Based on evidence or theory?

In line with the medical model, different psychotherapy models have gradually moved towards an “evidence-based” evaluation of their effectiveness. This is grounds for celebration: it is better to have an evaluation of the effectiveness of our approach based on science rather than have no evaluation at all.

However, when we rely solely on the effectiveness of a therapeutic approach, we are concealing a sizable problem: by neglecting an understanding of the mechanisms at play within a psychotherapeutic approach, we risk limiting future advances to the approach itself. No definitive answers have been discovered to resolve psychological disorders. By concerning ourselves only with the study of the effectiveness of an approach, we make it impossible to generalize the underlying processes and work towards a discovery of even more effective methods of treatment.

Such is the argument made by Daniel David and Guy H. Montgomery, who postulate that the evaluation of psychotherapy should be evidence-based, but also based on the validity of their theoretical model. Indeed, there are too many examples of psychotherapeutic models which act on the disorders but put forward a theoretical model which has never been tested, or has been refuted, or even offers elements of explanation in contradiction with the fundamental knowledge already gathered.

Consequently, a proposal for a serious psychotherapeutic approach cannot be satisfied with evaluating its level of efficacy alone. The approach should also test the mechanisms at play that are supposedly determining their observed effectiveness. One can only support David and Montgomery in calling each clinician to a degree of exigency in the therapeutic models he or she relies on: At a minimum, if the theoretical assumptions on which the therapeutic proposal is based are never evaluated by serious basic research, or are clearly invalidated by available research or knowledge, one should avoid promoting that therapeutic proposal. If it presents a certain effectiveness that could be satisfied in the short term, the unfounded theoretical claims of a therapeutic approach can only constrain research in fatal inertia to the advancement of knowledge.

The article summary is available here:

David, D., & Montgomery, G. H. (2011). The Scientific Status of Psychotherapies: A New Evaluative Framework for Evidence‐Based Psychosocial Interventions. Clinical Psychology: Science and Practice, 18 (2), 89-99.

Translated by Chelsea Davis-Laurin

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