Tuesday, March 26, 2013

Therapy That Works

If you ask most psychologists and if you look at the surveys conducted by the American Psychological Association you will learn that all forms of psychotherapy work.

Were you expecting them to say anything else?

Now, the New York Times reports that some therapies work better than others, but that the ones that work best are not very easy to obtain.

According to the Times, the evidence-based cognitive-behavioral therapies are the most effective at healing what ails you.

Harriet Brown reports:

Over the last 30 years, treatments like cognitive-behavioral therapy, dialectical behavior therapy and family-based treatment have been shown effective for ailments ranging from anxiety and depression to post-traumatic stress disorder and eating disorders.

She continues:

C.B.T. [cognitive-behavioral therapy] refers to a number of structured, directive types of psychotherapy that focus on the thoughts behind a patient’s feelings and that often include exposure therapy and other activities.

You would think that highly professional and highly credentialed practitioners would be enrolling in programs that would teach them cognitive-behavioral treatments. If you did, you would be wrong. Most therapists prefer to offer what Brown calls a “dim-sum approach:”

Instead, many patients are subjected to a kind of dim-sum approach — a little of this, a little of that, much of it derived more from the therapist’s biases and training than from the latest research findings. And even professionals who claim to use evidence-based treatments rarely do. The problem is called “therapist drift.”

“A large number of people with mental health problems that could be straightforwardly addressed are getting therapies that have very little chance of being effective,” said Glenn Waller, chairman of the psychology department at the University of Sheffield and one of the authors of the meta-analysis.

What do therapists have against cognitive treatment? They find it to be too standardized, too impersonal and too scientific. You see, most therapists got into the field because they are people-people. They believe that empathy cures. Thus they reject any approach that does not allow them to effuse empathy and compassion.

And many therapists consider their work to be an art, not a science. All of their advanced training in scientific disciplines has convinced them that they are artists.

In Brown’s words:

According to Dianne Chambless, a professor of psychology at the University of Pennsylvania, some therapists see their work as an art, a delicate and individualized process that works (or doesn’t) based on a therapist’s personality and relationship with a patient. Others see therapy as a more structured process rooted in science and proven effective in both research and clinical trials.

“The idea of therapy as an art is a very powerful one,” she said. “Many psychologists believe they have skills that allow them to tailor a treatment to a client that’s better than any scientist can come up with with all their data.”

Of course, if therapy is an art, what are patients? Are they blocks of marble, blank canvases, cans of play doh or balls of silly putty… waiting to be molded into who-knows-what by these therapist-artists?


Bobbye said...

Physicians receive a degree; Doctorate of Medical Arts. Of course they are artists.

Stuart Schneiderman said...

How did I miss that??

Anonymous said...

How to irritate an MFT: tell them you want to work on/work out an issue and that you don't want them to be your friend.