What about the treatment approach?
Applying particular therapeutic methods to specific psychiatric diagnoses is the considered by many a “best practice”–the core of what some label, “empirically-supported” (EST) or “evidence-based psychological treatments” (EBPT).
Now, imagine a place where diagnosis and prescriptive protocols are not required or even considered essential to clinical practice. A place where practitioners are free–even encouraged–to focus on helping people in whatever way works. More on that in a moment.
In the meantime, consider a study just out in the Journal of the American Medical Association (JAMA). Back in 2004, the lead author coined the term, “psychological treatments,” arguing that the future of the field depended on creating a formulary of “psychological treatments…matched to specific forms of pathology.” The impact of this idea on clinical practice is nothing less than staggering. Around the world, practice guidelines and funding for services are based on and restricted to methods applied to specific psychiatric diagnoses.
Participants in the newly released study either were treated with an approach specifically designed for their particular diagnosis or a generic alternative. The results? No difference in outcome at termination or 6-month follow-up! Said another way, diagnostic-specific protocols did not improve the effectiveness of treatment. In their place, the authors promote “transdiagnostic treatment protocols”–a term, I know you will be hearing more about in the future. No need to be confused (or impressed) by the sophisticated sounding name. Given decades of research showing all psychological approaches work equally well, this new one is, if nothing else, is a perfect example of “boldly charging forward into the past.”
The truly revolutionary implication of this study is not mentioned by the researchers: neither psychiatric diagnosis or diagnostic-specific treatments improve the outcome of psychological care. That was the promise. It failed.
Bottom line: it’s time to move on.
That’s exactly what psychologist Birgit Valla has done. The leader of a large, community mental health center in Stange, Norway, Birgit publically announced neither she or her staff would employ psychiatric diagnoses or standardized treatment protocols.
Was she brave or foolhardy? For sure, she had the weight of evidence on her side as well as an unwavering commitment to delivering effective services. Still, she was soon accused of failing to follow the “standard of care.” An investigated was started. Sanctions and a withdrawal of funding were threatened.
What happened next? Watch the interview to find out!
That’s it for now. Until next time,
Scott . Miller, Ph.D.
Director, International Center for Clinical Excellence