On one side are experts who argue that what therapists do in their consulting rooms should be backed by scientific studies proving its worth.
On the other are those who say that the push for this evidence threatens the very things that make psychotherapy work in the first place.” (New York Times via Dennis)
What may hang in the balance is literally nothing less than whether talk therapy survives as an accepted treatment for emotional distress. Increasingly, the insurance companies that pay for treatments demand “evidence-based” proof of their efficacy, and research into the effectiveness of psychotherapy over the past decade has led to the ascendency of cookbook approaches which are easily standardized and controlled. The increasing penetration of this instruction-manual approach, even into some topnotch clinical psychology training programs, has stimulated outrage.
“Some therapists say that the healing they offer in their offices every day is too complex to be captured in standard studies, and that having to justify it to a third party is a breach of patient privacy. They argue that to insist on proof that a therapy works denies many people adequate treatment, or the forms of treatment that they most need.”
The empiricists insist that the move to evidence-based treatment has augmented the credibility of the field. Indeed, to the extent that it serves as a basis to differentiate reputable treatment from fringe therapies promising miraculous and instant results, it is tempting to agree. But the more crucial threat of evidence-based treatment is that it will take the art, the inspiration and inventiveness, the empathy and sensitivity out of treatment techniques that depend on them. The more crucial differentiation it achieves, at least in the eyes of the third-party payors, is from the open-ended exploratory treatment such as psychoanalysis, already a dying art because the only clientele who can afford it are the worried affluent self-paying. While various psychotherapeutic approaches — from the interminable self-indulgent open-ended to the structured problem-centered evidence-based to the brief and ultrabrief focused interventions to the unsuitability for any psychotherapy at all — ought to be stratified by the nature of the patient’s clinical presentation, severity and desire to change, insted they are coming to be stratified entirely by ability to pay and extent of insurance coverage.
Some therapists worry about the threat of lawsuits if they depart from “accepted” techniques. How about the threat of lawsuits if they refrain from using their inventiveness and creativity and tailoring the treatment to the unique requirements of each therapy client? There are precedents for a malpractice judgment when a therapist does not utilize a technique which is the standard of care for a given mental health problem. Studies cited in the article are only a small sampling of what used to be the consensus (in a generation of psychotherapy outcome studies designed by thoughtful ingenious competent researchers rather than beancounters) that it is the therapist’s competence, rather than anything about the specific technique she uses, that most closely correlates with therapeutic success. Instead, the new paradigm threatens to impose techniques, in the interest of being able to measure and replicate success, which mitigate against success. But at least the insurers will be able to economize on mental health treatment.
And, turning from psychotherapy to the care of the severely, chronically, mentally ill, here is an example of society’s treatment of them. (New York Times ) Believe me, obtaining redress as some of the clients mentioned in this story do is by far the exception.
