Young Grasshoppa
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- Feb 19, 2024
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Fascinating.I dunno...honestly, I think that their publicly announced position on the definition (tri-partite) of 'evidence-based therapy' is one of the few things recently that APA has 'gotten right.'
We older psychologists remember way back in the dinosaur 1990's when we were in training and they rolled out this new term 'empirically-validated' to describe a handful of protocol/manualized therapies that had at least one methodologically sound outcome trial under their belt.
Then they had to 'back off' of that term a little bit and it got reframed as 'empirically-supported.'
Then, at some point, I suppose out of medical envy and chasing of reimbursement (which I understand), it morphed into 'evidence-based' (to sound similar to 'evidence-based' medicine).
There certainly are psychologists who use the term 'evidence-based' therapy to mean only manualized/protocol treatments. It's how they may employ the term and may be what they imply when they use it but I don't think I've ever seen an explicit definition of the term to mean only the manualized alphabet therapies. I think that the reliance on manualized, step-by-step, one-size-fits-all, cognitive-behavioral protocol therapies--though definitely having their place in psychotherapy and doing a lot of good for the field--have had unfortunate side effects such as teaching an entire generation of therapists that manualized psychotherapy is the 'one true way' and that anyone not using a manual is 'not doing evidence-based therapy.' It has also lessened the (critical) role of individualized clinical case formulation specific to the client and idiographic (functional) assessment. These are some of the things that a renewed focus on process-based therapy is designed to remediate.
Quantifying the highly individualized pieces of a clinical case and particular assessment and then examining the efficacy of the process-based therapy is a huge challenge. I would love to see this approach succeed. The human condition is much deeper and more nuanced than can be properly captured by any protocol-to-syndrome approach.
On the other hand, protocol-to-syndrome approaches are much much simpler to study. They have clear unambiguous implementation that leads to straightforward RCTs with very compelling evidence for efficacy.
Do you think that process-based research will be able to come up with clear implementation and solid evidence? Or has it already?