Mental Illness Counselors and Evidence-Based Treatment

Patty Guzikowski contributed a guest post the other day about how to find an atheist counselor.  My reaction to the piece was…

Evidence-based treatment (EBT), also called empirically-supported

treatment (EST) refers to use of mental and behavioral health interventions for which systematic empirical research
has provided evidence of statistically significant effectiveness.

Seriously?  Seriously????

They have to have a term distinguishing evidence-based treatment from non-evidence based treatment?  Don’t people have to go to school for this stuff?  Do you learn anything in school aside from how to do CBT and not get sued?

Are therapists not bound to use methods proven to work?

What if you went to a doctor and the doctor was not bound to use evidence-based treatment?  Hello malpractice suit!  Well, mental illness is a physical illness, just like cancer, diabetes, etc.  If counselors are not bound to use treatment proven to work, that needs to be changed.

Patty has promised to write a follow-up.

Imagine you’re a Licensed Professional Counselor and you’re sitting at the annual convention of the American Counseling Association will 3000 of your colleagues, waiting for the keynote speaker to be introduced. Who is the last person you’d expect? The last person I expected was a shaman, and yet, the next thing I knew, Dr. Bradford Keeney, world renowned shaman, was being introduced as the keynote speaker of the 2008 American Counseling Association (ACA) convention.

Here’s the text the ACA used to describe Dr. Keeney in a press release prior to the event:

“Keeney, who is accepted as an elder shaman and spiritual teacher in numerous cultures, including the Japanese tradition of seiki jutsu, will discuss his creative approach to psychotherapy that draws upon cultural practices from all over the world. He has conducted one of the broadest studies of global shamanism in history.”

I don’t know why I was so surprised. After all, the first ACA convention I went to opened with a performance by a gospel choir. And by the time of the 2008 annual convention featuring Bradley Keeney, I’d been in the counseling profession long enough to realize that something insidious permeated the counseling culture—something I refer to as a spirituality bias in the counseling profession.

I’ve been a skeptic all my life and an atheist for most of it, but becoming a Licensed Professional Counselor was a midlife career change for me. I went back to graduate school after working in nonprofit business administration for about 10 years. While my career change has been one of the most rewarding life changes I’ve ever made, I didn’t expect to encounter such a spirituality bias and anti-science sentiment in my chosen profession. This bias permeates the profession, beginning with counselor education and continuing to the highest levels of leadership.

This bias is the reason that someone like Bradley Keeney gets a standing ovation from 3000 cheering and hooting counselors, after he has spent an hour and a half telling them to throw away their professional journals and thumb their noses at scientific research. This bias is what allows the ACA President to think it’s a good idea to welcome a shaman to speak at the annual convention—the same convention that was opened with a prayer by a native Hawaiian who happened to be Christian and ended his prayer “in Jesus’ name.”

When I read the convention workshop schedule, I held out a glimmer of hope when I saw a workshop about evidence-based practice (the practice of using treatment methods that have been empirically validated). Unfortunately, this workshop generated very little interest among attendees and was held in the tiniest room they could find. I estimate there were about 20 of us there when it started, and significantly fewer by the end. I stayed to talk to the presenters and ask them what they thought of the keynote address and the standing ovation given to the speaker. One of the presenters described the convention attendees as “basically a bunch of people who don’t like science.”

A bunch of people who don’t like science? How can that be? Professional counselors serving in a wide range of capacities—rehabilitation, mental health, school counseling, counselor supervision—who think evidence-based practice is just not for them, and that professional journals are so useless they cheer someone who would have us abandon research altogether?

If you are interesting in reading more about evidence-based practice and the spirituality bias in the counseling profession, stay tuned. I’m working on another guest blog post for J.T.—coming your way soon.

  • becca

    Interesting. A large reason I’m an atheist today is because of an excellent MSW therapist.

  • Ms. Crazy Pants

    I’ve had to research and choose a counselor recently. The ones from religious universities appeared to peddle a lot of woo. I have no patience for that kind of stuff.

  • The Duke of Highway J

    Just yesterday I called a Dermatologist to set up an appointment to have a wart removed. In their “on hold” recording they mentioned that the whole clinic was “evidence based” (yes they used that exact same term). I couldnt beleive my ears, and will certainly ask when I go for my appointment.

    Apparently, no toads will be involved.
    Darn it.

    • Nentuaby

      My guess would be that they’re using the term in a much stronger sense than merely “comports with empirical reality.” There are specific techniques in some disciplines that go by that name which involve a great deal of detailed record-keeping and datamining, trying to apply scientific research ideas not just to general knowledge of human health but to the personal and family histories of individual patients.

  • sarahm

    Wow. I guess I got really lucky when my therapist turned out to be an atheist (or at least disparaging of the elevation of religion beyond criticism).

  • papango

    Interesting. But before I get my panties all wadded up about this, is it possible to find out what is actually meant by EBT or EST and how if differs from other treatment approaches in this context. I know that many pysch treatments are not easy to research in the same way you might with other medical treatments. Often doctors are looking at off-label uses for drugs (topiramate is a good example), and treatments that are shaped around individual circumstances and difficult to repeat. I don’t mean that in the homeopathic sense, that’s just bullshit, but I’m on four different pysch drugs and I carry sedatives in my purse for emergencies, doing a large trial on that mix might be unreasonable. Plus, I’m a huge risk for violence against myself and others, that’s a tricky group to experiment on, many of us think we are already being experimented on, and it would probably be unethical to leave the placebo group in the everyday surroundings. I’m sure all of these things can be worked through and I don’t doubt that research will continue to bring forward new and more effective treatments. But I’m not going to throw my doctor on the trash heap because she tries treatments that don’t have a wealth of evidence behind them.

  • crayzz

    I know what you mean. I was simultaneously relieved and annoyed when I realised that my therapist had so specifically mention that his treatment methods actually had some scientific foundation. Then somewhat horrified at realising that hundreds of people far worse-off than me were being treated by glorified horseshit peddlers. As far as I’m concerned, they should be among the first to “get in the fuckin’ sack.” http://www.youtube.com/watch?v=YMvMb90hem8

  • http://www.facebook.com/profile.php?id=1583067300 alisonmeyer

    Counselors aren’t bound by the same restrictions as medical doctors, and they can, indeed, include a lot of woo-ey stuff in their practices. I know in many countries, medication and counseling is provided by the same person, but here in the US, medication is prescribed by a psychiatrist, and counseling is provided by a psychologist, master in social work, licensed clinical social worker, life coach, religious leaders, and so on. There are no legal limits as to who can claim to offer counseling, only what they can call themselves.

    What we really should be looking for is not evidence-based treatments, but science-based treatments. Since psychology is one of the “soft” sciences, a lot of evidence-based treatments can be based on highly biased, even anecdotal studies. Even science-based psychology has a wide margin for error, but it’s more reliable (and possibly more ethical) than evidence-based, regardless of how trustworthy that description might sound.


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