empirically supported treatments

The McDonald’s Approach to Therapy: Why Empirically Supported Treatments are Not the Way to Go…

Let’s take a rich experience of a real world therapy interaction, considered by both therapist and client to have meaning, intensity, and benefit.

The client is free to go where he or she may, to enter into new territory of emotion and thought, and to follow new leads and surprises uncovered through the therapeutic interaction…

The therapist is free to learn from a multitude of signs emitted by the client – consciously and unconsciously, verbally and nonverbally – indicating where the client might need to venture next, where the pain might be, and where truth has yet to emerge…

The course of therapy is free to be determined by the mutual input from both client and therapist and to take situational factors into account such as timing and the presence and absence of a variety of factors in the present moment, informing an organic intuition of where to go next…

Now compare this to a therapy where the client is given instructions of what to talk about and how to talk about it in a way that that has been determined in advance, and where the same instructions are being applied uniformly to each and every client regardless of specific circumstances and needs.

…to a therapy where the therapist is not free to follow his or her moment-to-moment intuitions or to adjust interventions on the basis of attunements to the importance of the timing and context of the situation.

…to a therapy where the course of therapy is determined not by client and therapist, but by a schedule that specifies what conversations or activities need to take place, when and for how long they need to be done, and in what order they must be accomplished.

The latter form of therapy, which I would call “therapy as technology” or “therapy as mass production”, has one benefit which the richer, more organic, and more tailored therapy does not: It is simplistic and rigid enough to lend itself well to the requirements of a scientific study that demands that an inflexible set of interventions be “administered” uniformly to a large number of clients that have been grouped in advance into uniform “categories”.

It is this set of restrictions, imposed on an otherwise rich, complex, and organic process, that is needed in order to prove what specific interventions can be said to be effective for which specific “type of problem” or which specific “category of client”.  If an effect is found that is greater than the effect of a chance encounter, as evaluated by some yard stick that is uniformly assumed to represent a good outcome, then the therapy in question is deemed to be “empirically supported” (EST) and to have earned the stamp of scientific proof.

Some therapists treat people as if they were “categories of problems” rather than unique individuals

The problem, as you can see, is that to get the stamp of approval, a series of operations had to be performed intended to simplify the richness of an actual flexible, organic, and complex therapy interaction. The intensity and meaningfulness of an experience evolving gradually between therapist and client had to be straight-jacketed and turned into a “technology” (a predefined set of procedures). Therapy had to become a machine-like process, the therapists had to become machine-operators, and clients, well… they had to be treated with the uniformity of “stock”, losing their individuality and autonomy completely in the process.

So let’s dispel the myth that empirically supported treatments are in fact superior forms of treatment. Let’s not fall into the trap of assuming that scientific proof is always the hallmark of the gold standard of treatment.

A uniformly produced McDonald’s hamburger, mass produced and mass-consumed, may have been found to be effective at reducing hunger, but it is not a superior hamburger of that accord. It cannot compete with a hand-crafted premium burger tailored exactly to the needs of each client.

I am not against scientific proof, but when we have to distort reality to make it conform to the needs of our scientific methods, we are committing tomfoolery in the guise of science and are contributing to a lowering of our standards rather than a bettering of our collective destiny.

Therapy is a complex relationship, not a science-based technology, and no scientific study will ever be able to question that fact…