PSYCHOTHERAPY: EVOLUTION OR DECLINE: The misuse of 'evidence'

I am at the Evolution of Psychotherapy Copnference in Anaheim, California. This conference attempts to showcase the best practice in psychotherapy. The presenters are exemplars for the profession and the information presented is intended to shape the thinking of the thousands of practitioners who attend. The amount of academic data presented is huge.

The net result is unfortunate. The work of being a researcher and that of being a therapist require very different mentalities. As the divide between the two activities erodes, so psychotherapy deteriorates. Psychotherapists now have their eye on generalisable evidence, not on the uniqueness of the client. The data mountain is mostly a distraction and a barrier, only rarely an aid.

I have now watched a number of clinical demonstrations. These are what the thousands of people here are learning to imitate. In all cases, in my view, the practices has been poor, ranging from excruciatingly bad to simply inappropriate. I would not be happy to see this kind of practice by my own students.

The fact that you know, or think you know, from having read piles of statistics, that 60% of successful people or couples do X, Y & Z gives you no right to try persuade the client or clients in front of you to do or say those things. Even if you know that 90%, even 99%, of supposedly successful people do X, Y or Z, that does not tell you anything about the unique, precious soul that is undressing in front of you and as soon as you start to pressure him or her to fit into your predetermined idea of what the right people do, you have stopped doing psychotherapy.

There is a fundamental philosophical divide between research that looks for generalisable conclusions and psychotherapy which looks for what is uniquely precious in the particular case. The therapist should be treasuring and being in awe of precisely those ways in which this client deviates, not trying to get them to fit in. Of course, getting them to fit in will help the therapist increase his or her ‘evidence base statistics’ and this means that the modern therapist tends to be self-justifiying rather than truly client-centred. A real therapist approaches the client in humility, confident of meeting something he or she has never encountered before, something that is not to be found in the statistical generalisations. It is that uniqueness that is the focus of true therapy and the increasing focus upon statistics is making modern therapists blind.

This trend is not the evolution of psychotherapy, it is its decline.

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