Scrutinizing psychotherapy

The New York Times has an interesting article about a major rift in American clinical psychology.Of course, rifts are nothing new in psychotherapy. Psychodynamic therapists have been skirmishing with each other and with their more empirically oriented colleagues for decades.

Talking therapists used to have the upper hand. Cognitive, behavioral, and biological approaches may have held sway in laboratories and hospitals, but the talking therapists dominated in private practice. Now the insurance companies have reversed the balance of power. Insurers are increasingly willing to fund short term cognitive behavioral interventions because their benefits are well established and easily quantified. A cynic might argue that insurers prefer cognitive behavioral therapy simply because it is cheaper than talking cures or long term drug treatment.

As a die hard proponent of evidence based medicine, I am pleased to see the empiricists gaining the upper hand. Of course, I would have preferred to see empiricism triumph through persuasion rather than corporate interference, but I'll take what I can get. At least this time the insurance companies have good evidence on their side.

This guy earned the last word, even if the New York Times didn't give it to him:

"It deeply frosts me, these people who are against measurement and evidence," said Dr. David Burns, a psychiatrist who trains residents at Stanford University School of Medicine. "It's a kind of narcissism in our field to say, 'I'm so great, I know what I'm doing,' and it puts us back 2,000 years to a time of cults, when every snake oil salesman's got something and the parade just goes on."