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21st April 2016

‘Evidence Based’ Psychotherapy in the House of Cards.

The ‘Sciencey’ thread of this blog is partly a description of the context within which art therapy has to survive.

There are fashions in psychological therapies, (like anything else people do). Cognitive Behaviour Therapy, (CBT), demonstrates when fashion becomes tyranny.

'Evidence Based' practice sounds like an unarguable good doesn't it? We legitimately want to know if something works before paying for it, and are led to believe that Scientific Research will give us reliable yes/no answers to that question.

The research into psychology research demonstrates that the accuracy of its yes/ no answers is in fact less than you’d achieve tossing a coin to answer the question.

A key concept in the scientific method is reproducibility: repeating the same experiment should yield the same evidence, right? Wrong. This was recently tried with 100, very 'credible' peer reviewed psychology research publications. Less than 40% of the original research findings were confirmed. Our evidence is a very shaky house of cards indeed. (This seriously shocking fact can be verified, as reported in 'Nature', in 2015 here).

Valid ‘evidence’ is defined in a bizarrely inappropriate way within the house of cards: The Randomised Control Trial, (RCT), is believed to be sole arbiter of ‘The Truth’. RCTs isolate and compare single variables. Nothing to do with human beings is that neat. You can't learn anything meaningful about a wave by putting a bit of one in a bucket and weighing it. Yet this is the 'gold standard' evidence by which psychological therapies are rationed by state services. Its’ why you will probably not be offered art therapy by your GP if psychological therapy looks like it could help you.

CBT, to play by RCT rules and get superficially ‘sciencey’ ‘evidence’ purported to be a ‘clipboard’ therapy, (i.e. allegedly  identical therapy ‘scripts’ were trotted out to experimentees,), so there was no variation between therapists: ‘treatments were ‘identical’ so they had their ‘single variable’: whether CBT was offered or not. (Of course this assumes that the ‘Depressions’ being treated were all the same too…)

Even then, The National Institute for Clinical Excellence, found in 2006, (in very small print), that ‘there was insufficient evidence to determine the efficacy of individual CBT for depression compared to either pill placebo (plus clinical management), or other psychotherapies’

Overwhelmingly, psychological therapies research evidence shows that working alliance is the key to efficacy. Many CBT therapists know this and have the necessary skills. I have many friends among them. Some, (especially hastily, narrowly and formulaically trained ones), don’t. People respond to relationships, not scripts, and can tell the difference. Who’d have thought it?

Thousands of people in despair, distress and disturbance are failed, (and often left feeling patronised, unheard, invalidated, and angry), by the CBT lobby’s simplistic hubris, misrepresentation of the evidence and deliberate exclusion of human and social complexity.

Demanding ‘Happy Thoughts’ from unhappy hearts doesn’t work. If it did, unhappiness is merely a personal stupid choice, and CBT could teach us better in 8 sessions. Inequality, exploitation, abuse, neglect, deprivation, oppression, fear, lovelessness, hopelessness and powerlessness would be irrelevant. Conveniently for capitalism, insultingly to people, that’s what CBT tells us.

The ironically titled ‘Improving Access to Psychological Therapies’, (IAPT, i.e. CBT), programme was funded by The Department of Work and Pensions, not Health, because our depression epidemic is economically damaging. CBT was meant to ‘fix’ broken profit-friendly, unit-shifting, consumer work-drones, and it hasn’t achieved even that.

The backlash to this psychotherapy of ‘blame the victim’ is inevitable, predictable, and probably imminent.

We will no doubt be returning to the subject here. In the meantime, keep thinking those happy thoughts everyone!

ML

The image is House of Cards.  Jean Michel Liotard  (Swiss, Geneva 1702–1796 Geneva)  After François Boucher (French, Paris 1703–1770 Paris)

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