Many depth psychotherapists have not taken a strong interest in the empirically supported treatment movement largely because it does not appear relevant to the practice of depth psychotherapy. However, this may be a naïve and dangerous assumption. In this brief article, an overview of some of the critical issues of empirical support for therapy will be examined from the perspective of irrelevance and relevance. The hope is to generate a more genuine engagement of what depth psychotherapists can learn from this movement.

Defining Movements

Four movements can be identified as being part of the empirically supported movement. The discussion emerged within the American Psychiatric Association’s development of the Empirically Validated Treatments (EVTs; Harris, 2004). These were largely biological treatments (medications) and validation methods favored biological treatment approaches.

Psychologists, partially out of response to the above mentioned movement, developed their own approach to the Empirically Validated Treatments (Harris, 2004). However, the choice of the word “validated” quickly came under attack. The concern focused on the idea that “validated” could be interpreted as “proven.” Psychologists tend to be skeptical of the idea that research proves therapy works or any other claims that the success of therapy can be proven. A revision ensued which changed the terminology to the more commonly used wording of the Empirically Supported Treatments (EST).

Early standards which needed to be attained for inclusion as an empirically supported treatment were narrowly defined and clearly biased toward the brief and solution-focused therapies (Harris, 2004). Through time, this has changed to become more open to alternative methods of gaining empirical support. However, there remains a clear bias toward brief approaches, which formed part of the impetus for developing alternatives.

The first new alternative was the empirically supported principles (Harris, 2004). This approach is inclusive of more general principles which are believed to be effective, rather than specific techniques. Still considered too narrow by many therapists, a fourth approach, the empirically supported relationships, emerged. This is the broadest approach to empirically supported movement, maintaining that aspects of the therapeutic relationship are the most important part of the healing process.

A fifth movement which could be identified comprises therapists who stand firmly against the necessity of empirical validation. Within this movement, two related movements can be further identified. First is a group which maintains that the focus on evaluating therapy is important, but that we need to move beyond empirical approaches. A second group stands in opposing to the evaluation movement in general and believes this is an issue between therapist and client.

To summarize, here we can discuss five broad trends related to the empirical support movement, each with a different focus. The field of psychotherapy may benefit most from taking all of these voices seriously. Each voice adds uniquely to our broader understanding of how therapy works. Once again, here are the five historical movements and their general value which they believe is most essential:

1. The Empirically Validated Treatments: Focus on intervention and technique
2. The Empirically Supported Treatments: Focus on intervention and technique
3. The Empirically Supported Principles: Focus on healing processes and aspects of relationships
4. The Empirically Supported Relationships: Focus on healing relationships
5. Opposition Empirical Evaluation of Therapy: Focuses on the consumer and therapist subjective evaluation of therapy.

The History of Empiricism

In discussing empirical support for therapy, it is beneficial to take a quick review of the history of the term “empiricism.” The meaning and use of the empiricism evolved during the modern period; a time in which empiricism also gained great influence and privilege as an epistemology.

In the early modern period, epistemology initially referred to “knowing through the experience,” which was typically associated with sensory experience (Hergenhahn, 2001). The application was knowing through observation. This form of empiricism came into popularity before modern science emerged as a force. In the modern period, logic and empiricism began taking over the privileged epistemological position previously held by religion.

With empiricism and reason now forming the new paradigm (modernism), a logical marriage between these two epistemologies seemed inevitable. Scientific empiricism resulted from the merger. In applying the principles of logic to the empirical process, a scientific method emerged which led to the scientific revolution of the modern period.

This modernist approach to knowing maintained dominance until the postmodern period emerged. Postmodernism questioned any singular epistemology having a privileged position. Rather, postmodernism prefers an epistemological pluralism in which several approaches to knowing are utilized. This epistemological shift can now be seen in hard science in quantum physics and popular culture through the surprise success of movies such as What the Bleep?!.

Irrelevancy and the EST’s

The story of irrelevancy begins by calling into question the primacy of empiricism to evaluate therapy (i.e., the postmodern response). Entire books could be written on this critique. Though a comprehensive critique is valuable and needed, it is beyond the scope of this article. However, allow me to highlight a couple of important points about the irrelevancy of the empirical evaluation of therapy.

Empiricism as the only valid, primary, or most valuable approach to assessing therapy is clearly a product of modernist thought. A postmodern perspective would invite empiricism into the discussion, but view it as one important voice among many. Each of the voices needs to be honored and taken into consideration. It can further be argued that exclusive reliance upon a modernist epistemology in the assessment of therapy will lead to psychotherapy becoming increasingly irrelevant and out of touch with contemporary postmodern society.

Several other important points are highlighted in brief:

1. Limitation of measures: It is common to ascribe too much confidence in clinical measures as if they perfectly attained the essence of what they are measuring. Measures are limited and give one view of a construct (such as depression) from within a theoretical framework. Many measures reflect the assumptions of brief therapy in approaching a construct. Depth therapy often brings a different understanding of the construct under investigation.
2. Limitation of research methodology: The empirical movements typically give preference to quantitative research over qualitative approaches. Additionally, there is often an excessive confidence in quantitative research which could be called into question.
3. Myopic views of mental health: As discussed above, many measures are theory dependent and overly simplistic. For example, many depth therapists would argue that no 10-25 item test can come close to assessing the complexity of depression, especially as experienced in different individuals across time.
4. Limitations of creativity and innovation: Requiring empirical validation of treatment and the usage of empirical supported treatments could greatly limit creativity while slowing the process of innovation. While some of this is beneficial in protecting the consumer, it begets the question of whether there may be other, less problematic ways of accomplishing these goals.
5. Assumptions of appropriate ends: Measures must be consistent with the theories they are measuring. Different measures may bring different results measuring different therapies. The factor is not considered in most empirical research.
6. The narrowing of therapy: Using measures of symptoms to assess therapy implicitly makes many assumptions about the purpose of therapy. Even with the emergence of new measures of well-being and psychological health, these measures limit our understanding of how therapy impacts the broader being (or ontology) of the individual.
7. Can quantitative measures assess depth psychotherapy?: This question has received the most attention in depth psychotherapy responses to the empirical support movement. Essentially, it questions the ability of research, primarily quantitative research, to assess the broad ways depth psychotherapy impacts the individual.

Relevancy and the EST’s

In examining the relevancy of empirical assessment, it is important to consider the context in which manage care arose in relation to psychotherapy. In the 1970’s and 80’s, a proliferation of therapy approaches emerged along with increased consumer interest in therapy. While this was a very positive movement for the mental health field, it also brought about an environment in which therapist were largely unchecked.

A first problem that arose was that many of these therapy approaches were applied without an examination of the dangers associated with them or the validity of their theories. One development which exemplifies this danger is the proliferation of repressed memory therapy for satanic ritual abuse. As it turns out, many of the repressed memories were falsified and created through the therapy process. This created a credibility problem which was minor in comparison to the pain inflicted upon many people who underwent this therapy.

Evaluating the effectiveness of therapy protects the consumers and the credibility of the field. There should be little doubt that we need to be engaged in this process. The challenge is whether empiricism is the only appropriate way to determine its effectiveness. Again, it is the exclusivity of the empirical assessment that concerns most depth psychotherapist, not the presence of the empirical voice in the discussion.

The irony of the empirically supported movement is that it has caused many depth therapists to shy away from empirical perspectives altogether. Previous valuing of the empirical voice is now often ignored because of misuse. However, this over-reaction is just as dangerous as the other extreme of exclusively privileging the empirical voice in assessment.

A Place for Dialogue

The field of psychotherapy is best served by divergent perspectives and open dialogue about critical issues in the field. The empirically supported treatment movement has become an increasingly divisive issue in the field. This article has maintained that by returning empiricism to its place as a voice instead of the voice, we can move to a more productive dialogue.

References

Harris, M. L. (2004, March). Empirically supported treatments and alternative methods. Paper      presented at Christian Association for Psychological Studies, International Conference, St. Petersburg,      FL.

Hergenhahn, B. R. (2001). An introduction to the history of psychology (4th ed.). Belmont, CA:      Wadsworth/Thompson Learning.

How to Cite in APA Style:

Hoffman, L. (2005). Depth psychology and the empirically supported movement: Critical issues.      Retrieved from the Depth Psychotherapy Network: http://www.depth-psychotherapy-network.com
     /Professional_Section/Emprically_Supported_Treatment_Debate/Hoffman_EST_1.htm

Author Bio

Dr. Hoffman is a practicing existential psychotherapist. He has developed a website on existential psychotherapy (www.existential-therapy.com) which provides a more extensive overview of the theory, resources, and training opportunities. Dr. Hoffman is the Dean of Faculty and a faculty member of the Colorado School of Professional Psychology and the Editor-in-Chief of the Colorado School of Professional Psychology Press. Dr. Hoffman is also an editor and contributor to the new book, Spirituality and Psychological Health.