Do the Right Thing

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Does Psychotherapy Work? It Depends on Who You Ask

Psychotherapy is a lot like cooking: An art and a science

You may have seen the recent provocative Time magazine article entitled, Q&A: Yale Psychologist Calls for the End of Individual Psychotherapy (September 13). In it Maia Szalavitz interviews former American Psychological Association President and noted Yale professor, Dr. Alan Kazdin, about the status of psychotherapy in 2011. According to Dr. Kazdin, it isn't pretty!

Current APA president, Dr. Melba J. T. Vasquez, has written a retort to the piece and it appears that some of what Dr. Kazdin said was taken out of context and wasn't accurate. Regardless of the facts associated with the interview, the issues raised by the Time article warrant reflection and comment.

The question of whether psychotherapy works or not has been debated for decades and there is an enormous amount of quality peer reviewed scholarly research now available regarding this question. No need to repeat it here. However, one of the major challenges we have in answering this important question is the fact that researchers and clinicians in psychotherapy often act like two ships passing in the night. Top researchers typically don't treat actual patients in clinical settings such private practices, clinics, and hospitals. And if they do, the patients are often atypical who have agreed to participate in a research protocol and have been carefully and selectively screened for particular characteristics often making them very different from the typical patient in the real world. Clinicians rarely do research once they complete their doctoral training and often don't read all of the very latest research coming out in the best professional journals and research conferences. Too often the researchers live in one world while the clinicians live in another. This is often true in many other fields as well such as medicine. 

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The push for empirically validated and manualized treatments has been tempered in recent years with the more current focus on evidence based practice. Without getting into too much details about these issues here, the bottom line is that in 2011 clinicians clearly must be attentive to and mindful of quality empirical research that can inform them about the very best strategies available to treat patients with various diagnoses. They really do need to do this to provide competent care. Otherwise malpractice risks increase as well as potential harm to their patients. However, what is often difficult for researchers to understand is that each patient is remarkably unique and that each clinical patient tends to have other co-morbid diagnoses operating at the same time as well as unique biological, psychological, social, cultural, and spiritual dimensions to make each case special and one-of-a-kind. So, one size clearly doesn't fit all when it comes to psychotherapy interventions. You can't apply an empirically validated and manualized treatment on all patients with the same diagnosis. It needs to be tweaked thoughtfully to serve the individual needs and desires of each patient. 

At the end of the day psychotherapy is much like quality cooking. There is a science to cooking but there is also an art to it as well. Both science and art are part of the equation for good psychotherapy. We must embrace both and neglect neither. As someone who has treated clinical patients for 30 years and conducts empirical research as a college professor, I'm reminded of this important need to blend quality science and art every day in efforts to help people who suffer from various challenges in living. Science without art and art without science makes no sense in psychotherapy ... or in cooking. 

So what do you think?  

And by the way, if you're interested in reading the Time interview you can do so at... http://healthland.time.com/2011/09/13/qa-a-yale-psychologist-calls-for-the-end-of-individual-psychotherapy/

 

Thomas Plante, PhD, ABPP, is the Augustin Cardinal Bea, SJ University Professor at Santa Clara University and Adjunct Clinical Professor of Psychiatry at Stanford University.

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