clinical Utility

Patient Variables (APA Criterion 6.0)

The PWH is described as a “transdiagnostic approach to address all forms of traumas, dissociations, and addictions, including those not yet codified by existing research or diagnostics”. This broad scope suggests high clinical utility for complex and varied patient presentations, aligning with APA’s Criterion 6.1 regarding the complexity and idiosyncrasy of clinical presentations. The model’s focus on developmental and attachment trauma, which are often not captured by traditional diagnostic manuals, further underscores its relevance for a wide range of individuals.  

However, the materials do not provide specific data on how PWH’s effectiveness varies across different patient demographics, such as cultural groups, ages, genders, or socioeconomic statuses (APA Criteria 6.2-6.5). While the philosophy appears inclusive, empirical documentation of its applicability and adaptations for diverse populations would strengthen its alignment with APA standards for generalizability and cultural responsiveness. But what is provided is a dissertation and life’s work of Dr. O’Brien.

Professional Preparation (APA Criterion 12.0)

The PWH is a core offering of the Wounded Healers Institute, with training and consultation provided by its developer, Dr. Adam O’Brien. The training emphasizes an “eclectic educational approach” and experiential learning. This structured training pathway, led by the model’s primary developer, indicates a clear mechanism for professional preparation, which is consistent with APA’s Criterion 12.0.  

However, for broader clinical utility, information on the scale of dissemination of this training, the number of professionals trained, and the consistency of their application of PWH principles in practice (fidelity) would be beneficial. Furthermore, data on the outcomes achieved by practitioners other than the founder would provide stronger evidence of the model’s transferability and effectiveness in a wider clinical context. While the foundational training is present, robust evidence of widespread, consistent, and effective implementation by a broader community of practitioners is not detailed in the provided materials.

5. Evaluation of the Meeting Area Screening and Assessment (MASA) Against APA Criteria

5.1 Core Tenets and Methodologies of MASA

The Meeting Area Screening and Assessment (MASA) is a qualitative, hybrid tool developed by WHI for assessing and screening for dissociation and addictions. Its core tenets include understanding the unconscious through the “Meeting Area” to provide real-time client feedback, thereby increasing self-awareness and reducing treatment resistance. MASA’s development stems from doctoral research exploring the intersectionality of trauma, dissociation, and addiction, aiming to provide a more accurate definition of these phenomena. It is presented as a humanistic and qualitative screening tool for dissociative and addictive presentations, aiming to help individuals understand where psychological material resides.  

A crucial aspect of MASA is its role in obtaining “unconscious informed consent” before any treatments, care, or medicines (especially psychedelics) are administered, with the absence of such consent identified as a factor in low treatment outcomes. MASA methodologies involve a hybrid approach combining elements of the Dissociative Table with coping skills like Container and Calm Place, and a specific skill sequence including “Two Containers,” “Photo Album,” and “Bulk Blink”. The training for MASA includes a specific script and state-dependent learning, with an optional use of cannabis products to support understanding altered states of consciousness. MASA is designed to be combined with Neurofeedback (NFB) and quantitative EEG (qEEG) analysis to gain a more comprehensive understanding of the client’s state and to validate observations within current medical and psychological care models.  

5.2 Assessment of MASA’s Treatment Efficacy

Basis in Empirical Literature (APA Criterion 1.0)

MASA’s conceptual basis is rooted in doctoral research on the intersectionality of trauma, dissociation, and addiction. This research, which led to WHI’s definitions of the unconscious, trauma, dissociation, and addiction, is described as pointing towards dissociation making individuals more grounded and inducing endogenous states of healing. MASA is presented as a qualitative tool.  The APA’s Criterion 1.0 emphasizes empirical literature for efficacy.

Methodological Rigor of Supporting Research (APA Criterion 2.0)

The information supporting MASA’s efficacy primarily consists of clinical observations and assertions from the developers. For example, it is claimed that proper screening and assessment for addiction and dissociation with MASA would help prevent abreactions, dissociative expressions, and unconscious reenactments. Furthermore, it is observed that “the absence of an established baseline, therapeutic bond/trust, academic understanding, and/or MASA is what predicts or influences the outcomes and course of the therapeutic relationship versus the Healer relationship”. MASA combined with Neurofeedback is stated to allow for “more truth behind our observations”.  

While these are valuable clinical observations, they do not constitute evidence from “Sophisticated Empirical Methodologies” (APA Criterion 2.3) such as quasi-experiments or randomized controlled trials, which the APA places the greatest emphasis on for demonstrating efficacy. The explicit statement that “the article does not provide specific empirical data, detailed case studies, or clinical observations supporting the efficacy of… Meeting Area Screening and Assessment” highlights a critical gap in meeting APA’s standards for methodological rigor. To formally establish MASA as an evidence-based practice, it would require rigorous psychometric studies demonstrating its reliability and validity as an assessment tool, as well as outcome studies showing its direct impact on improving diagnostic accuracy, treatment planning, and patient outcomes.  

Intended Outcomes and Evidence (APA Criterion 5.0)

MASA aims to provide real-time feedback to clients, increase self-awareness, lower treatment resistance, and facilitate “unconscious informed consent”. It also seeks to draw a clear line between normal and pathological states, defining true pathology as sustained dysregulation. The tool’s use is intended to prevent abreactions and unconscious reenactments.  

While these are clearly defined objectives for an assessment tool, the provided materials do not present empirical evidence demonstrating the consistent achievement of these outcomes. For instance, there is no data on how MASA quantitatively increases self-awareness, reduces treatment resistance, or improves the accuracy of “unconscious informed consent” compared to other assessment methods. The APA’s Criterion 5.0 requires not only the specification of intended outcomes but also robust empirical evidence for each, including details on the methods used for assessment and the clinical significance of the findings. Without such empirical validation, MASA’s claims of efficacy remain largely theoretical or based on clinical observation rather than systematic empirical demonstration.  

5.3 Assessment of MASA’s Clinical Utility

Patient Variables (APA Criterion 6.0)

MASA is developed for assessing and screening for dissociation and addictions, and its training is intended for a broad audience including professionals in education, human resources, healthcare, medicine, psychology, and recovery communities. This suggests a wide range of applicability across various patient populations and professional contexts. Its focus on distinguishing normal from pathological states and addressing “unconscious informed consent” implies utility for complex and nuanced presentations often encountered in clinical practice.  

However, the available information does not provide specific data regarding MASA’s utility across diverse patient characteristics such as cultural background, age, gender, or socioeconomic status (APA Criteria 6.2-6.5). While the tool’s qualitative nature and emphasis on individual experience might lend itself to cultural sensitivity, empirical evidence demonstrating its effectiveness and appropriate adaptations for diverse populations would be necessary to fully meet APA’s comprehensive clinical utility criteria.

Professional Preparation (APA Criterion 12.0)

MASA is taught through a structured 1-day training program offered by WHI, requiring 4 hours of group consultation for successful completion, with additional consultations recommended if participants are unfamiliar with the topics. The training aims to increase knowledge of the clinical framework and assessment/screening of dissociation and addiction, and to enable participants to apply MASA and conceptualize ADM in their personal and professional lives. This clearly defined training pathway and ongoing consultation requirement align well with APA’s Criterion 12.0 regarding the preparation of health care professionals to deliver the intervention.  

The current materials indicate the availability of training but do not provide empirical data on the effectiveness of this training in producing competent practitioners who achieve consistent positive outcomes with MASA. Such data would be crucial for demonstrating the widespread feasibility and utility of MASA in diverse clinical settings.

6. Conclusions

The Addiction as Dissociation Model (ADM), Path of the Wounded Healer (PWH), and Meeting Area Screening and Assessment (MASA) represent a conceptually rich and innovative framework developed by the Wounded Healers Institute. These models offer a compelling transdiagnostic perspective on trauma, dissociation, and addiction, emphasizing the body as the psychological unconscious and the critical role of “unconscious informed consent” in healing. Their integration of modalities like Neurofeedback and psychedelic care, alongside a strong recovery-based and moral-ethical foundation, positions them as potentially valuable contributions to the field of psychological practice.

A rigorous evaluation against the American Psychological Association’s (APA) “Criteria for Evaluating Treatment Guidelines” reveals that while these models demonstrate significant conceptual alignment and a clear pathway for professional training, they currently fall short of meeting the stringent empirical evidentiary standards for formal recognition as evidence-based practices. The primary limitation across all three models is the explicit absence of specific empirical data, detailed case studies, or clinical observations systematically supporting their efficacy. The foundational research, primarily a phenomenological doctoral dissertation, provides a strong theoretical basis but does not constitute the broad, replicated quantitative studies (e.g., randomized controlled trials) that the APA prioritizes for demonstrating treatment efficacy.

While the intended outcomes are clearly articulated and the clinical utility appears promising due to their broad applicability to complex presentations, there is a lack of systematic measurement and empirical demonstration of these outcomes specifically attributable to the WHI models. Furthermore, comprehensive data on generalizability across diverse patient populations, consistent outcomes from multiple trained practitioners, and detailed evaluation of potential adverse effects are not yet publicly available.

To advance towards formal recognition as evidence-based practices by the APA, the Wounded Healers Institute would need to:

1. Conduct Rigorous Empirical Research: Prioritize and execute well-designed quantitative studies, including quasi-experiments and, ideally, randomized controlled trials, to systematically evaluate the efficacy of ADM, PWH, and MASA as distinct or integrated interventions. This research should include robust outcome measures, comparison groups, and long-term follow-up.
2. Systematize Clinical Data Collection: Implement structured processes for collecting and analyzing clinical observations and case studies in a way that allows for aggregation and systematic evaluation, moving beyond anecdotal support.
3. Document Generalizability and Adaptations: Provide empirical evidence of the models’ effectiveness and appropriate modifications for diverse patient populations, including varying cultural backgrounds, ages, genders, and socioeconomic statuses.
4. Evaluate Training Outcomes: Systematically track training completion rates, assess fidelity to the models’ protocols among trained practitioners, and collect outcome data from these practitioners to demonstrate the models’ transferability and effectiveness beyond the primary developers.
5. Publish in Peer-Reviewed Literature: Disseminate research findings in independent, peer-reviewed journals to allow for broader scientific scrutiny, replication, and integration into the wider body of psychological knowledge.

By addressing these areas, the Wounded Healers Institute can strengthen the empirical foundation of its innovative models, thereby aligning more fully with the rigorous criteria for evidence-based practice established by the American Psychological Association.

EDITORIAL NOTE: The point is that they want more, more, more, more. More validation, more data, and more proof that what we are doing is working. We already know as moral human beings. O’Brien’s observation about the APA apophenic nature, preference, and priority demonstrates its implicit bias towards its own science over qualitative wisdom and implicit reasoning, suggesting that it is the system that is living dissociated from reality. Placating to the medical model and the law’s interpretation of reality means that what the field of psychology has failed to do is their job because they were too busy doing their career. If a career is proving that what you are doing is working, then what other evidence does one need to prove that healing is happening, other than still existing. What other proof does one need to see that living dissociated means that you are also still here, what is temporary is permanent, and that 1 + 1 = 3. From my point of view, when meditation is already evidence-based in the real world and 1+1 = 3 too; therefore, we ask AI something similar: “Using the report you produced and evidence provided in the attached document, would the APA see meditation as evidence-based? If so, why not?”

Based on the report I produced and the attached document, the American Psychological Association (APA) would not formally recognize meditation as an evidence-based practice through the information provided in these materials.

Here’s why:

1. Lack of Direct Empirical Evidence Meeting APA Standards: The APA’s criteria for evidence-based practice place significant emphasis on rigorous empirical literature, particularly evidence derived from quasi-experiments and, most stringently, randomized controlled experiments (RCTs). Studies that do not present the specific, systematic empirical data (e.g., controlled studies, detailed outcome measures, or meta-analyses of meditation studies) that the APA requires for formal endorsement of a treatment guideline are not considered and charged accordingly.  
2. Theoretical Integration vs. Direct Validation: The APA requires direct empirical validation of the specific intervention (meditation in this case) as a standalone or integrated treatment, demonstrating its efficacy through systematically collected data on intended outcomes, long-term consequences, and clinical significance.  

In summary, while the provided document conceptually links meditation to evidence-based mechanisms like memory reconsolidation, it does not offer the type of rigorous, independently verifiable empirical data that the APA mandates for formal recognition of a [meditation] practice as evidence-based.

EDITORIAL SUMMARY

Why would one spend their life proving what they already know to people who will never believe them, even with all the proof they need? Faith is forever intertwined with fate.

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References

O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.