Spotlight on Psychoanalytic Psychology, V. 27 No. 3

By Louis Rothschild, PhD

For the Spotlight of Volume 27, Issue Number 3 of Psychoanalytic Psychology, I wish to comment on Paul Wachtel’s article, "Beyond "ESTs": Problematic assumptions in the pursuit of evidence-based practice".

Wachtel’s paper draws from a controversy that many of us are already familiar with and recently illustrated by the absurdist claim found in a 2009 issue of Newsweek suggesting that clinical psychologists reject science, which was shortly followed by Shedeler’s 2010 scientific publication showing the effectiveness of psychodynamic psychotherapy. Something didn’t smell right in the Newsweek article, and Shedeler’s publication in the American Psychologist provides ample redress.

Wachtel does a masterful job of identifying what I refer to as a foul smell. He notes that the narratives of Empirically Supported Treatment arise from a movement with an agenda whose politics run amuck in a manner that works against a spirit of scientific inquiry. If we are to move beyond buzzwords and slogans in a conflict in which one may attack by calling another anti-scientific, careful analysis matters. Wachtel does not disappoint. He eloquently critiques the assumptions made by the manualized treatment movement. His critique deserves the attention of anyone who cares about the clinical practice of psychotherapy and the science of psychology.

Wachtel states his goals clearly: To examine the assumptions found in the Empirically Supported Treatment movement, and to provide an alternative view regarding evidence and practice. Among several interesting points, Wachtel finds a degrading branding problem. What was first called “empirically validated”, became “empirically supported”, and now becomes “evidence-based.” That alone would be a knockout punch, but Wachtel hasn’t really started at this point in the paper. He provides a significant critique of the practice of studying the treatment of one DSM disorder at a time (not prototypical), manualization (evidence that it may be counter-productive), and randomized controlled trials (not a gold standard from which to practice science). In the wake of his critique and illustration of what certainly looks to be political intent on the part of Division 12, Wachtel argues for multiple methods and the use of effect sizes in order to combat what he refers to as the “Walmart” approach to treatment in which low level technicians dispense treatment that just might not constitute a best practice.

Towards the end of his paper, Wachtel notes that convergence does exist between some aspects found in cognitive behavioral therapy and psychoanalysis. Such an observation is to be expected from a writer who has been interested in integration between psychoanalytic therapy and behavior therapy for some time (e.g., Wachtel, 1977). The simple fact that his project has sustained itself over decades (Wachtel, 1997) is all the more reason that this paper deserves our attention.

References

Begley, S. (2009). Ignoring the evidence: Why do psychologists reject science? Newsweek, October, 12, 2009.

Shedler, J. (2010). The efficacy of psychodynamic therapy. American Psychologist, 65,98-109.

Wachtel, P. (1977). P sychoanalysis and Behavior Therapy. Toward an Integration. New York: Basic Books, Inc.

Wachtel, P. (1997). Psychoanalysis, Behavior Therapy, and the Relational World. Washington DC: American Psychological Association.