The Problems With Evidence-Based Psychotherapy

The Problems With Evidence-Based Psychotherapy

There has been a tremendous movement toward evidence-based treatment in clinical psychology over the past decade. On its face, this is a good thing — the idea that we should use scientific findings to make sure the types of treatment we’re using in psychotherapy actually work. My own clinical training included a wide array of these empirically based treatments, and I happily use many of their key…

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"The notion of species is simply a 17th-century convention of biological classification begun by Linnaeus, because when you visually look around, with no awareness of geological time, you do seem to see distinct plants and animals. But now that we are aware of such things as bacterial transfer of genes from one organism to another and this sort of thing, we realize that the apparent fixity of the species is an illusion, and that actually there is only a gene swarm on the planet, and it coagulates into centers. The densest kind of center it coagulates into, we call an organism. But it also coagulates into more loosely bound systems, such as symbiotic relationships, or yet more loosely bound relationships — ecotomes and biospheres. And really, in any given biological center, there is just a series of concentric shells of influence going both directions, and that’s a more true view of the situation on the planet than the notion that there are distinct species." -Terrance McKenna

Motivational Enhancement Therapy is a brief, structured application of motivational interviewing that I learned while training at the VA. It’s very useful for building up a therapeutic alliance in cases where a client may otherwise be likely to drop out due to ambivalence.

It’s really low-pressure and egalitarian, while still being directive enough to help the patient actually accomplish the difficult task of sorting through their conflicting motivations and desires. I like it for that reason — because in cases where someone is feeling ambivalent, trying to push your own ideas onto them will only make them feel resistant. Motivational interviewing allows me to be comfortable rolling with that resistance for a few sessions without getting attached to an outcome. Because the purpose of the treatment is temporarily reframed — I’m not treating any particular problem yet, I’m just helping someone figure out what problems they want treated (if any).