It continues to confuse me why some CBT-oriented practitioners insist on painting psychodynamic/psychoanalytic techniques in a negative light, believing that their interventions are superior as proven by studies with exclusion criteria that would render any mental health organization bankrupt. What is it that people say about all or nothing thinking?
Effective CBT therapists pay attention to the process, effective psychoanalysts pay attention to the evidence. Hack jobs exist everywhere.
I agree in part and have actually previously argued here that we need an increased focus on effectiveness/T2 research. It seems to be happening, albeit slower than I'd like.
However, the most commonly stated reason is because of co-morbidities. This is definitely a problem, but I think it is often 1) Over-stated and 2) Often the result of sloppy diagnosing. I think the latter is in large part due to the way the DSM is structured, but that is a discussion for another day.
Regardless, my issue is not with people making an informed decision not to apply a certain "standard" EST to a client, my problem is when people throw caution into the wind based on some vague philosophies and start doing things with no evidence when the reason to do so is based more on the practitioner's beliefs than the patient. I referenced analysis above because that is different from modern dynamics, which have actually been shown to be effective in certain situations (last I checked, some evidence for MDD, GAD and some of Axis II). To my knowledge, none of those treatments involved dream interpretation. Furthermore, one of the mainstream MDD treatments actually has a pretty solid evidence-base (IPT) and certainly has more of a dynamic foundation than a cognitive one.
If a client doesn't meet the inclusion criteria for one study because of a co-morbidity, we have two options - we can try and combine two things that work as best we are able, or we can try something with virtually no evidence that it works. I firmly believe the former is a better choice, at least until that fails, in which case it is fine to move to the latter. All of this can be jumbled up a bit if for whatever reason the client isn't suited to one treatment or another (or refuses) but my experience is that these are often decisions made by the therapist and the client has virtually no input.
Philosophy certainly has a role to play. Many of the ESTs were derived from philosophical approaches (see Ellis's early work, or more recently Hayes' writing on the foundations of ACT). The question is whether that is sufficient, and I think a quick glance at the current state of the field suggests that it isn't.
To DreamInterpret: You are correct, it IS fascinating. Many things are fascinating, but do not serve any particular clinical function. Prove it serves a clinical function. (Note: I actually believe it might in that specific situation, though my explanation why is likely very different from yours).
