Friday, March 29, 2013

Scientific Evidence and the Art of Therapy

There was a very interesting article in the New York Times a few days ago: Looking for Evidence That Therapy Works. While I have mixed feelings about it (and the comments—good lord, people are getting feisty!) that are no doubt a result of my own experiences in therapy, the author raises a lot of great questions about the nature of treating mental illness, and how to regulate quality in a field that relies on empathy, trust, and human relationships as much as research findings.

This quote caught my eye:

“'The idea of therapy as an art is a very powerful one... 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 with all their data.'”

The idea is compelling, and seems to make a lot of sense: that individual therapists—people who have presumably entered the profession out of a desire to help others—rely more on their compassionate, creative human instincts than armchair theorizing from a textbook.

BUT. Psychology is a science, no? A human science, and one that incorporates a lot of unpredictable variables, but a science nonetheless. And in order for mental health treatment to get the same attention, insurance coverage, and research funding as, say, HIV or Alzheimer's or breast cancer, there need to be measurably beneficial outcomes, and a standardized quality of care.

Of course, I've been thinking about my own therapist, Dr. P (whom I love more and more every week). I don't really know what to call her style—online, she mentions CBT and interpersonal therapy, although I'm never aware of what exact methods she's employing during our sessions. Maybe I should ask. It feels natural and conversational and "therapeutic" in that I'm able to get out a lot of what's on my mind, and invariably leave her office feeling better than when I entered. She does periodically ask me how I feel our sessions are going, and if there are any adjustments she should make. (I think I may have scared her by ranting about past therapists, haha.) Anyway, my point is: she's wonderful. I'd like to think that she's treating me according to strict, evidence-based therapy guidelines, but not knowing doesn't necessarily bother me.

The article goes on to say:

"Besides, evidence-based treatments like C.B.T. still require expertise, clinical judgment and skill from practitioners,' noted Terry Wilson, a professor of psychology at Rutgers University. 'A stereotype of manualized treatment is: you go buy a book and it’s a rigid, lock step thing,' he said. 'But when done competently, it’s anything but.'"

So, I'm torn about the issues raised in the article, and I don't necessarily have a neat conclusion to this. I feel very strongly that mental health care must be subject to the same rigorous standards of research that other medical practices are; at the same time, as someone who's been through my share of therapists, I understand that there's no "one size fits all" here. Mental illness is not a biologically reducible infection; you can't just stop by the local clinic and pick up a round of antibiotics. (Hell, wouldn't that be nice?) But I think it's certainly possible for empathy, compassion, creativity, and humanity to be incorporated into the manualized, evidence-based treatment modalities.

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