Where Is the Evidence for “Evidence-Based” Therapy?

“Buzzword. noun. An important-sounding usually technical word or phrase often of little meaning used chiefly to impress.”

This article has been written by psychotherapist Dr. Jonathan Shedler. It begins:

“Evidence-based therapy” has become a marketing buzzword. The term ‘evidence based’ comes from medicine. It gained attention in the 1990s and was initially a call for critical thinking. Proponents of evidence-based medicine recognized that ‘We’ve always done it this way’ is poor justification for medical decisions. Medical decisions should integrate individual clinical expertise, patients’ values and preferences, and relevant scientific research.1

But the term evidence based has come to mean something very different for psychotherapy. It has been appropriated to promote a specific ideology and agenda. It is now used as a code word for manualized therapy—most often brief, one-size-fits-all forms of cognitive behavior therapy (CBT). ‘Manualized’ means the therapy is conducted by following an instruction manual. The treatments are often standardized or scripted in ways that leave little room for addressing the needs of individual patients.

Behind the “evidence-based” therapy movement lies a master narrative that increasingly dominates the mental health landscape. The master narrative goes something like this: ‘In the dark ages, therapists practiced unproven, unscientific therapy. Evidence-based therapies are scientifically proven and superior.’ The narrative has become a justification for all-out attacks on traditional talk therapy—that is, therapy aimed at fostering self-examination and self-understanding in the context of an ongoing, meaningful therapy relationship …”

1. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312(7023):71–2.

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