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Unread December 13th, 2006, 12:48 AM
Gandalwaven Gandalwaven is offline
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Default Re: Do Empirically-Supported Treatments make a difference

Comments on the comments on the comments
Actually, I don't think it's a straw man argument. I don't know of anyone who still uses orgone boxes but I do know of instances where therapists were manipulating undetectable "energy fields", were using crystals and channelling, were using past-life regression, or were using questionable techniques to "recover" repressed memories. Unfortunately, some of our colleagues have very interesting ideas about what therapists should do.
There is a simple test for the straw man argument. Substitute some more middle of the road therapies (for example family therapy for orgone boxes and narrative therapy for crystals) and see if the argument carries as much weight. In my view it doesn’t. It is on this basis I conclude a straw man argument. I share your concern for bad therapists but think they exist no matter what the modality.
Some hear that "all of the most through research shows that all types of therapy are equal in terms of client outcomes" and conclude that it doesn't matter what therapists do as long as there's a good therapeutic relationship. I think this is a risky conclusion.
Which "some" are you talking about. Therapists of all varieties including CBT will abuse therapy. Again I think this is a fallacious argument. “All types of therapy” would only include those therapies that were reviewed in the research. You are extending this to both reviewed and unreviewed therapies. There is always a danger that some will misinterpret the conclusions or use this as an excuse to abuse, this does not invalidate the “rightness” of the conclusion. The conclusion and what people do with it are separate issues.
Even if it were true that every therapy that was empirically tested turned out to be equally effective (which I doubt).
There is a reasonable amount of evidence for this. See for example the Super-shrink article I cited in my earlier posting. I would also point you to the extensive work by Luborsky and Fonagy.
However, I'd also argue that the commonly used therapies which have not been tested are an unknown quantity. They may or may not turn out to be effective.
Most of the common therapies have been researched and have been found to be effective. How they have been tested is the issue of a whole debate. For an excellent example of this current debate have a look at Castelnuovo et al’s paper. She lucidly outlines the pros and cons of both sides of this debate.
Thus, when I see a commonly used therapy (psychoanalysis) being used for a common problem (a driving phobia) and turning out to be ineffective, I'm inclined to think that a treatment approach that has been found to be effective with driving phobias would have been a better choice. (Note: this is a real example from a few years ago)
Here you are arguing by example. Because it was ineffective in the case you cite does not make it in general ineffective. There may be research showing this and if there were then this would be a better argument. In general, psychoanalysis, is in my understanding about gaining a deeper understanding and insight of oneself and in general is not focussed on the curing of a single symptom.

If you are holding out CBT to be superior (more effective) and as having a scientific basis supporting this (this is my interpretation of your stance) then in my view some things must be addressed to maintain that position.

All science must be able to explain the exceptions to its theory or hypotheses. CBT seems good at explaining or providing why it does work (RCTs etc) but has difficulty explaining when it doesn’t work. Remember at best CBT only works for about 66% of clients suffering depression and this is under controlled conditions. It must also explain why large real world studies (therapy takes place here) show that CBT is neither better or worse than other therapies (Lambert and co cited above).

It also needs to be kept in context. CBT is great for reducing symptoms, is a readily learnable therapy and appears very cost effective but it still has little to say about dealing with the big things in life, love, sex, death, god and poetry. Other therapies appear to not be as effective at reducing symptoms but have a lot more to say about these others things in life.

Interestingly enough (although the research is limited) who do behavioural therapists go to see when they are having problems? Psychoanalysts (Lazarus 1971). Lazarus was a behaviourist btw.

Regards
Chris
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