Can Psychotherapy Be Too Evidence Based?

In his review of Sex in Psychotherapy: Sexuality, Passion, Love, and Desire in the Therapeutic Encounter, Charles Golden notes:

As evidenced by Hedges's case studies, the book becomes clear on the emphasis of psychotherapy as art rather than science in the sense being promoted today by professional psychology. In our emphasis on science and attempts to emulate the medical model of evidence-based techniques, we may be shortchanging students in learning the art of psychotherapy. Too often I see cases in which techniques have replaced an ability to understand the client, causing the therapist to miss important clues that therapy has focused on the wrong issue despite generating pretty graphs and impressive data. The importance of the art must always be remembered if we are to produce the most effective psychologists.

Have clinical and counseling training programs gone too far in their attempt to be evidence based? Or are clinical and counseling training programs already striking a good balance between art and science in psychotherapy training? What would you consider to be the best balance between art and science in psychotherapy?

Read the Review

Not Your Evidence-Based Psychotherapy...
By Charles Golden
      PsycCRITIQUES, 2011 Vol 56(9)

Comments

[Kate Thomson]

Science and art are related. Da Vinci was both an artist and a scientist. Photographers, in addition to their creativity, have a strong foundation in the science of light and movement. In fact, most great artists study specific techniques to learn the “science” behind their tools and their craft; for example, understanding the chemistry of how materials work together or what combination of shapes and colors are esthetically pleasing. In other words, artists may use feelings, intuition, and imagination to guide their work, but their creations are made possible by relying on the foundation of their skills. Scientists are not polarized to one extreme either; they are not devoid of creativity, passion, or imagination. Successful scientists, in addition to understanding the intricacies of their laboratory work, must also be passionate and willing to think outside the box and take risks to make new discoveries.

In much the same way, an effective clinical psychologist must also strike a balance between art and science. Clinical psychologists are not people who are simply paid to be “good listeners” or a “nice friend” to someone. Clinicians are professionals who train for years to understand the various biopsychosocial etiologies of mental illnesses, they apply academic rigor to the treatment of their patients, and they take years to master their clinical skills. Of course, clinicians have to be also be highly intuitive, responsive to individual needs, and creative. Human behavior is complex. One cannot rely of universal traits across people and settings; predicting behaviors with algorithms is near impossible due to free will, situational variables, and complex interactions between aspects of each person’s identity.

Thus, as it relates to the debate about evidenced-based treatments (EBTs), clinicians have a responsibility to stay abreast of the latest EBTs, but not to the exclusion of their clinical intuition. I believe a strong clinician is an informed statistician, one who is able to digest statistical methods and apply meaningful inferences to their clinical world. However, a responsible clinician must also think critically about research and recognize its limitations. They need to acknowledge that many groups are often not represented sufficiently in mainstream research and that findings can be spurious or biased, depending on researchers’ methods or goals. Many EBTs are not suited for all individuals, and several treatments that have yet to be studied are effective for many people. At a recent Grand Rounds, the presenter reminded us that new treatments take 15-20 years to move from the laboratory to the community. Experienced clinicians know what works and what does not; sometimes science has to “catch up” to clinical expertise. In sum, I believe that clinical psychologists should be respected as scientist-practitioners, in the same way as medical doctors. I understand our field’s desire to legitimize our work in a similar way to medical sciences, however, there is something to be said about not going too far down that path, so as to lose the effectiveness of the very nuances that make our work effective.