Adam Blatner

Words and Images from the Mind of Adam Blatner

On “Evidence-Based” Psychotherapy

Originally posted on September 3, 2016

Edward Schreiber has published one of the last sections (on Psychodrama, Sociometry, Sociodrama, and Sociatry, pages 2952-2956, in Chapter 30 in Kaplan & Sadock’s Comprehensive Textbook of Psychiatry—a major textbook in the field. (Previous editions had given Moreno himself significantly greater number of pages.) Interestingly, the earlier editions in 1973 or thereabouts gave psychodrama a bigger section all to itself.

Notable is the relative decrease in space given to psychotherapy. While sections on several types of therapy were included, such as Psychoanalytic Therapy, Cognitive Therapy, Hypnosis, Group Psychotherapy, Family and Couple Therapy, Behavior Therapy, Interpersonal Therapy, Dialectical Behavior Therapy, Narrative Therapy, Positive Psychology, etc., as well as five pages on psychodrama, in the interim non evidence-based therapies, such as Transactional Analysis, Gestalt Therapy, and scores of others, had been dropped. Although these other forms of therapy  remained relatively popular through the 1980s and had been taught in mainstream counseling curricula nationally, some of them have been dropped.

Today, apparently, only “Evidence-Based” forms of treatment are being paid for by insurance companies, and these include cognitive-behavior therapy, Dialectical Behavior Therapy, and Motivational Interviewing, all of which seem to be simple enough for graduate students to do “hard” research on and write papers and journal articles. My comment is that psychotherapy addresses such a very broad field that varies greatly in the degrees of motivation, psychological-mindedness, overall ego-strength, co-morbidity, degrees of accessibility to psychotherapy, length of therapy, and so forth. Having a single name for this broad category is as misleading as trying to make generalizations about “animals.”

Although many different types of psychotherapy were developed in the 1960s or earlier, and many more during the 1970s, and even a few more since then—and all “worked” insofar as having satisfied patients, they couldn’t be proven to have worked according to academic “evidence-based” standards. Consider though how fashion and educational pseudo-rigor combine: Unless you reduce the number of variables tested for to a manageable number, it’s hard to establish an adequate “evidence-based” status.

For example, Cognitive-Behavior Therapy works because it does also with normal people. It’s a way to help people not in the sick role to behave more rationally. Another way of saying this is that irrational thinking compounds inclinations to neurosis as much as germs compound raw wounds (in the 19th Century).The more resources you bring to the helping process the more it helps. The more entrenched one is in one’s living and psycho-pathology, the harder it is for any therapy to help. Anyway, this is a heads-up at a pseudo-scientific argument being used (success-fully, I’m sorry to say) to reduce attention to non-easily “tested” approaches to therapy!

In summary, I question the currently popular forms of psychotherapy based on their support from people who only believe in “evidence-based” support, because I question the basis of evidence-based research.

One Response to “On “Evidence-Based” Psychotherapy”

  • I am just learning about Evidence Based Psychotherapy, and it is my understanding that it is the position of most of the Federal Government supports the basis for Evidence Based Psychotherapy. It is my understanding that Evidence Based Psychiatrist believe in educating a people with Mental Health conditions, what their condition is and how it affects the mind and thinking and feeling. This makes a lot of sense. Also I noticed a lot of Youtube videos that think mental illness is just a part of life and is not a disease. These videos do not seem very professional and they remind me of Marijuana Smokers that claim no one has ever died from smoking Marijuana, when common sense would tell you that Marijuana can cause Heart Attacks in people with Heart Disease. If you really want to debunk evidence based medicine, why not take the view of many Christians that thinking sinful thoughts causes Mental Illness. I am open minded to different approaches to treat Mental Illness, but if you go by what you are saying, you seem to be implying their is a conspiracy in the Medical Community to make money prescribing pills. The problem actually probably lies in misdiagnosis and or whether a doctor gets lucky with a certain pill working for a given patient. I can tell you that Seraquel has completly changed my life in treating my Paranoid Schysophrenia, and I admit that I got very lucky that the pill worked. I will agree with you to the point being, that it may have been possible to cure me through educating me about my condition and how it has affected my life. I probability that you are right in your views however in my mind are very slim. The real problem with evidence medicine is that its’ effectiveness is still in the process of getting better and has not peaked yet as a method that provides good results. I was limited in how well my recovery went, until I educated myself what Schyzophrenia is and how it affects a persons life and his family members.

    Good Regards
    I look forward to reading some of your blogs
    Luke Daniel

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