Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice.

Wachtel, Paul L.

doi:10.1037/a0020532

Cited by 111 publications

(96 citation statements)

References 68 publications

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“…The task force's notion of what should be defined as a scientifically based treatment and its consequences for the field of psychology has since then been met with everything from praise to extreme criticism (see, for example, Cushman &Gilford, 2000 andWachtel, 2010). There is, however, no need to repeat the international disputes here in any great detail as they have little direct impact on the Swedish debate.…”

Section: What Work and By Whom?mentioning

confidence: 99%

Professional reinventions: Swedish psychologists, 1990–2010.

Skagius

Münger

2016

History of Psychology

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Since the early 20th century, the Swedish psychology profession has undergone several changes in its essential tasks, epistemological foundations and social roles. These changes occurred through an on-going "tuning" with Swedish society where the profession strove to appear relevant to society's concerns and problems as well as enroll others to share the profession's goals and aims. Studying the history of the profession can thus shed light on the changing definitions and contours of the psychology profession itself as well as on the organization of the society in which it acts. This article examines the history of the Swedish psychology profession from 1990 to 2010, through an analysis of the discussions and debates taking place in the Swedish Psychological Association's journal. The analytical framework used draws on work done within actor-network theory and science studies. We argue that the profession's institutional connections, defining tasks, epistemological underpinnings, and social position have changed in major ways during these 2 decades. Overall, as a result of an increasingly felt insecurity, the profession has turned outwards and tried to find new ways to legitimize itself to politicians, the media, patients and customers through means such as a more economized vocabulary and novel forms of empirical research. These changes have led to a more socialized profession, now more closely tuned to other actors in Swedish society, leading to conflicts within the profession over whether this is an opportunity to better control their own destiny or if it will lead to a loss of autonomy.

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Section: What Work and By Whom?mentioning

confidence: 99%

Professional reinventions: Swedish psychologists, 1990–2010.

Skagius

Münger

2016

History of Psychology

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“…I will mention just a few. Advocates of using the RCT approach to study psychotherapy would have us believe that in the name of good science, it is necessary to mimic the double-blind methodology employed in drug studies (2). However, it is impossible to be blind in a study of psychotherapy.…”

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confidence: 99%

“…There are 256 ways to meet DSM-IV criteria for BPD. This implies that therapists should be trained to respond flexibly and creatively to the particular and often myriad needs of a given patient and not be confined by the dictates of a manual (2). Are patients with BPD not entitled to something better than the amelioration of one symptom that may or may not remain improved over time after treatment ends?…”

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confidence: 99%

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Treatment for borderline personality disorder: perils of the randomized controlled trial paradigm

Bender¹

2011

Acta Psychiatrica Scandinavica

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“…Psychotherapy research should inform practice when applicable but it is also important to acknowledge that not all individuals seeking psychotherapy services do so because of specific DSM symptoms. Evidence indicates the importance of life history, dispositional variables, and contextual factors in bringing about lasting change, variables that are ignored in most EBT studies (Doesschate, Bockting, Koeter, Schene et al, 2010;Hafner, 1984;Keltner, 1987;Ottenbacher & Ottenbacher, 1981;Shea, Elkin, Imber, Sotsky, Watkins, et al, 1992;Wachtel, 2010;Wampold, 2005Wampold, , 2007Westen & Morrison, 2001;Westen, Novotny, & Thompson-Brenner, 2004). …”

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confidence: 99%

Psychotherapy Outcome Research: Issues and Questions

Shean

2016

Psychodynamic Psychiatry

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Emphasis on identifying evidence-based therapies (EBTs) has increased markedly. Lists of EBTs are the rationale for recommendations for how psychotherapy provider training programs should be evaluated, professional competence assessed, and licensure and reimbursement policies structured. There are however methodological concerns that limit the external validity of EBTs. Among the most salient is the circularity inherent in randomized control trials (RCTs) of psychotherapy that constrains the manner in which the psychological problems are defined, psychotherapy can be practiced, and change evaluated. RCT studies favor therapies that focus of specific symptoms and can be described in a manual, administered reliably across patients, completed in relatively few sessions, and involve short-term evaluations of outcome. The epistemological assumptions of a natural science approach to psychotherapy research limit how studies are conducted and assessed in ways that that advantage symptom-focused approaches and disadvantage those approaches that seek to bring broad recovery-based changes. Research methods that are not limited to RCTs and include methodology to minimize the effects of "therapist allegiance" are necessary for valid evaluations of therapeutic approaches that seek to facilitate changes that are broader than symptom reduction. Recent proposals to adopt policies that dictate training, credentialing, and reimbursement based on lists of EBTs unduly limit how psychotherapy can be conceptualized and practiced, and are not in the best interests of the profession or of individuals seeking psychotherapy services.

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Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice.

Cited by 111 publications

References 68 publications

Professional reinventions: Swedish psychologists, 1990–2010.

Professional reinventions: Swedish psychologists, 1990–2010.

Treatment for borderline personality disorder: perils of the randomized controlled trial paradigm

Psychotherapy Outcome Research: Issues and Questions

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