Adam Blatner

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.