Recently there was a notice sent on email of a website promoting Evidence Based Therapies for psychological problems. It’s clear a great deal of work went into this professional looking website. But I will not give you the web address, because while I don’t doubt the good work of the site’s designers, what they are promoting should concern us all greatly. EVT/EBT is a potential threat to psychotherapy. It is a potential tool for managed care to further corral and control the work we do as psychologists and it threatens the creativity so needed for the work of psychotherapy.

This problem has been well addressed by many others (see Goodheart’s article in this publication several months back, or Ron Fox’s words in various venues) but this does not seem to have stopped the ardent supporters of the EBT movement. The gist of the website is clear. For each common psychological problem, as defined by the DSM-IV-R nomenclature largely, there are psychotherapies that are empirically validated. That means these are good therapies for that problem, because science has shown they are effective. Seems good enough. The problem is nearly all of the empirically validated treatments the website offers are cognitive-behavioral in nature. Almost no word of humanistic, and certainly none of the psychoanalysis or psychodynamic therapy or existential, not to mention many other varieties.

We’re all well trained and I think we all know the simple truth, as put forth so clearly by Bruce Wampold in “The Great Psychotherapy Debate”. Most psychotherapies can be effective, if practiced by a competent professional with a motivated patient. The common factor is the relationship with between professional and patient(s). How one goes about getting there doesn’t matter as much as long as the patient feels understood, cared for and a mutual understanding is forged. While I recognize this is a simplification of a more complex question, I think the statement stands with merit.

The EBT website seems to lack this recognition. Instead, it uses the guise of scientific research to identify only those treatments which can be studied and validated by the scientific method; i.e. psychotherapies that can be more readily standardized, replicated and reproduced across multiple practitioners, thus making them quantifiable, objectified and easy to measure via outcome data. Other therapies are not so easily measured this way. Though much data on outcome exists, it does not seem to meet the criteria deigned for “empirically validated”. For example, Peter Fonagy’s work on psychoanalysis is not mentioned, nor that of Wallerstein’s in “42 Lives in Treatment”, nor any of the narrative case studies throughout the analytic and humanistic literature. These are just some examples of the myriad of work out there demonstrating the efficacy of many types of psychotherapy.

It is the framing of EBT/EVT that should worry us most. The very language implies that if science, which consumers know is “objective and unbiased” deems something good, then anything that science does not comment on or cannot empirically validate, must by inference be somehow lacking. By the very use of terms, we are making one form of therapy routinely superior. George Lakoff has been talking about this kind of framing as the way the Republicans have been trouncing Democrats recently – they are framing the issues the right way such that any objection or deviation from their position is somehow lacking (I am indebted to the person on the 42 email group who posted the note about “Don’t Think of An Elephant”, Lakoff’s volume about the issue of framing). Even before Lakoff, we as psychologists have known all about “framing”; Paul Wachtel has written wonderfully on this, and other solution-oriented practitioners have been discussing how we frame things for decades.

In a time where health care dollars are coveted by many, and where insurance companies do what they can to limit what they must pay out in costs, EBT is a boon. Managed care has already begun taking this idea and running with it, and it can get much worse. EBTs typically focus on short-term therapy, and as they are standardized they can be practiced by any number of folks – amount of training and personality matter much less than simply having the knowledge of how to conduct the Evidence Based treatment. So we have fewer sessions, with less expensive professionals (or quasi-professionals), and therefore less cost. And it is all justified in the name of science.

The issue is complex, and the salvo of this editorial is designed only to raise awareness not offer a full description of the problem. I’m hopeful the designers of the website in question will get a copy of this and offer a rebuttal showing me how and why I’m wrong to be concerned about what they have done. But my bottom line wish is that they would stop what they are doing, because we are their colleagues and they are going to harm us.

(Thanks to Frank Froman for his input on this editorial).

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