“Gold Standards,” Plurality and Monocultures: The Need for Diversity in Psychotherapy

Abstract

For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform “one fits all” approach.

Psychodynamic Based Equine—Assisted Psychotherapy in Adults with Intertwined Personality Problems and Traumatization: A Systematic Review

“…The severe consequences of adverse childhood experiences on mental health patients [ 26 , 49 ] and for some possible insufficient alignment to the more cognitively oriented (and protocol-based) therapy methods [ 50 , 51 , 52 ], justify the expansion of treatment modalities. Different patients may benefit from different approaches or may benefit through different routes [ 53 ], specifically for adults with insecure attachment with traumatization originating in early (preverbal) development.…”

Whose anxiety are we treating, anyway?

“…The outcome data from studies of ESTs clearly demonstrate that no one model is a panacea, even for a particular diagnosis. Therefore, no psychotherapy approach can claim to be the gold standard (Leichsenring et al, ). Rather many can claim to be beneficial, and none without limitations.…”

“…Thus, different evidence‐based psychotherapies are required. Instead of a uniform “one‐size‐fits‐all” approach, there is a need for a plurality of ideas and approaches in science in general, and in the field of psychotherapy in particular (Leichsenring et al, ).…”

“…The authors concluded that manualized treatments are useful as research tools but should not be promoted as superior to nonmanualized psychotherapy in clinical practice. While ESTs have been shown to be effective, they are far from a panacea; at least one‐third to half of the patients remain symptomatic following any given EST (Leichsenring et al, ). The battles over the relevance, ethics, and applicability of EBP and ESTs are numerous and well‐documented and play an important role in refining the quality of patient care.…”

Equivalence testing: reversed hypotheses, margins, and the need for controlling researcher allegiance

“…However, this claim would only be justified if there was another therapy with (close to) 100% efficacy. Response rates for the different forms of psychotherapy including CBT, which seems to be regarded as the gold standard by Rief and Hofmann (2018a), are about 50% and rates for remission are even lower (Cuijpers et al, 2014;Loerinc et al, 2015). Thus, many patients do not sufficiently benefit from one specific psychotherapeutic approach.…”