Why "Evidence-Based" Therapy is a Straw Man

Misconceptions About Modern Therapeutic Practices

Modern therapeutic practices often face scrutiny and misunderstanding, particularly when it comes to therapy methods and the concept of evidence-based therapy. Many people mistakenly believe that evidence-based therapy is a one-size-fits-all approach, disregarding the nuanced and individualized nature of mental health treatment. This misconception can lead to the erroneous belief that therapies not labeled as "evidence-based" are ineffective or inferior. In reality, the term "evidence-based" is frequently used as a marketing tool rather than a definitive measure of a therapy's efficacy. This oversimplification ignores the complexity of human psychology and the diverse needs of individuals seeking mental health support.

Through large scale studies over decades, it has been observed by researchers that despite the explosion of new methods and diagnostic procedures in therapy, the overall efficacy of psychotherapeutic treatment has not significantly improved (1). In fact, of all factors that impact therapy outcomes, treatment model, technique, or method makes the "smallest percentage size contribution to outcome of any known ingredient," (2). In other words, large scale research suggests that different treatment approaches do not definitively produce better outcomes than others. However, according to Scott D. Miller “Study after study, and studies of studies show that the average client is better off than 80% of untreated sample,” (2).

Limitations of Therapy Labels: A Critical Look at Evidence-Based Practice

The labels used in therapy, particularly "evidence-based practice," often come with significant limitations that can obscure the true efficacy of various therapeutic approaches. While the term "evidence-based practice" suggests a rigorous, scientific foundation, it can also create a misleading hierarchy among therapies. This label may cause individuals to overlook valuable treatments that do not fit neatly into this category but are nonetheless effective for certain conditions or populations. Additionally, the focus on evidence-based therapy can sometimes prioritize short-term outcomes over long-term well-being, neglecting the importance of sustained mental health improvement.

Moreover, the criteria for what constitutes "evidence" can be narrow, often excluding qualitative data and patient experiences that are crucial for understanding the full impact of a therapy. This can result in a skewed perception of what is effective, potentially marginalizing innovative or holistic approaches that do not conform to traditional research methodologies. It is essential to recognize that the therapeutic process is inherently complex and multifaceted, requiring a broader perspective that values both empirical evidence and individual experiences. By critically examining these labels, mental health professionals and patients alike can make more informed decisions that better address the diverse needs of those seeking support.

The Role of Research in Effective Therapy

Research plays a crucial role in developing effective treatments and advancing the field of psychotherapy. It provides a scientific basis for understanding which methods are most beneficial for specific conditions, helping clinicians make informed decisions. However, it is important to recognize that research alone cannot capture the full complexity of human experience and the therapeutic process. While empirical studies offer valuable insights, they often rely on controlled environments that may not reflect real-world scenarios.

Moreover, research can sometimes be influenced by funding sources or publication biases, which may skew the perceived efficacy of certain treatments. This underscores the need for a balanced approach that integrates research findings with clinical expertise and patient preferences. By combining these elements, therapists can tailor their interventions to meet the unique needs of each individual, leading to more personalized and effective care.

Additionally, ongoing research is essential for continually improving therapeutic practices and adapting to new challenges in mental health. It encourages innovation and the development of new techniques that can address emerging issues. Ultimately, the role of research in effective treatment is to provide a foundation of knowledge while remaining flexible and responsive to the evolving landscape of mental health care.

Why Context Matters in Therapeutic Outcomes

Context plays a pivotal role in determining the outcomes of therapeutic interventions. The effectiveness of therapy is not solely dependent on the techniques used but also on the environment in which it is delivered and the unique circumstances of each patient. Factors such as cultural background, socioeconomic status, and personal history can significantly influence how a patient responds to treatment. Ignoring these contextual elements can lead to suboptimal outcomes and a lack of engagement from the patient.

Furthermore, the therapeutic relationship itself is a critical component of successful treatment. Trust, empathy, and mutual understanding between the therapist and patient can greatly enhance the effectiveness of any therapeutic approach. Research has shown that the quality of the therapeutic alliance is often a stronger predictor of positive outcomes than the specific type of therapy used. This highlights the importance of creating a supportive and individualized therapeutic environment.

Additionally, external factors such as family dynamics, social support, and life stressors can impact the progress and sustainability of therapeutic gains. Therapists must consider these elements when designing and implementing treatment plans to ensure they are addressing the whole person, not just the symptoms. By acknowledging and integrating context into therapeutic practice, mental health professionals can provide more comprehensive and effective care, ultimately leading to better long-term outcomes for their patients.

Moving Beyond Simplistic Therapy Debates

The ongoing debates about the superiority of different therapeutic approaches often oversimplify the complexities of mental health treatment. These discussions frequently pit one method against another, creating a false dichotomy that overlooks the multifaceted nature of effective therapy. It is essential to move beyond these simplistic debates and recognize that no single approach holds the key to addressing all mental health issues.

Each therapeutic method has its strengths and limitations, and the effectiveness of any given approach can vary widely depending on the individual and their specific circumstances. For instance, cognitive-behavioral therapy (CBT) may be highly effective for some individuals dealing with anxiety, while others may benefit more from psychodynamic therapy or mindfulness-based interventions. The key is to adopt a flexible, integrative approach that draws on the best practices from various therapeutic models.

Moreover, the focus should shift from arguing about which therapy is superior to understanding how different approaches can complement each other. By fostering collaboration among mental health professionals and encouraging the integration of diverse therapeutic techniques, the field can better serve the complex needs of patients. This holistic perspective acknowledges that mental health is influenced by a myriad of factors, including biological, psychological, and social elements.

Additionally, it is crucial to involve patients in the decision-making process, respecting their preferences and values. Empowering patients to take an active role in their treatment can enhance engagement and improve outcomes. Moving beyond simplistic therapy debates allows for a more nuanced and effective approach to mental health care, ultimately benefiting both practitioners and patients.

(1) Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. Miller, S.D., Hubble, M.A., & Chow, D. American Psychological Association. (2020).

(2). https://scottdmiller.com/wp-content/uploads/What%20Works%202010.PDF

Introduction to Interpersonal Nonduality

Most often when we go to a group, a workshop, a class, or even a meditation we are learning content through some presentation, or in the case of meditation we are being guided into directing our attention in a specific way to try and produce a specific result.

While these modes of working have much utility for too many reasons to list here, from the perspective of Nonduality they all fall within a structure that looks like something like this:

Process = Sense-of-Self + Directed Attention + Content.

Which then culminates in:

Sense-of-Self + Directed Attention + Content = Attempt Towards Intended Outcome

They all operate within a framework that tacitly assumes we need to identify with a sense-of-self and direct our attention towards some object. That is, they all operate within a framework of Subject towards Object with the intention of producing some result (e.g. learning, relaxation, insight).

Again, this does not mean these approaches do not have value, or utility. This kind of learning has been essential for all of us. Also, many different perceptions and experiences can and do arise within this framework, which can include experiences outside of the perceptual habit (e.g. during process of guided meditation, there is an experience of expansiveness of Self, or even selflessness). However, regardless of outcome the process can reinforce this underlying structure of perceptual habit.

Interpersonal Nonduality is a completely different process of interaction through which we are connecting with another or others with the primary intention of embodying Nondual Awareness.

Within the context of interactions in this intentionality, whatever we say, or don’t say, is of little importance. We aren’t trying to direct our attention in any which way, because attention is simply awareness that has been narrowed, and there is no narrowing necessary here as we are connecting with awareness as the backdrop of the entirety of any and all experience.

There is no content being presented, no concept to learn, and while one could argue that the intended outcome is to rest in the effortless experience of Nondual Awareness, we wouldn’t know if we were achieving that outcome because there would be no content of awareness to signal any achievement and nothing to compare achievement or non-achievement to.

Furthermore, the Sense-of-Self that is implicit in other processes is not necessarily a given variable in this context. Meaning, just because in the rest of our lives we assume that our Sense-of-Self may be somewhat concrete, we don’t start with the presupposition in Interpersonal Nonduality. We don’t start with any presupposition. Rather we start with an effortless non-presupposition, or what we might call innate not-knowing.

If we return to the formula I posited earlier of:

Process = Sense-of-Self + Directed Attention + Content

In Interpersonal Nonduality we might render this something like the following:

Process = Innate Not-Knowing = Sense-of-Self (None and/or No Presupposition) + Directed Attention (None and/or Awareness Itself) + Content (No Content) = Outcome-Whatever-It-Is

So in this sense we aren’t doing anything, but there is no pressure. There isn’t some suppressive silence. Rather, the shared recognition is simply that whatever words we have can not or ever capture the profundity and simplicity of awareness itself. We can talk about awareness, but our words are not themselves awareness. And yet somehow, our words are not, not awareness. Yet in this framework there is no work to be done, we simply have the opportunity to share and rest in the awe of the ground of experience itself.

Nonduality and the Psychotherapy of Transcendence

How does nonduality relate to psychotherapy? How might it be distinct? Is nonduality a method or approach to psychotherapy? What does nonduality offer psychotherapy?

In order to answer these questions we must start with how we understand who and what we are and what therapy is. In technical terms (which you can leave aside if you choose) we must try to understand the ontology behind our approach in order to understand the epistemology. That is, we must be differentiate how each approach sees itself in relationship to the process of being human or if you favor redundancy, being a human being.

Encyclopedias could be written about what psychotherapy actually is. Generally speaking, we can think of psychotherapy as an interpersonal methodology applied with the intent of helping the client develop awareness/insight and into their mental, emotional, and behavioral patterns in order to facilitate change. Some schools of therapy may frame therapy more centrally as a process of skill-building also aimed at facilitating change.

In either instance, therapy operates within a primarily secular worldview that is both individual to each therapist, and in the context of the therapeutic interaction intends to stand outside of belief (unless that is we specifically seek out a faith-based therapist) resulting in opaque or inexplicit ontology. Yet, whether or not belief is explicit it is impossible that the therapist and client would not include their respective world-views in the therapy process. Meaning, how the clients understand themselves in relationship to their world and existence must be part of the therapy process and by proxy how their therapist understands themselves in relationship to the world is impossible to eradicate from the therapy process, no matter how client-centered our values are.

Why am I making this point? Well the aim of conventional psychotherapy methods are built upon presuppositions that both client and therapist bring into the room. In the most general, structural sense some of these presuppositions are:

• the client exists as a sense-of-self

• the client is experiencing problems related to that sense-of-self

• those problems are related to one or more areas of dysfunction within the sense-of-self system

• those problems may be explained variably by different epistemological and etiological concepts (i.e. therapeutic theories and methodologies).

• emotional and relational development are emphasized as structurally formative factors in problems with the sense-of-self

• therapy seeks to ameliorate problems of the sense-of-self

These presuppositions are distinct from a nondual orientation to therapy which may respond to each point as such:

• the client sense-of-self exists as a relativity (some schools of psychotherapy may agree) and from another perspective the sense-of-self is non-existent; it is empty of self-nature

• “Problems,” or the roots of mental affliction, arise from the client’s identification with the sense-of-self as being substantial

• investment in remedying the sense-of-self reinforces the belief that the sense-of-self is ultimately existent and important

• Nonconceptual/Nondual Awareness is the ground of all experience

• the experiential revelation of Nonconceptual Awareness naturally divests energy from the identification with the sense-of-self, emphasizing experiential selfless spaciousness

• the conceptual mind may or may not naturally re-assert itself into Nonconceptual space

• The conceptual mind is divested of it’s relevance

• Resting in experiential selfless spaciousness

• Problems can not be constituted; awareness is unstructured; there is no it, there is no that, there is no I, there is no there.

The aims of conventional and nondual psychotherapy are different. Conventional therapy is a useful and important endeavor. It often implies certain presuppositions that are not explicit, however the reality is that most people who go to therapy find it helpful. In therapy we look at how we became who we are identified with today, and how certain patterns of emotion, affect, and thought serve or do not serve us— broadly speaking.

Nondual therapy is a totally transpersonal-consciousness based approach which is based on going beyond identification with the sense-of-self to an innate, experiential ground of being that has nothing to do with who we think we are. This is a psychotherapy of transcendence.