When I originally learnt psychotherapy, psychoanalysis was the dominant force and its arch foe was behaviourism. Freud had claimed to offer the first scientific psychology. The behaviourists came along with what they claimed was really scientific. Humanistic methods were also on the rise and were a reaction against both the established antagonists. Humanists such as Rogers, Maslow and Perls stressed human potential and personal growth. In reality all of these three movements added to human knowledge from the perspective of the outside view as well as offering actual therapy in which an inside view was essential to success.
Freud and Jung provided us with detailed accounts of actual therapy and built a model of the mind much of which has entered into the general culture - the unconscious, defense mechanisms, archetypes, complexes, association of ideas, interpretation, projection, transference, and so on. Behaviourism tried hard to adopt the language and attitude of hard science, but the success of particular behaviourist therapists owed a great deal to their individual genius and ability to tune in to the real needs of the particular client. Humanists rejected behaviourism and analysis, but, in fact, Rogers was one of the great pioneers of psychology research and his ideas grew out of his early exposure to the work of Otto Rank, a disciple of Freud.
Behaviourism’s attempt to deal only with inputs and outputs of the mind, taking the mind itself to be, as it were, an empty box, was never entirely convincing and led eventually to the addition of cognitivism as a scientifically flavoured way of thinking about what might actually be going on inside the box. I still have doubts whether this attempt to be “scientific” about subjectivity makes sense, but it has been bolstered in recent years by the slogan “evidence based”. This slogan was originally introduced as a way of giving cognitive therapy a political edge over other forms, especially over psychoanalysis and humanistic methods which were all then lumped together as not evidence based. This strategy worked in the sense that it convinced social administrators and insurance companies and thereby attracted funding to cognitive approaches, while causing a good deal of chagrin in other areas of the psychotherapy profession. Earning the epithet “evidence based” became the name of the game, though hardly any approaches to therapy do actually derive from evidence. Rather established methods attempt to achieve the “evidenced based” stamp of approval retrospectively.
There are psychotherapy courses to this day that do not teach the work of Freud or Rogers because they think it is not evidence based. Rogers, however, we should remember, was one of the great pioneers of psychological research. Rogerians have had to go to considerable lengths to revalidate their approach in terms of the new evidence based criteria. Evidence based now means that there exists a body of research of a certain kind that purports to show that the method in question is effective in treating specified psychological conditions. It is debatable whether the conditions in question actually exist as psychological entities, but this has become the fashion. Even behaviourism, as practised in the 1950s and 60s, would not qualify as evidence based in the modern sense, despite its pretensions to being strickly scientific, nor would it meet contemporary ethical criteria. None of this means, however, that it was not sometimes highly effective, just as other now supposedly non evidence based methods were effective in the sense of enabling people to live more creative and meaningful lives.
Rogerian method has now established some credibility as an evidence based approach, but the therapy being done by Rogerians is no different from that which they were doing when they were not considered so. Insofar as becoming accepted as evidence based has changed in any way the actual practice of Rogerian therapists, it is questionable whether such change will have been for the better. To do Rogerian therapy well, the therapist should not have her mind on research papers, she should have it on the client before her.
Much of the hoo-haa around whether an approach is evidence based or not is simply a political game, but it has distorted the field. The simpler the method, the easier it is to research and so the easier it is to produce the heap of research papers needed. This does tend to lead to a dumbing down. More sophisiticated methods do not lend themselves to being qualified as evidence based because they are more difficult to research and so less attractive to researchers. Thus, it has been easy for mindfulness to achieve some status as evidence based because it is extremely simple so is a favourite for PhD students. Thus large numbers of research papers came into existence very quickly. However, most of this research is of very poor quality.
The recent move to validation by evidence base has actually been accompanied by a shift in public attitude rather counter to what might have been expected. While insurance companies and hospital managements have moved toward favouring cognitive approaches, the forms of therapy that seem to be on the rise in terms of public popularity are existential therapy and hypnosis.
All this concern with supposedly scientific credentials has not changed the fact that the general impression from reviews of a great many large scale surveys is that all the main methods of therapy are of more or less of equal effectiveness. This suggests quite strongly that it is not the particular techniques or protocols employed by this or that school that really make the difference. Rather these are the games that therapists play with their clients while the actual therapy goes on on another dimension. Whether the therapist passes the time with the client doing dramatic reenactments, as in psychodrama, playing in the sand tray, as in Jungian projective therapy, teaching and learning desensitization procedures, as in behaviourism, interpreting dreams, as in analysis, or participating in encounter groups, as in some Rogerian work, is probably not the pivotal variable. If it were, much bigger differences in effectiveness would appear. If the research were done it might well be found that teaching people to play chess or going on sailing trip expeditions were just as effective in “curing depression”, say, as any of these other methodologies. In all probability, what really makes the difference, is something more subtle that goes on at a personal and interpersonal level. Identifying the real therapeutic element is probably beyond the reach of science as we know it and not likely to be detected by the kind of search for “evidence” that currently obsesses the profession.
This conclusion is in line with what we learn from a spiritual perspective. Zen masters and Tibetan gurus also have their pastimes in the form of rituals and temple routines. Shakyamuni Buddha had a massive impact upon the lives of many people and he too engaged them in certain activities, like watching corpses decay. The particular activity chosen certainly has some intrinsic features that teach the participant something, but the crucial, truly therapeutic (life changing) factor is surely something else. Indeed, it may well have a great deal more to do with that notion so totally remote from the evidence base, introduced by that bete noir of all the moderns, Sigmund Freud, namely transference, or, in Buddhist terms, transmission. As Ananda asked Kashyapa, “What was it that Shakyamuni transmitted to you other than the robe of gold brocade?”