Psychodynamic Treatment and EBT's

[Logic Prevails]

I had an interview recently at an outpatient clinic affiliated with one of the local hospitals. The people in this clinic are very respectable and well recognized individuals in the community.

In discussing their approach to treatment, I was surprised to find them advocating the most manualized form of CBT I have ever been exposed to. I was curious and asked a few questions. They repeated many times that CBT was the only real Empirically Based Treatment (EBT) out there, and literally laughed at anyone who would dare engage in Psychodynamic therapy, going even so far as to say that it is based on "hocus pocus" principles and should be unethical.

Has anyone else had such experiences?

Is there a problem that too many people view EBT to mean "valid?"

How long before more research is done on the short-term psychodynamic approaches and more people, including HMO's, start taking it seriously?

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[toby jones]

I have found that some groups are very keen to practice CBT 'by the book' because the studies have been done on the efficacy of the 'by the book' version. The 'by the book version' was the version that was found to be effective. They think it would be unethical to practice something that hasn't been shown to be effective. I have sympathy for psychodynamic approaches and existential approaches etc so I feel your pain with respect to the lack of studies that have been done on alternative techniques. I could be wrong here, but is part of the reason for the lack of studies that there is a lack of 'by the book' existential or psychodynamic therapy techniques so as to ensure that the clients in the experimental group are all receiving the same therapy?

Just thinking out loud...

One thing I hate is when CBT is found to JUST outperform brief psychodynamic for something or other and people conclude that it would be unscientific (or invalid) to practice psychodynamic because CBT has been empirically validated as the best for that disorder. What gets me here is that there are a certain number of people who CBT therapy didn't help and for all we know those people might have benefited from the psychodynamic approach.

I guess HMO's won't start taking it seriously until the research is done. I don't know when the research will be done... I hope it is done though. There is some out there. People just tend to pick the studies that support what they already want to believe ;-)

 

[doctorpsych]

I have found that some groups are very keen to practice CBT 'by the book' because the studies have been done on the efficacy of the 'by the book' version. The 'by the book version' was the version that was found to be effective. They think it would be unethical to practice something that hasn't been shown to be effective. I have sympathy for psychodynamic approaches and existential approaches etc so I feel your pain with respect to the lack of studies that have been done on alternative techniques. I could be wrong here, but is part of the reason for the lack of studies that there is a lack of 'by the book' existential or psychodynamic therapy techniques so as to ensure that the clients in the experimental group are all receiving the same therapy?

Just thinking out loud...

One thing I hate is when CBT is found to JUST outperform brief psychodynamic for something or other and people conclude that it would be unscientific (or invalid) to practice psychodynamic because CBT has been empirically validated as the best for that disorder. What gets me here is that there are a certain number of people who CBT therapy didn't help and for all we know those people might have benefited from the psychodynamic approach.

I guess HMO's won't start taking it seriously until the research is done. I don't know when the research will be done... I hope it is done though. There is some out there. People just tend to pick the studies that support what they already want to believe ;-)

I think that it also depends on the region of the country that you are in... I know that NYC and Boston, and maybe Chicago are more psychoanalytic/dynamically oriented but the majority of the country tend to be CBT... as per your 'snobish' experience, I found it to be both ways, psychodynamic/analytic folks look down on cbt and tend to see it as 'not real therapy' or less intellectual; meanwhile cbt'er see analytic/dynamic folks as outdated, treatment without much scientific evidence... in my experience, (even though I was primarily trained in cbt) again in depends on the pt and their presenting problems. I found CBT to be very useful with depression and anxiety d/o, but with individuals with less characterological difficulties. Those with axis II, a dynamic approach appeared to be more relevant... also these pts tend to 'buy in' into dynamic approaches and views cbt as too simplistic... interesting, reflecting similar views as folks in the field... nothing implied here though...

also, I found that minority individuals tend to respond well to cbt, at least initially, then when comfortable with the therapy process, are willing to do more dynamic exploration...

 

[Dr.JT]

The outcome literature is quite clear in that all the major orientations of psychotherapy work as well as each other, although CBT may be slightly better. The reason is that the specific components are likely not the major mechanisms of change, but, rather the common factors. Check out Wampold's book "The Great Psychotherapy Debate" for a good discussion of this issue.