Looking for evidence that looking for evidence that therapy works works

What can one do, other then let out a wearied and ironical sigh, when The New York Times publishes a blog post as polemic, condescending, and factually inaccurate as Harriet Brown’s “Looking for evidence that therapy works“? In asserting that any form of psychotherapy other than so-called “evidence-based treatments” is akin to trepanation, Brown writes from the perspective of neither therapist nor client, which would have been more palatable had she attempted to wear the mantle of journalist.

I do not want to devote too much time to eviscerating what I imagine was a haphazardly written post for The Times’ lighter-than-air “Well” blog. Never mind the evidence that psychodynamic therapy is as effective as cognitive-behavioral approaches in treating the most severe and pervasive psychiatric disorders (and may in fact lead to longer-lasting positive outcomes), or that the seeming lack of empirical evidence for dynamic treatment is largely artificial. A lengthier critique would lend too much credence to Brown’s sophomoric piece.

I would only like to offer an alternative to Brown’s suggested approach when seeking a new therapist. First of all, I disagree that people should discount the impact of the therapeutic alliance, which is a significant and consistent predictor of outcome; in other words, go with someone you like and with whom you feel comfortable rather than someone who claims to be on the cutting edge of research. Second, seeking hyper-focused evidence-based therapies designed to treat specific disorders is appropriate for some, but it discounts the idea that 1) people don’t always know what they need help with, and 2) some people seek treatment for one thing but quickly feel that a quite different thing is what actually needs work and attention.

The comments section of Brown’s article has, in the couple days since its publication, yielded a (mostly) thoughtful panoply of responses from mental health professionals and consumers on various sides of this fence. I regret having to use that term, as I do not think that psychological treatment should be an either/or debate, but monolithic attitudes of a few make it difficult for many to appreciate the breadth and depth of available options.

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