It’s a complaint I’ve heard from the earliest days of my career. Therapists do not read the research. I often mentioned it when teaching workshops around the globe.
“How do we know?” I would jokingly ask, and then quickly answer, “Research, of course!”
Like people living before the development of the printing press who were dependent on priests and “The Church” to read and interpret the Bible, I’ve long expressed concern about practitioners being dependent on researchers to tell them how to work.
- I advised reading the research, encouraging therapists who were skittish to skip the methodology and statistics and cut straight to the discussion section.
- I taught courses/workshops specifically aimed at helping therapists understand and digest research findings.
- I’ve published research on my own work despite not being employed by a university or receiving grant funding.
- I’ve been careful to read available studies and cite the appropriate research in my presentations and writing
I was naïve.
To begin, the “research-industrial complex” – to paraphrase American president Dwight D. Eisenhower – had tremendous power and influence despite often being unreflective of and disconnected from the realities of actual clinical practice. The dominance of CBT (and its many offshoots) in practice and policy, and reimbursement is a good example. In some parts of the world, government and other payers restrict training and reimbursement in any other modality – this despite no evidence CBT has led to improved results and, as documented previously on my blog, data documenting such restrictions lead to poorer outcomes.
More to the point, since I first entered the field, research has become much harder to read and understand.
How do we know? Research!
Sociologist David Hayes wrote about this trend in Nature more than 30 years ago, arguing it constituted “a threat to an essential characteristic of the endeavor – its openness to outside examination and appraisal” (p. 746).
I’ve been on the receiving end of what Haye’s warned about long ago. Good scientists can disagree. Indeed, I welcome and have benefited from critical feedback provided when my work is peer-reviewed. At the same time, to be helpful, the person reviewing the work must know the relevant literature and methods employed. And yet, the ever-growing complexity of research severely limits the pool of “peers” able to understand and comment usefully, or – as I’ve also experienced – to those whose work directly competes with one’s own.
Still, as Hayes notes, the far greater threat is the lack of openness and transparency resulting from scientists’ inability to communicate their findings in a way that others can understand and independently appraise. Popular internet memes like, “I believe in science,” “stay in your lane,” and “if you disagree with a scientist, you are wrong,” are examples of the problem, not the solution. Beliefs are the province of religion, politics and policy. The challenge is to understand the strengths and limitations of the methodology and results of the process called science — especially given the growing inaccessibility of science, even to scientists.
Continuing with “business as usual” — approaching science as a “faith” versus evidence-based activity — is a vanity we can ill afford.
Until next time,
Scott
Director, International Center for Clinical Excellence
I agree, but we shouldn’t be surprised: psychotherapy -and research- are human activities where vested interests exist, organized groups that represent not only an approach but also the profits of that approach, the prestige, and above all, the power and glory. Ultimately, everything is political. Everything gets corrupted and friends leave. Who wants to be destroyed by windmills? You can’t fight the power of the industry! The research exists, but the problem is that it doesn’t align with the interests of the power groups… The conclusion of hundreds of studies: we need better research, better methodology, but I think it’s not just that. What we really need is greater integrity and honesty, more courage… Why are the studies that don’t align with the interests of the industry (power groups) left out? They don’t want to lose their benefits. The truth is always dangerous, Scott… Can we overcome our corrupt humanity? That is our real and true challenge…
Well said. Thanks.
Many who practice psychotherapy, were they to go directly to the conclusions and discussion, would be seriously misled. I do agree that policy has led NIH, for example, to favor funding research for CBT and its derivatives over any other kind of approach. Because those studies can be more easily manualized, they fit the “scientific method” more readily than studies involving other approaches. RCTs being the “gold standard,” are highly favored.
The issue for us is not that science is inapplicable, in your work (Scott) you cite research studies extensively; rather, it is that the research base related to psychotherapy, itself massive, is approached with a naivete that leads to conclusions that are inaccurate.
That is precisely why training in the critical appraisal of research is one of the core competencies in psychology. Relying on a study read in isolation from the overall body of research is common and not scientific.
It is the job of the clinical scientist to provide the overall context within which to understand a study when disseminating the results of any study.
IMHO, the basic problem with psychotherapy in general is that it lacks a sufficient enough of an understanding of what it is trying to do. That is, our beloved profession works to the extent that the therapist provides sufficient support for the client’s explicit and implicit experiencing, and where the latter is typically the more important. This requires the therapist to think for her/himself rather than following a theory. When done sufficiently, it typically results in an emotional reaction which I’ve termed therapeutic catharsis. Such a release is therapeutic when it spontaneously/ naturally occurs because the client has received sufficient support for their experiencing. An emotional release that is forced, or unexpected, is NOT therapeutic and may be regarded as re-traumatizing.
I teach research to graduate students in a helping profession. Some have never read a research article. Some students are so fearful of research that they avoid learning about it until they have finished all their other courses, and, thus, cannot apply research thinking to critique information in any of their previous courses. With online learning, some students have never entered the university library, and they don’t know how to access articles in the online databases, which are not available to those students once they graduate, anyway. So why bother to read research studies? It’s just another hoop to jump through.
I think that research courses must teach how to gather and apply practice-based evidence in a meaningful way, which involves skills that even many of us instructors lack. I have yet to see a research course dedicated to the topic, but it is sorely needed. Without this information, in an attempt to stay current, therapists often get their information from charismatic continuing education speakers who promote fanciful but ill-founded psychotherapy fads, all the while failing to recognize when the emperor is wearing no clothes.
Mental health research faces a crisis of relevance. Unless our focus changes to learning and teaching how to teach the processes involved in gathering and using practice-based evidence throughout a session, we will soon be replaced by robots that spit out CBT maxims and pills. After all, if the outcomes are the same and the cost is less, why not? I hope that I am wrong.
I agree! Thank you Scott for your calmness in the chaos, pointing out so eloquently Our North Stars. Thank you (so much) for your work and dedication!
Economically, my taxes have paid for research. Why then can I not access for non-extortionate prices from ‘Journals’ the world’s knowledge. Is this not everyone’s knowledge?
Then the enthusiasm and relief with which Associate Professor Andrew Huberman’s podcasts is met speaks to thirst in the drought people feel for science. And it’s absence. Fascinating questions to leading thinkers and researchers, makes Science accessible.
We don’t need science the noun (status, inflexible, past), we need science the verb (active, alive, relational, flexible, interactive, curious).
It’s part of an incredible change (even filling conference centres with 3000 people in Brisbane – Feb 2024) and a move in the market of the masses while in the abundance of AI and the internet overwhelm, the wisdom of avoiding the overwhelm, makes trusted sources even more important.
Sabine Hossenfelder’s insightful painful takedown on YouTube “My dream died, and now I’m here” 2.6 million views – of the whole Failled physics research science grant game is as disappointing as it is realistic. A growing revolt.
However the future is changing before us, and the market I see of the masses will not be denied forever. The frustration you feel Scott, is the magic waiting to be unleashed. It is the very power of the success that is coming. And can be harnessed. But not by Big Tech. Or American alone.
It calls for empowering the masses through ownership affluence – as I would call it – not the myth of the free, asset inflating, loss lead, venture capitalist gambling big tech casinos, big anything really, treating us as us/them binary data mining opportunities rather than ownership inclusion, relationship, affiliate participation.
We need Trusted Friends/Advisors who can play that Coach role without Agenda. (drawing in part on Thaler’s YouTube “Big Think Interview with Richard Thaler” of book Nudge fame.)
We actually, have a structural failure but there in lies the opportunity. To every disadvantage there is an advantage. And what can be of more value than the amazing work, therapists do, But oh, how, singular and wage-slave-escapees we are. Hostage to our own isolation.
The Age of Coders is over. They are too binary. The game is changing. They miss, and cannot do, Liminality.
The new revolution will be Relationship.
Humans, as AI is finding out, are the most liminal entity in the universe. And CBT is losing this race in the market of the masses in its own narrative, brokenness and binariness. Trying to take people down. Focusing on the negative. And limiting options.
To paraphrase Steven Kotler, they (CBT) went Self-Centric Coach is extrinsically rewarded (fame, fortune, and acclaim). The Craft-Focused Coach is intrinsically motivated (passion, purpose, curiosity). Scott’s ration de etre.
Where is the trust in the market going?
Check out 2024 Edelman Trust Barometer – Australia. Real people talk to people. They trust peers as much or more than scientists, governments and certain businesses with agendas, like CBT.
For too long, CBT has dealt in power rather than relationship. And it’s hurting them.
In my opinion, people are flooding gyms. And podcasts. For good reason. It’s useful. It’s fun. It’s heading in the right direction. It’s about an Abundance mindset. Mutual learning. When you are not relevant, you are not useful.
I believe there is tremendous gap in the market, and people could get a fair go that includes them. Therapy is a team sport. And Australians love team sport. We’re a village. But it need to be subscription based, like Netflix, with skin in the game. The future looks awesome. And it’s local. Not Californian. Not Google. And not the myth of free and phantom costs. We are not Global, and we are not one size fits all.
The key is in relationship. And Scott you have always been about the craft, the process, the relationship.
Thank you for being there for us. With us.
While challenges like bias, vested interests, and the inaccessibility of research are real, I hope in positive steps being taken to address these issues.
Initiatives like open-access publishing and public science outreach would make research more available and understandable.
Though it’s unlikely that science will ever be entirely free from influence or bias, greater awareness of these issues is fostering a movement toward more transparency and accountability.
By focusing on improving methodology, promoting integrity, and encouraging open dialogue, we can gradually work toward a system where science remains a powerful tool for truth, even within its limitations.
Progress may be slow, but the commitment to these values offers a realistic path forward.