Hey Therapist, What Is Your Role in Evidence-Based Treatments (EBTs)?

“…there is beyond question a body of very important but unorganized knowledge which cannot possibly be called scientific in the sense of knowledge of general rules: the knowledge of the particular circumstances of time and place.” -F.A. Hayek

If that quote doesn’t make any sense to you or seems trivial – bear with me.

Sometimes I still hear this idea that EBTs take the heart out of psychotherapy. They tell you what to do and you do it mechanically. Generally there are lots of worksheets to fill out. And, “you may as well just have a computer administer the treatment, that’s where everything is headed anyway…” (Given the efficacy of computerized self-help and computer supported therapy, yes – it is probably terrific that we are heading that way and as a field reaching more people.)

I want to say:  Look, EBTs are not mechanical.  Maybe sometimes EBT are done in a mechanical way – but, trust me, that is not the best way to work an EBT. And that is not how the dedicated staff at clinical research centers working overtime to establish efficacious treatments deliver their treatments either.

Doing evidence-based therapy takes as much human touch and skill and critical thinking as does any genuinely touching psychotherapeutic, spiritual, educational or leadership task you can think of. Sometimes more, because an EBT is likely to ask you to tackle directly what your client wants to avoid (and you too?). It doesn’t matter if the particular EBT you are doing is principle based or manual guided or even computerized. When you sit down with someone and want to motivate them to move through a problem they haven’t been able to solve themselves, a problem that involves the most vulnerable aspects of their psychology – if you want things to go optimally, you better be attuned and you better care. If there is a computer in the room telling you what to do, you better be even more attuned.

That is part of our unique role in the delivery of EBT. We are at our most effective when we convey science-based principles of change with care and attunement. EBT are the most direct route to a caring practice.

But there is more to our role than this – and this speaks directly to the nature of computer-based therapies or evidence-based treatments. Like our clients, we come to know intimately the realities of the particular clinical situations in which we find ourselves. This is what application of an EBT entails: applying the general principles of the treatment(s) to the particular circumstances of the clients you serve. Treatment developers cannot and should not anticipate all these particularities. That is our job as holders of local knowledge – the ones who sit and listen to and care for our clients. That’s why this next month we have two courses that tackle this blend of knowing the principles and science and solving the immediate problems you and the client face in implementing EBT solutions.

FYI: The fact that a central agency can’t perform perfect top-down economic planning because the knowledge needed to make that planning perfect is contained in local contexts inaccessible to the central agency is called the local knowledge problem in economics. That’s what Hayek is writing about in the quotation above. You can say that psychotherapy researchers face a similar problem when it comes to developing perfect ‘plans’ (i.e. evidence-based treatments) for psychological problems.

Clients of course can and do supply their own local knowledge as a context for applying the general principles of, for example, common sense, the advice of friends, or a self-help text. The value of our role as experts in these processes emerges at the limits of this self-understanding and self-motivation.

So what is your role in evidence-based treatments? I’ve never heard it said clearly before during my excellent graduate school training.

You are the face of care and the vessel for a collective understanding passed to you by the efforts of thousands of people striving to alleviate human suffering. Don’t think of an EBT as lifeless and disconnected. Think of yourself as the living link between these efforts and the person sitting across from you.