← Mental models for therapists
A label like evidence-based can describe what was studied rather than what works. Who was compared with what, and how long the treatment ran, decide what a trial can show.
Their wordsNo research ever suggested that manualized CBT was more effective than psychodynamic therapy. It was just more often researched. There is a world of difference between saying a treatment is less often researched and saying it has been scientifically discredited.
Their wordsThe American Psychological Association (APA) just issued guidelines for treating trauma. Patients and therapists would be wise to ignore them.
Their wordsIt takes more than 20 sessions, or about six months of weekly therapy, before 50 percent of patients show meaningful improvement. It takes more than 40 sessions for 75 percent of patients to show meaningful improvement.
Their wordsIf one really wanted to know whether a treatment (e.g., CBT, IPT, ACT, EMDR) was more effective, it had to be directly compared to an approach intended to help - what Wampold and colleagues termed, a "bona fide" treatment. Doing otherwise, they argued, conflated artifacts of research design with actual research results.
Their wordsWhen patients don't get the help they need, they don't come away thinking, I didn't get good treatment. They come away thinking, I am too broken to be helped. They leave more hopeless and demoralized than when they came. That is harm.
Their wordsPsychiatry has unearned confidence in both its theories of mind and its theories of brain.
Their wordsBut we can measure psychological health by how closely a person approximates this hypothetical ideal.
Their wordsTalk therapy alone often struggles to shift the felt, physiological charge of a stuck memory, even once the story is fully understood.