A colleague of mine often talks about psychology’s “physics envy,” by which he means an insistence in the field of psychology to be a science. Indeed, you would be hard-pressed to find another field that rests so uneasily on the fence between a soft and hard subject. For example, if somebody tells you they are a psychologist, you have no idea whether they spend most of their time conducting research in a university, or providing therapy in a private practice. Graduate students in clinical psychology also split their time between the quantitative, “hard” science activity of conducting research, and the more fluid, “soft” science of practicing therapy.
The field of psychology is unsure how to answer the question: “Is therapy more of an art or more of a science?” “Is therapy subject to Whitman’s ‘obstetric forceps of the surgeon,’ or, like all artistic endeavors, is it irreducible?”
Recently there has been a push toward more “evidence-based” approaches. This is a positive move, in theory, the idea being that we should have evidence for the effectiveness of the approaches we use. However, there is thoughtful debate around how we are measuring progress. If someone comes to therapy because they are anxious and feel that life is not worth living, do we consider it a success if their anxiety decreases, but their feelings about the worthlessness of life do not? What if their situation reverses during the time they are in therapy, but returns as soon as they leave? Finally, even if we do agree on what success is, and how it can be measured, how do we separate the contributions of the therapist, approach, space, and other components that might go into personal change?
Not to mention that politics are at play, as is always the case when funding relies on the results. CBT, for example, has shown strong results for a variety of issues, but founders and supporters of the approach have been more aggressive in conducting and marketing their research. Just because an approach has more studies to its name, does not mean it is more effective. Studies on the effectiveness of psychodynamic approaches are fewer and farther between, but there has been an increased emphasis recently, leading to some positive results. Jonathan Shedler, in his paper “The Efficacy of Psychodynamic Psychotherapy,” shows that psychodynamic approaches have plenty of evidence for their effectiveness—even that the benefits might be longer lasting.
I remember reading a good deal of research as a graduate student, thinking it would make me a good therapist. When I began my internship, I realized how little those studies had helped me. It is only now, years into practicing, that some of the research is coming back around to help me: I can remember a snippet here or there and look further into it. But by far and away, the greatest experience has been sitting with clients and understanding what they are saying. And in my few years of doing that, I have discovered a few commonalities among mental health issues that are rarely discussed in textbooks.
More about those in my next post.