Should My Therapy Be "Evidence-Based"?
There is a great deal of talk in the therapy world about "evidence-based" treatment. I hear this alot, especially in the context of referrals from pediatricians and doctors. And I think for people who are wanting help, the words "evidence-based" can feel quite reassuring. It's something of a magic wand--there's some identifiable, measurable, concrete thing that the therapist knows that research has shown to dissolve symptoms. It's short term, just a few weeks. And once I learn what the therapist tells or shows me, I'm all done. It's easy. Convenient. I can feel better FAST. What doesn't sound great about that?
Well, sure that DOES sound great! But here is a hard truth. Nothing easy is ever as good as it seems. In this post, I'm going to pop the bubble of the magic wand, the illusion of "evidence-based". But I'm also going to offer something much more valuable.
Unpacking the Promise of "Evidence-Based"
"Evidence-based" refers to therapies that have been through research trials, typically in academic institutions. If you've ever done a research project, you might know that you have to control for variables, so that you can be sure that what you are measuring is accurate. Because of this, research protocols often look very dissimilar to real world therapy.
Research trials use curriculum-based therapy models. This way, every "therapist" (who is often not a practicing therapist) delivers exactly the same therapy. The same education, the same interventions, the same coping skills, etc. Most often real people don't want a standardized, curriculum-based therapy. Most people want and need individualized treatment--therapy based on them, and what they need.
Research trials also microfocus on certain symptoms. For example, if a research participant has difficulties with depression, ptsd and relational problems, the trial will choose several symptoms of ptsd, and measure the intensity/frequency of these symptoms before and after the treatment. That is exclusively what the outcomes--the reported success, or evidence is based upon. It does not address the depression, the relationship troubles, or most importantly the person and their experience. In real life, people are complicated. We are full human beings, not symptoms of a DSM diagnosis. Usually people seeking therapy have several things they want to work on, not just 4 or 5 specific diagnosis related symptoms.
Here's the worst news. Even with this microfocus, outcomes are often less than great. In a study of CBT among war veterans with symptoms of ptsd, only 1/3 had no symptoms upon the study's end, and all of these shortly after the trial ended experienced their symptoms again.
These trials leave out the most important factor in what's helpful in therapy: your relationship with a therapist!
"Evidence-based" treatment doesn't mean what you think it does. When you are looking for a therapist, I would encourage you to put that term in the background, and instead focus on two very important things:
Making sure that the therapist is experienced and educated so that they are able to offer a quality therapy. These therapists understand a variety of models, they know, from research and practice, what works. They have more than a PESI certificate that is accomplishable in one day or a matter of hours; they have strong post-graduate education. And, I think most importantly, they also know what they don't know. There are no easy answers when it comes to human experience and psychology. Anyone who promises that they do represents a warning flag for me.
Can you imagine having a strong relationship with the therapist? Can you speak freely with them? Do they listen, and really hear you? Do they own mistakes, apologize? Do they give you feedback in a thoughtful, caring way?
These are the things that matter in psychotherapy.
For more information on "Evidence-Based", tune in to the following podcast: