“Beyond ‘ESTs’: Problematic assumptions in the pursuit of evidence-based practice.” By Paul L. Wachtel; published 2010 in Psychoanalytic Psychology.

• ABSTRACT: There has been much confusion in the literature of psychotherapy between the broad concept of evidence-based practice and the narrower set of criteria that have been employed in designating certain treatments as “empirically validated” or “empirically supported.” In contrast to the appropriate concern with examining the evidence for the efficacy of various approaches to therapy and for the theoretical assumptions that underlie them, the “empirically supported treatments” movement has been characterized more by ideology and faulty assumptions than by good science. This paper examines in detail the scientific and logical limitations of the “EST” movement and aims to place the empirical investigation of theory and practice in psychotherapy on a sounder basis.

CBT: The Cognitive Behavioural Tsunami: Managerialism, Politics and the Corruptions of Science. By Farhad Dalal; published 2018 by Routledge.

• OVERVIEW: Is CBT all it claims to be? The Cognitive Behavioural Tsunami: Managerialism, Politics, and the Corruptions of Science provides a powerful critique of CBT’s understanding of human suffering, as well as the apparent scientific basis underlying it. The book argues that CBT psychology has fetishized measurement to such a degree that it has come to believe that only the countable counts. It suggests that the so-called science of CBT is not just "bad science" but "corrupt science.”

“The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials.” By Drew Westen, Catherine M. Novotny, and Heather Thompson-Brenner; published 2004 in Psychological Bulletin.

• ABSTRACT: This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.

Evidence-Based Practices in Mental Health: Debate and Dialogue on the Fundamental Questions. Edited by John C. Norcross, Larry E. Beutler, and Ronald F. Levant; published 2006 by the American Psychological Association.

• OVERVIEW: Few topics in mental health are as important and controversial as evidence-based practices. EBPs have profound implications for mental health practice, training, and policy. What is designated as "evidence-based" will determine in part what therapies and tests are conducted, what is reimbursed, what is taught, and what is researched. Unfortunately, this multifaceted topic has been reduced to simplistic and polarized arguments. This book, designed for mental health practitioners, trainers, and graduate students, addresses nine fundamental questions in the debate on evidence-based practices (EBPs).

“Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons.” By Bruce E. Wampold, Stephanie L. Budge, Kevin M. Laska, A.C. Del Re, Timothy P. Baardseth, Christoph Flűckiger, Takuya Minami, D. Martin Kivlighan, and Wade Gunn; published 2011 in Clinical Psychology Review.

• ABSTRACT: Objective: The aim of this study was to examine the relative efficacy of evidence-based treatments (EBTs) versus treatment-as-usual (TAU) in routine care for anxiety and depression in adults. Method: A computerized search of studies that directly compared an EBT with a TAU was conducted. Metaanalytic methods were used to estimate effectiveness of EBTs relative to TAU and to model how various confounding variables impacted the results of this comparative research. Results: A total of 14 studies were included in the final meta-analysis. There was significant heterogeneity in the TAU conditions, which ranged from unknown and/or minimal mental health treatment to psychotherapeutic interventions provided by trained professionals. Although the effect for EBT vs. TAU was significantly greater than zero, the effect for EBT vs. TAUs that were psychotherapeutic interventions was not statistically different from zero. Conclusions: Heterogeneity of TAU conditions in this meta-analysis highlight the importance of clarifying the research questions being asked when investigating and drawing conclusions from EBT–TAU comparisons. Researchers need to clarify if they are comparing an EBT to psychotherapeutic services in routine care or to minimal mental health services. Extant research on EBT versus TAU reveals that there is insufficient evidence to recommend the transportation of EBTs for anxiety and depression to routine care, particularly when the routine care involves psychotherapeutic services.

“‘Gold Standards,’ Plurality and Monocultures: The Need for Diversity in Psychotherapy.” By Falk Leichsenring, Allan Abbass, Mark J. Hilsenroth, Patrick Luyten, Thomas Munder, Sven Rabung, and Christiane Steinert; published 2018 in Frontiers in Psychiatry.

• 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.

The Great Psychotherapy Debate : The Evidence for What Makes Psychotherapy Work. By Bruce E. Wampold and Zac E. Imel; 2nd ed. published 2015 by Routledge.

• OVERVIEW: The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapy studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy; an examination of therapist effects; and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

“Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy? The Need for Plurality in Treatment and Research.” By Falk Leichsenring and Christiane Steinert; published 2017 in JAMA.

• ABSTRACT: Mental disorders are common and associated with severe impairments and high societal costs, thus representing a significant public health concern. About 75% of patients prefer psychotherapy over medication. For psychotherapy of mental disorders, several approaches are available such as cognitive behavioral therapy (CBT), interpersonal therapy, or psychodynamic therapy. Pointing to the available evidence, CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders. For example, the American Psychological Association’s Division 12 Task Force on Psychological Interventions currently lists CBT as the only treatment with “strong research support” in almost 80% of all mental disorders included in its listing.

“Overlooked Ethical Problems Associated With the Research and Practice of Evidence-Based Treatments.” By Enrico Gnaulati; published 2018 in the Journal of Humanistic Psychology.

• ABSTRACT: Proponents of evidence-based treatments (EBTs) have directed complaints of potential unethical practice against psychotherapists who refrain from using EBTs as first-line interventions for a range of psychiatric disorders on the grounds that these treatments should be given priority because of their exceptional scientific backing. This article counters these claims and highlights core ethical concerns associated with the research and practice of EBT itself; namely, the appropriateness of saturating the field with short-term models of psychotherapy and the questionable assumption that these can yield meaningful and lasting change; the uncertain relevance of the results of EBT investigations for psychotherapists working with real-world clients; the foreclosure of opportunities to address clients’ unmet developmental needs and self-fragility posed by the directive/didactic therapeutic stance inherent in EBTs; and, the reduced quality of psychotherapy offered to the public at large and threats to the clinical competence of early-career mental health professionals caused by overemphasizing training in EBTs over the acquisition of relational skills in graduate schools and postgraduate training sites.

“Psychotherapy and Psychosocial Treatment: Recent Advances and Future Directions.” By Eric M. Plakun; published 2015 in Psychiatric Clinics of North America.

• ABSTRACT: unavailable.

“Where is the Evidence for ‘Evidence-Based’ Therapy?” By Jonathan Shedler; published 2015 in The Journal of Psychological Therapies in Primary Care.

• OVERVIEW: “Evidence-based therapy” has become quite the catchphrase. The term “evidence-based” comes from medicine. It gained attention in the 1990s and was, at the time, a call for critical thinking. It reflected the recognition that “we’ve always done it this way” is not a good enough reason to keep doing something. Medical decisions should reflect clinical judgment, patients’ values and preferences, and relevant scientific research.

“Why the Scientist–Practitioner Schism Won’t Go Away.” By Jonathan Shedler; published 2006 in The General Psychologist.

• OVERVIEW: Discussions about the scientist-practitioner schism rarely rise above the level of cliché. To judge from the rhetoric, there is broad consensus that the schism is pointless and self-defeating. We hear periodic reminders (often coincident with American Psychological Association elections) that the fates of science and practice are intertwined. We hear exhortations that we should just “all get along.” The exhortations are probably well meaning, but they are sadly naive. The schism is getting wider, not narrower. The issues that divide clinicians and researchers run too deep for feel-good answers.