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

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.

5 Tips For Cultivating a Meditation Practice During COVID

Despite the challenges that it presents, living in the time of COVID also offers us a unique opportunity to look at how we practice self-care. Of all the forms of self-care practice, perhaps the most commonly recommended is meditation, or mindfulness. In this post, I am going to discuss some tips for developing a regular meditation practice. I have practiced meditation in fits and starts since I was 20 years old, with extended periods of daily meditation. It changed my life, and it could very well change yours. So here it goes:

1. Consistency is the best way to practice. In almost all cases, is better to practice a little (5-10 mins) regularly than a lot rarely. Meditation is a form of workout for your mind. When we work out, we start small and build up. Other ways to help stay consistent is to develop a routine. Try choosing the same time every day, or meditate after you do something else that you do everyday (e.g. brushing your teeth). Try meditating in the same place. Find what works for you, and do your best to commit to that daily.

2. Don’t judge your practice. I can’t tell you how many times I have heard, “I’m not sure meditation works for me… I was so distracted while trying to meditate!” People often think they are supposed to be laser focused from the get go during meditation. While some advanced meditators may get to that stage (so I have heard) for most of us this is NOT realistic as we start out… In fact, distraction is a normal part of meditation! What is important is that you are paying attention. It is best to not place such high expectations on our meditation practice, and to see it as a process of learning about our minds.

3. Try some different meditations, but then stick to one practice that you connect to. I am all for people trying different meditations. There are apps that may guide you through several different kinds of meditations. However, at a certain point if we are trying so many different meditations we might end up getting confused. We might not be able to develop a rhythm or relationship with that practice. In meditation the idea is that we are not giving ourselves MORE to think about. Therefore, I suggest that once you find a practice you connect to that you give it some time to go deeper with. That is not to say you have to be locked in forever, just try being consistent with one practice for a month or two. If you feel inclined to try something else after that, then go for it. If you are comfortable in your practice at that time, then keep it up!

4. Be kind to yourself. If you miss a session, don’t beat yourself up. If you are so distracted during a session that you lose hope, don’t worry. You are human, and meditation is not about being perfect. There is no benefit to shaming or putting undue pressure on yourself. Rather, try to remember what motivates you to meditate. What is good about it. Meditation is a privilege, not an obligation. It is something to do for your health and well-being out of self-love, not self-hatred.

5. Enjoy it. This one might seem difficult if you are new to meditation, and just learning how much your thoughts run the show. Yet, I am very confident that if you stick with it, you will find pockets deep enjoyment that come with giving our minds the opportunity to rest. No need to chase the experience, but when it shows up its okay to appreciate it and gently remind yourself that this is one of the greatest gifts you can offer to you!

Building a Legacy

I am not a fan of the hyper-individualism that is marketed to us everyday. I have no intention for the name Legacy Psychotherapy to be used to sell you the idea that I can help you “be your uniquest self.”

Yet, I do believe that our actions have enormous significance. What we do speaks volumes about who we are. And I’m not saying this to try to pigeon-hole anyone either. When it comes to leaving a legacy, what we leave is in our actions.

Good therapy should reflect this. The proof is in the pudding. That is, good therapy should support us in learning to take actions that are of significance to us, or in alignment with our values. Additionally, it should support us in learning to not take action when that action would compromise our values.

Therapy is a self-awareness building exercise. Family therapy is a self-and-other awareness building exercise. When we develop awareness of our patterns, and motivations behind our behaviors we actually increase our ability to make choices about how we want to act. That is, with increased awareness, there is increased choice. It is my opinion that such choices offer us the opportunity to live a life full of meaning, self-empowerment and integrity.

In therapy, I first try to understand what motivates “problematic” behaviors in my clients, whether in adults, children or in families. We do this by bringing attention to and reflecting on our feelings, thoughts, and behaviors. Often there are feelings that have never been talked about, or we might struggle to verbalize. In learning how to talk about these feelings, we open the door to new possibilities for our actions.

However, there is no perfect. This process is one of continual trial-and-error. With children this takes patience and support from parents. With adults this takes learning how to accept the myriad of feelings that are part of our human experience. In each case, I am here to support you along the way. I am so confident that you or your child can make progress through this process, whether it is with me or another therapist. One of my mottos is that “showing up is half the battle.” If you have questions pertaining to the therapy process, please reach out to have a free consultation with me. I would be glad to offer my experience to you.