Written by David van Nuys

Imagine I receive an invitation to present a keynote at a major therapy conference. Essentially the charge is something along the lines of: 

I say “imagine” because I’ve not actually received such an invitation, but I have had such reveries in the shower, where I’m prone to such daydreams of glory. With the hot water beating on my head and shoulders and stimulating my fantasies, it occurred to me that the advent of evidence-based practice is one of the most interesting developments in the field. 

I guess the reason I find it interesting is that I’m surprised to see that evidence-based practice has taken hold to the extent that it apparently has. I must confess that when I first heard the term I was skeptical. It seemed like the sort of good idea that people would pay lip service to but not much more. Fortunately, I would not have to take it too seriously inasmuch as I hadn’t practiced as a therapist in quite a few years, having embraced an academic career. Also, as a humanistically inclined psychologist, I tended toward the belief that psychotherapy involves processes too varied and subtle to lend themselves to any sort of meaningful quantification. I’m more of a qualitative research guy than a quantitative guy. To keep my confessional honest, I should add that my defensive reaction to the idea of evidence-based practice betrays a certain intellectual laziness on my part. 

At the same time, it must be acknowledged that I was not the only doubting Thomas questioning the validity of evidence-based practice. For example, my podcast interviewee, Dr. Jonathan Shedler, has written: 

The term evidence-based therapy has become a de facto code word for manualized therapy—most often brief, highly scripted forms of cognitive behavior therapy.

It is widely asserted that “evidence-based” therapies are scientifically proven and superior to other forms of psychotherapy. Empirical research does not support these claims. 

Empirical research shows that “evidence-based” therapies are weak treatments. Their benefits are trivial, few patients get well and even the trivial benefits do not last.

Troubling research practices paint a misleading picture of the actual benefits of “evidence-based” therapies, including sham control groups, cherry-picked patient samples, and suppression of negative findings. (Shedler, 2018, p. 319) 

To cite one more source in the litany of opposition, Berg and Slaattelid (2017) recently argued: The notion of research-supported psychological treatments is based on a reductive conceptualization of psychotherapy. Research-supported psychological treatments hinge upon an empirical reduction where psychotherapy schools become conceptualized as mere collections of empirical propositions. However, this paper argues that the different psychotherapy schools have distinct ethoses that are constituted by normative claims. Consequently, the evaluation of the different psychotherapy schools and the practice of psychotherapy should include the underlying normative claims of these ethoses. (p. 1075) 

I take this to mean that the evidence-based folks and the therapist folks come from different underlying world views.

Keywords; evidence-based psychotherapy, reductive conceptualization, cognitive behavior therapy.

This is an extract of an article published in the Neuropsychotherapist.

About the author: Dr. Van Nuys, over the past 13 years you’ve conducted more than 700 in-depth interviews with a wide variety of movers and shakers across the field of psychology. We think that gives you a unique overview. What significant changes have you seen across that span of time?