The Empirically Supported Treatment - Case Study Example

1 The Effectiveness of Psychotherapy: Science and Policy Introduction The history of 'EST', i.e. the Empirically Supported Treatment movement goes back to 1995. Initially, the idea of creating a list of empirically supported treatments came about when it was observed that practice guidelines were giving priority to psychopharmacology over psychotherapy. Psychopharmacology was presumed to be more scientifically and research based as compared to psychotherapy. It was believed that, if there was a list of therapies which used controlled research methods and claimed success in treating disorders, then psychotherapy could also claim to be research and true science based. This in turn would help promote psychotherapy. In 1995, it was determined that professionals should be trained exclusively in the use of Empirically Supported or Validated Therapies. This move was given a push when the American Psychologists Association (APA) published the first of its task force reports. Since then Empirically Validated Therapy (EVT), Empirically Supported Therapy (EST), and Evidence Based Practice (EBP), refers to therapeutic treatments which are deemed empirically sound and valid, by a particular research methodology. Thus these therapies or treatments can be officially used in the psychotherapy. This however implied that those therapies which do not make the list are not empirically valid and these alternative methods of treatment are therefore considered irrelevant. This stirred up a hornet's nest in the world of psychotherapy and was the beginning of a controversy which persists even today. The Empirically Validated Treatment movement brought about a split between psychotherapists, i.e. those who saw themselves as scientists and those who saw themselves as practitioners. 2 Many Psychotherapists believed and in fact, still believe that although this therapy is a science, it deals with human emotions which vary a great deal from person to person and hence a humanistic psychodynamic approach has to be used which is tailored to individual clients. If this is the case then most of their techniques would not validated by the strict research methodology put forward for Empirical validation. Today, the controversy continues as the psychotherapists challenge the traditional methods of research and expose unsubstantiated assumptions on which this research is based and therapies accepted as Empirically Validated/Supported Therapies. Arguments for the Empirically Validated/ Supported Treatment It is important to know why and how the Empirically Validated/Supported Treatment came into being. The American Psychiatrists Association developed the Empirically Validated Treatment (EVT). These were mostly medications and validation methods favoring biological treatment approaches. This is when the American Psychologists Association decided to develop their own EVT. The psychologists did not like the idea of research proving therapy or the claim that the success of a therapy could be proven. Since validated could mean proven, they changed the terminology to EST, i.e. Empirically Supported Treatment. The arguments for having EST in psychotherapy are extremely valid and relevant. 3 1. Psychotherapy is a Science: Psychotherapists have always been considered scientists and psychotherapy a science. However science demands empirical validation of theory. Thus it is maintained that only effective psychotherapy which is supported by empirical proof should be considered for treatment. It is inconceivable that physicians would conduct experimental treatments without the consent of patients or that FDA would approve medicines without proof of their efficacy and knowledge of side-effects. To the scientific committee it is therefore shocking that there is no way of determining what is and what is not effective psychotherapy. Hence for psychotherapy to remain in the realms of science it is necessary that ESTs be used in the clinics. 2. Protection of Patients: In the 1970's and 80's there were a multitude of psychotherapy approaches and many more were being developed. Interest in Psychotherapy was on the rise and in this environment it flourished unchecked. These therapies were being applied without examining the dangers or the validity of their theories. An example of this was the therapy for satanic ritual abuse. There is also a possibility that these therapies could prove dangerous for the patient, who has had no way of determining what is and is not effective psychotherapy. Thus formulation of ESTs leads to effective therapies and protects the patient as well as the credibility of Psychotherapy. 4 3. Protection of Psychotherapists: In a society in which litigations are on the increase and the risks of psychotherapists being sued are high, it is imperative to have and follow a standard like ESTs for their own safety. 4. Psychotherapy and Medical Science: A standard like EST helps the science of psychology to hold its own and be parallel to medical sciences, such that it remains viable in an atmosphere where cheaper and less time consuming medical sciences like psychopharmacology hold sway. Arguments against the Empirically Validated/ Supported Treatment It is necessary to understand what characterizes EST research to be able to understand the arguments of psychotherapists against it. The most important criteria for EST laid out by Division 12 task force is as follows: (a) a specified focus of treatment that can be reliably and validly assessed; (b) a specified treatment population; (c) a treatment well-described, typically by a treatment manual; and (d) the use of random assignment to treatment or comparison conditions for group research or of solid single-case experimental designs for small sample research. It is believed by many psychotherapists that Empiricism is not the only valid, primary or most valuable approach to assessing therapy. They believe that empiricism often does not relate to the real world and that the insistence for empirical research, for all its talk about science, is a dogmatic position of faith that downplays and ignores the possibility of 5 alternative methods. They believe that legitimate alternative techniques exist, and that they are probably more promising than a strictly empiricist methodology. Some of the arguments against EST are 1. Limitation of measures: too much confidence is ascribed to clinical measures. Measures are limited and give one view of a construct (such as depression) from within a theoretical framework. 2. Limitation of research methodology: The empirical methodology gives preference to quantitative research over qualitative approaches. 3. Myopic views of mental health: many measures are theory dependent and overly simplistic. 4. Limitations of creativity and innovation: Using treatment which is only empirically validated would limit creativity and slow down the process of innovation. 5. Assumptions of appropriate ends: Measures should be consistent with the theories they are measuring. Different results might be obtained if different measures are used than the ones that should be for measuring different therapies. The factor is not taken into consideration in most empirical research. 6 The narrowing of therapy: Using measures of symptoms to assess therapy tends to make many assumptions about the purpose of that therapy. Despite the emergence of new 6 measures of well-being and psychological health, our understanding of how therapy impacts the individual on the whole is limited. Applications of Both Positions The case study, that is going to be looked into, is that of an eight year old male child who has a phobia of dogs. The child has a history of breaking into a sweat at the sight of a dog, even at a distance. He complains of palpitations, sweating and dizziness when a dog comes close to him. He starts screaming and collapses when the dog is next to him. The parents brought the child in with a hope to get him over his phobia. He isn't comfortable with most animals but panic assails him when he is in proximity to a dog. Treatment plan of those who support EST: The treatment thought to be most effective to treat this type of phobia in a child is the Cognitive- Behavior Therapy. This therapy is known to bring about a significant improvement in cases dealing with phobias and anxiety. It is based on Desensitization and Confrontation, relaxation techniques and reward systems. The child was initially made to see a dog's picture in a book and assess his feelings and rationalize them with the help of a therapist. The next step was to observe a dog in a pet shop from a distance. All the time the therapist tried reasoning with the child, restructuring his thoughts and actions into a more assertive and adaptive framework. As the child 7 overcame his anxiety, he was made to observe another child petting the dog. The next step was to enter the shop and be close to a small puppy and then petting it while somebody helped him. At each step as the boy overcame his phobia he was rewarded. Later he was made to pet a dog of a larger size on a leash and then one without a leash. At the end of the therapy, the child had overcome most of his phobia and could handle being around dogs. Treatment plan of those who did not support EST: Psychodynamic therapy was used to treat the boy who suffered from a phobia of dogs. This therapy, which is very like psychoanalysis but less intense, is not supported by the EST. Here the therapist helps make a connection between mind and body. The child is not made to directly confront his phobia. Instead through play therapy, the child confronts his fears. The therapist labels these feelings to help the child put them into perspective. The therapist also interprets the child's attitude and behavior towards him, the child's family and environment through their interactions. The child is made to think into the past and associate his feelings with past experiences. Individuals in the child's environment are asked to participate to enable them to help the child make the required changes in his surroundings. Confronting his problems helps him to deal with his phobia for dogs. References 1. The Effectiveness Of Psychotherapy: Science and Policy by D. H. Barlow. Published in Vol. 3 of the 1996 journal, Clinical Psychology: Science and Practice, on pages 236-240. Read More