A new article on Psychology Today by Jonathan Shedler, Professor of Psychiatry at University of Colorado, takes a critical view of new guidelines by the American Psychological Association for the treatment of trauma.
The new guidelines only considered treatments that have been studied using randomized controlled trials (RCTs). RCT’s are often thought of as the gold standard in medical research. However, relying solely on RCTs ignores large bodies of evidence from years of practice and observation. As he points out:
The basic or hard sciences, like physics, chemistry, and astronomy, do not rely on RCTs. No astronomer in history ever conducted an RCT, but knowledge in astronomy progresses. (Shedler)
So what is one to do when looking for effective treatment? Terms such as “evidence based practice” add more confusion to the mix. If some techniques are labeled evidence based, the suggestion is that those without the label have no evidence to support them. Evidence based only points to one particular kind of evidence. It has been used to promote psychotherapy techniques which lend themselves well to RCTs (Behavioral therapies and manualized treatments) and to exclude those which do not (psychodynamic and humanistic psychotherapies).
It turns out that whether you find a therapist that practices CBT, psychodynamic, or integrative psychotherapy isn’t the most important predictor of whether your therapist will be helpful. Research suggests that the effectiveness of any psychotherapy treatment is highly dependent upon factors other than technique – so called “common factors”. These common factors can include a positive relationship between therapist and patient, an expectation by the patient that therapy will be helpful, and the collaborative identification of goals.
This is not to say that a therapist shouldn’t be knowledgeable in theory and technique. The common factors need a coherent conceptualization of treatment through which to operate. In other words, worry less about effective an ineffective techniques and more about effective and ineffective therapists.
For more on qualities to look for in a therapist, I recommend one of Shedler’s past posts on Psychology Today – How to Choose a Therapist.
You can also reach out to me with any questions you may have. If I’m not the right therapist for you, I’ll try my best to connect you with someone who will be.