If They Don’t Make You Happy, Sue Them

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As a result, a growing number of psychotherapies are banned from the forum and a very limited number of short term and protocol-based treatments are promoted as the supposedly only reliable ones. As they are short term and protocol-based, they are easy to teach and easy to apply, and indeed, today, they are everywhere.

There is only one tiny problem: they don’t work. First of all, they don’t work because they are used with the wrong patients, meaning: with real patients. Remember: these methods were tested with those very rare clients who have only one problem. In real life, what in these studies is called “the naturalistic treatments”, half of the clients don’t fit DSM-diagnoses and about two-thirds of them suffer from so-called co-morbidity. Secondly, there is growing evidence that by 18 months post-treatment, the initial positive outcome of brief psychotherapy is indistinguishable from a placebo-effect.

In summary, the scientific testing of psychotherapeutic effectiveness has resulted in an impoverishment of psychotherapy to protocol-based short term treatments. The growing evidence that the initial positive effects of the latter don’t last is leading more and more to the conclusion that psychotherapy as such doesn’t work. This is perverse, because the correct conclusion is that firstly, the larger part of psychotherapies cannot be tested with the RCT-methodology because of the limits of that methodology, and secondly, that the larger part of our clients cannot be treated by those treatments that can be tested via RCT.

Nevertheless, the damage has been done and the perverse conclusion operates as a self-fulfilling prophecy. It is perfectly possible that in the near future the British Health Professions Council will concentrate on those manualised treatments, because they are the only ones that can be evaluated in a simple way on a behavioural level. With the other psychotherapies, this is not possible. The irony is that in case the council focuses on these manualised and supposedly evidence based treatments, chances are great that the council will receive a growing number of complaints. To put it in terms of the website: these forms of would-be psychotherapy don’t make people happy at all.

So, in summary: it is impossible to evaluate genuine psychotherapeutic treatments in terms of predictable skills and competences, because they are not predictable. If we are talking about manualised treatments, this kind of evaluation is possible and will reveal bad outcomes and unhappy patients. In its turn, this will increase the idea that psychotherapy as such doesn’t work, and that salvation has to come from the pharmacological or even the neurological department.