Most therapists have been trained in a particular approach to treatment for anxiety disorders: CBT, ERP, ACT, third-wave, psychoanalysis, or whatever. And if there is reasonable evidence for what you are doing, that’s great.
But are you TOO wedded to your way of doing things, to the point where it may actually be harming your clients?
Here is a simple test: Let’s say that you tried your usual treatment approach with your client. They gave it a fair shot. The client reported that it didn’t help or made things worse. Check the boxes below if you did any of the following:
⎕ Implied they were doing your approach wrong, or haven’t practiced it enough.
⎕ Stated that they
weren’t working hard enough at it.
⎕ Tried to “motivate” them to recommit to your form
of treatment.
⎕ Described them – in your notes, or worse, to
them – as a “treatment failure.”
⎕ Did
not suggest – or refused to try – any
approaches besides yours.
⎕ Used the terms “evidence based” or “gold
standard” at any time AFTER the client disclosed your approach wasn’t helping.
⎕ Said something to the effect of “Almost all my
clients succeed with my approach, but if you are an exception, I can refer you
out.”
⎕ Suggested that they should come back when they
are ready to work on their problems.
Scoring: Give yourself one point for every box you check.
If your score is anywhere between 1 and 8, you are putting your dogma ahead of your clients' interests, and the problem is you.
So what is the theoretical basis behind
this highly accurate clinical assessment? Simple. In my nearly 70 years on this
planet, and my own lived experience with anxiety disorders, I have been told
every single one of these things myself in treatment.
Moreover, this assessment has been
validated across every major treatment strategy of the last half century: I have
heard these things from people practicing psychoanalysis, CBT, ERP, third-wave approaches
and even finding my inner child (seriously).
Finally, this has been cross-validated
by years of seeing clients myself as a psychotherapist, as well as my
connections with other therapists dealing with their own anxiety disorders.
These results are consistent as well: collectively we are all TIRED of having treatment providers blame us for the failures of their approaches – and worse, having the
burden always be on US to navigate among clinicians who see just one way to do things, as we seek proper treatment.
Joking aside, evidence-based treatment strategies do matter. You just can’t use them as a blunt instrument for everyone, while ignoring how well they actually work for each client.
I actually
keep up with the literature on anxiety treatment, and actual research to date on
it is still nuanced, incomplete, and continuing to evolve. And it feels clear to me that, ever since the days of Freud, the single biggest cause of treatment
failure in our profession lies not in our methods, but our tribalism about these methods. And the EBT specialist who presses on when their approach isn't helping is just as guilty as, say, the Gestalt psychoanalyst who won't mention evidence-based approaches.
Personally, I am a hardcore cognitive-behavioral therapist who practices ERP, ACT, IBT, mindfulness,
and other evidence-based strategies. I am also an engineer by training who believes
in science. But I never shamed clients, gave up on them when something wasn’t
working (although I did sometimes collaboratively refer them to other experts), or put my
training ahead of the person in front of me – and perhaps more important, never stopped learning.
So, did you discover that your own dogma
may be getting in the way of your effectiveness as a therapist? There is a
proven approach for dealing with this, popularized a few years ago by Bob
Newhart’s fictional psychologist Dr. Switzer: Stop it!