Some methodological and epistemic limitations of evidence-based therapies.

Abstract

Emphasis on the importance of identifying evidence-based practices increased markedly after publication of a 1995 APA Task Force white paper. The APA call to action resulted in lengthy lists of therapies that have been reported to be effective. This body of research has been the rationale and justification for proposals to change how psychotherapy training programs in psychology are evaluated and accredited, professional competence is assessed, licensure granted, and reimbursement policies are structured. Given the potentially restrictive proposals set forth on the basis of lists of "empirically validated therapies," this paper describes methodological issues that should temper enthusiasm for adoption of training and certification restrictions based on this body of research. Several of these issues stem from a form of "circularity" inherent in design requirements of randomized control psychotherapy outcome studies. In effect, these requirements constrain the manner in which the psychological problems are defined, psychotherapy is practiced, and change is evaluated. Adoption of policies based on lists of empirically supported therapies will not legitimize the science of psychotherapy but rather limit how psychotherapy is conceptualized and practiced, stifle innovation and creativity in the field, and run counter to the welfare and interests of many individuals who seek psychotherapy services as well as many professionals. Alternative approaches to knowledge development based on the integration of process and outcome variables and the application of hermeneutics will allow for alternative and conceptually more informed approaches to describing and evaluating what actually occurs in most psychotherapy practices.

Counseling Psychology Model Training Program

“…Persons are recognized as holistic entities who cannot be reduced to the sum of their parts (Cooper, 2009). Reductionist thinking is discouraged in counseling psychology, in how both psychotherapy and research are approached (Shean, 2015; Zeldow, 2009). Environments are now understood to encompass multiple, dynamic interacting components, whether conceptualized through the lens of systems theory (Capra, 1997; Gelo & Salvatore, 2016), social-ecological theory (Bronfenbrenner, 1979), or other relevant models.…”

The effectiveness of couple therapy: Clinical outcomes in a naturalistic United Kingdom setting.

“…Wright and colleagues echo this, pointing out that such efficacy studies are not very representative of ordinary clinical practice (Wright et al, 2007). Shean (2015) points out the "circularity" involved in the methodology of efficacy studies, summarizing the objections to their influence on psychotherapy research and going as far as to suggest it is harmful rather than helpful for people seeking therapy. Carey and Stiles (2016) even suggest that the strict causal logic of RCTs means they cannot in any way be considered as a "gold standard" for psychological psychotherapy studies: psychotherapy is hugely more complex to investigate than pharmacotherapy.…”

Of interventive doppelgangers and other barriers to evidence-based practice in psychotherapy.

“…Even if one disagrees with the preparadigmatic diagnoses, it is difficult to deny that EBP in psychotherapy has for years traveled a divisive and contentious path. While many contend that RCTs, and the ESTs they beget, have outlived their evidentiary usefulness (e.g., Hayes, 2016;Norcross & Wampold, 2018;Shean, 2015;Tolin et al, 2015), I believe that the proliferation of psychotherapy models and interventions is a related and additional, yet no less troubling, irritant that conspires to keep psychotherapy in a Kuhnian holding pattern. The number of models is estimated at over 500 (Prochaska & Norcross, 2018).…”