“Therapy Drift” and What New Research is Telling Us

A 2009 study of psychotherapy patients in the U.S. and Great Britain found that many patients are “subjected to a kind of dim-sum approach — a little of this, a little of that, much of it derived more from the therapist’s biases and training than from the latest research findings. And even professionals who claim to use evidence-based treatments rarely do. The problem is called “therapist drift.”

In another study, 30 percent of psychotherapists were doing vaguely conceptualized things like “mindfulness” or “motivational work.”

Research also suggest that trends in the psychotherapy field are moving in the cognitive-behavioral direction — but very slowly. Cognitive-behavioral therapy is based on the idea that your emotions are caused by your thoughts, and challenging or correcting thoughts, often in a structured manner, is the way to address emotional problems or psychological conflict.

‘The idea of therapy as an art is a very powerful one,’ says Diane Chambless, a professor of psychology at the University of Pennsylvania. ‘Many psychologists believe they have skills that allow them to tailor a treatment to a client that’s better than any scientist can come up with all their data.’

There’s a persistent idea among many psychotherapists that the therapy relationship is the most important thing. ‘No one believes it’s a good idea to have a bad relationship with your client,’ said Dr. Chambless. ‘The argument is really more, ‘Is a good relationship all we need to help a patient?”

This is the very same thing I have been asking for years, including in my own book, ‘Bad Therapy Good Therapy (And How to Tell the Difference).’

Carolyn Becker, a professor of psychology at Trinity University in San Antonio, Texas, says, ‘You can become a therapist with very little training in how to think scientifically. A lot of students come in and say, ‘I hate science, but I’m good with people. I like to listen and help them.”

Therein lies the problem. ‘Talking and helping,’ with the mere intention of helping, are not the same as change. Change has to come from within the troubled person, and the therapist’s job is to prod the client into it. In order to foster change, a therapist must have some kind of scientific hypothesis to explain what emotions are, their nature, where they’re coming from, and how best to address or change them when required. Clients want this, because they often feel lost, troubled and confused. They want a sense of certainty, but the certainty must come from provable, testable theories, including to the layperson.

One of the problems not addressed in this interesting research is the biological model. Nowadays, therapists are being encouraged to look first and foremost at medication and drug therapy. Drugs can only be prescribed by a physician, and the vast majority of therapists are not physicians. Yet nearly all heads bow in this direction in the ‘treatment of the patient.’ Indeed, if therapy is in fact nothing more than ‘medical treatment,’ what is the point of having a science of psychology, upon which psychotherapy is to be based, in the first place?

The way the medical model works out in practice is like this: A therapy patient goes to a psychotherapist for troubling emotions. Most commonly, it’s something related to depression or anxiety. After a session or two, the psychotherapist determines medication might be needed and sends the client on to a psychiatrist. A psychiatrist spends only a short amount of time with the patient (sometimes as little as 10-15 minutes), and immediately begins prescribing medication. If the therapist or psychiatrist does not properly and clearly communicate with the stressed or troubled patient, the patient ends up believing that the only thing required is medication. Rarely, if ever, does that prove to be the case.

Worst of all, the patient is left with the impression that emotional conflict has nothing whatsoever to do with errors in thinking or poor choices in relationships. It’s all a passive process of medical change, kind of like taking your antibiotic and waiting for the infection to go away.

In addition to that issue, there is the problem of therapist communication. The research findings are right to suggest that therapists should move in a more cognitive-behavioral, objective and scientific direction. Therapy is in part an art—considering elements such as timing, communication, motivating the client—but it’s ultimately more of a science. It’s a terrible mistake to ignore science and reason when addressing emotional or behavioral problems. The art is what may possibly lead a therapy client to feel good while in the session; the science is what’s to take him through the rest of the week, and of life.

In addition, it’s crucially important for a therapist to ask a client what he or she is expecting out of therapy—not just in the beginning, but throughout. In other words, helping a client ask and answer the question, ‘How will I know that I’m improving?’ Forget getting ‘cured.’ A lot of times, the idea of ‘cure’ that people hold in their minds is a kind of effortless existence, in which they always feel good regardless of circumstances, or even their own faulty thinking.

One of the most important things a psychotherapist can do with a client is to establish objective criteria for success. I maintain that the client must be involved and invested in this process. Otherwise, the therapy isn’t going to help or work—since the therapist and the client might not even be defining ‘help’ or ‘work’ in the same way. ‘Feeling better’ is a meaningless goal if the specifics are left to implication.

This research affirms what I wrote about in my book, and what I have suspected for a long time, based on the consistency of complaints I hear from clients who were previously working with other therapists. Therapy is not and cannot be an open-ended, vague ‘working through’ of ‘motivational change’ or — all the rage now — undefined ‘mindfulness’ without any specific criteria for change, and how to get there.

(Source: ‘Looking for Evidence that Therapy Works,’ by Harriet Brown, The New York Times Blog online 3/25/13.)


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