Steve Diamond made an interesting post last week describing the longstanding tension between the brain/behavioral and the mind/psychodynamic camps in psychology as a civil war. I have written here a number of times about this conflict, one that is at the heart of what is happening in psychiatry as well (if you are interested in the state of affairs in mental health, you really should read 1BoringOldMan who does a superb job of taking apart the trail of studies and inflated promises that got us here). I wish that what we are in were a civil war because then at least there would be active debate and engagement on these issues, but the takeover of psychology by the cognitive behavioral/brain folks is near complete on the academic level so that many younger clinicians have no idea of what is/was missing in their training. My side, the psychodynamic/mind side finds voice mostly through blogs like this one and those of other likeminded psychologists, psychoanalysts and psychiatrists. But together our voices are far less audible than those of the pharmaceutical and insurance companies and those of mental health professionals whose careers have been built on the effort to topple us. And the average person seeking help has no idea that these issues even exist. Yeah, it makes me kind of pessimistic at times.
We live in an era in which treatments which are "evidence-based" are supported over all else. And in physical medicine that makes sense because science actually can be used to demonstrate that treatment A for hypertension is more effective than treatment B. Think about how germ theory and the discovery of how and which bacteria and viruses cause disease. There is nothing like that in mental health. The biochemical theory of depression has not panned out yet. Nor do we have solid bases for understanding the etiology of any mental illness or emotional problem. So the very idea of "evidence-based" treatment is in trouble from the start.
Combine this with, as David Allan in his blog puts it:
A type of psychotherapy known as cognitive-behavior therapy (CBT) is currently the predominant psychotherapy paradigm being taught in psychology graduate degree programs. Its practitioners love to claim that their type of therapy is the most "evidenced based" of all psychotherapies and is therefore vastly superior to more humanistic and relationship-oriented types.
While it is true that they have more studies than anyone else, that is because they have very limited and simplistic treatment goals which are very easy to measure, unlike repetitive complex interpersonal patterns. They also rarely bother to study people who have a lot of different (co-morbid) psychological problems. Even so, their claims of the superiority of their evidence base are highly inflated. I went into exactly how in detail in my last book.
It is also true that CBT therapists control the funding for psychotherapy research and tend to deny the followers of other psychotherapy schools a chance to prove their mettle in randomized clinical trials, which are very expensive to do. Psychotherapy researchers who are not CBT therapists refer to the "cognitive behavioral mafia" at the National Institute of Mental Health.
When one side in a battle of ideas holds all the power to fund research, then how can the competing way stand a chance? And this is not a new problem. I saw it when I was in graduate school at the University of Connecticut in the late 60s and early 70s. The previous director of the clinical program was psychoanalytic and an expert on the Rohrshach. When she stepped down or retired, the new director, Julian Rotter, brought with him students he had trained and colleagues from Ohio State. Rotter was the father of social learning theory and once he came, psychodynamic and psychoanalytic ideas got very short shrift in the curriculum. In my career, I had to find supervisors and seminars and workshops and do a lot of independent study to find what seen as out of date by these nascent behaviorists.
The best hope today for improving this sorry state of affairs is the combination of arrogant over-reach by the brain folks in what they propose for the DSM V and the scale of corruption continuing to come to light in the collusion of the so-called "thought leaders" in psychiatry and the pharmaceutical companies. As I wrote earlier, the APA has a petition and letter protesting aspects of the DSM V and they have been joined by other mental health professionals.