Optional discussion of each article, if present, goes between citation and excerpts.
Recent years have witnessed the controversial promulgation of practice guidelines and evidence-based treatments in mental health.The introduction of such guidelines has provoked practice modifications, training refinements, and organizational conflicts. For better and for worse, insurance carriers and government policymakers are increasingly turning to such compilations to determine which psychotherapies to approve and fund. Indeed, along with the negative influence of managed care, there is probably no more issue central to clinicians than the evolution of evidence-based practice in psychotherapy
Some clinicians argue that ESTs thus represent de facto treatments of choice that should be widely conducted and taught because we know that they work. Other clinicians argue that researched treatments are simply that – researched – and not necessarily treatments of choice.
EST lists do little for those psychotherapists whose patients and theoretical conceptualizations do not fall into discrete disorders (Messer, 2001).
Many depth psychotherapists have not taken a strong interest in the empirically supported treatment movement largely because it does not appear relevant to the practice of depth psychotherapy. However, this may be a naïve and dangerous assumption.
Empiricism as the only valid, primary, or most valuable approach to assessing therapy is clearly a product of modernist thought. .... It can further be argued that exclusive reliance upon a modernist epistemology in the assessment of therapy will lead to psychotherapy becoming increasingly irrelevant and out of touch with contemporary postmodern society.
The empirically supported treatment movement has become an increasingly divisive issue in the field. This article has maintained that by returning empiricism to its place as a voice instead of the voice, we can move to a more productive dialogue.
It is now well accepted that psychotherapy is effective. Indeed, about 80% of those receiving psychotherapy will have mental health status superior to those receiving no treatment. In addition, psychotherapy appears to be as effective as medication for many mental disorders, is longer lasting than medication, and less resistant to additional courses than medication.
...cases in which adherence to the manual was relatively high do not produce better outcomes, suggesting that was is standardized may not be the critical therapeutic ingredient.
Scientific knowledge about best care takes an average of 17 years to be applied broadly and systematically in actual clinical practice, according to the Institute of Medicine.
“The tension between science and practice in psychotherapy has been described as a war or a “bad marriage” (Greene, 2014.) Some writers on the research side of the divide characterize clinicians as lacking in knowledge and skill in empirically supported interventions (Karlin & Cross, 2014), ” “ Writers on the clinical side of the divide argue that randomized controlled trials represent a limited form of evidence (Westen et al., 2004), and that there may be a feeling of resentment among practitioners that researchers disseminate their findings upon clinicians (Greene, 2014)
Research findings can be complex and voluminous, and debates like those between evidence based practice versus empirically supported treatments (Laska et al., 2015) appear academic, at least on the surface (however, they are not trivial when you dig past the esoteric labels.).
Metanalyses (e.g. Smith, Glass & Miller, 1980; Wampold, et al., 1997; Luborsky et al., 2002) tend to corroborate Rozenzweig’s (1936) verdict that everybody has won and must have prizes, a line taken from the Dodo-bird in Lewis Caroll’s Alice’s Adventures in Wonderland. That very dissimilar interventions have similar effects diminished the seeming importance of specific techniques.
Research on treatment techniques as well as research on relationship variables may still hold great promises. But the needs of a nomothetic approach may be a hindrance to research on process. It may be that studying the fine tissue of therapy calls for a thoroughly ideographic and inductive strategy.
That the world’s supply of advice often exceeds the competence of its suppliers was amply illustrated this past week by NY Times journalist Harriet Brown in “Looking for Evidence that Therapy Works"
Brown gets it wrong by over-emphasizing the role of technique in successful treatment; confusing research-supported therapy for those therapies practiced with the aid of a treatment manual; and under-valuing the human reality that all effective psychotherapy, even manualized approaches, are relationships between people.
Brown simply gets it wrong. The Times article makes it seem as if research has established a gold standard for treatment and that gold standard is a treatment manual. This is wrong. Brown and the Times should know better.
…psychoanalysts are still struggling to make their views heard about the importance of personality and intrapsychic change, In particular, changes in personality are complex and hard to operationalize and quantify, Those at the behavioral end of the spectrum, in contrast, care primarily about easily observable changes in symptomatology.