Friday, December 4, 2009

Professional Identity

Straws in the Wind
Don Durkee, Ed.S., LPC, NCC

“It’s a good thing couches are too heavy to throw, because the fight brewing among therapists is getting ugly.” This is the opening line of Sharon Begley’s recent editorial entitled “Ignoring the Evidence: Why do psychologists reject science?” Writing in the October 12 issue of NEWSWEEK, Ms. Begley speaks of an issue among “psychologists” (by which she clearly means therapists in general), and she refers to “years of research” on therapeutic outcomes that have divided the professional community. On one side of the argument are those who believe in evidence-based approaches to therapy (EBT), and on the other are those who view those approaches as leading to more mechanical and less personal forms of therapy.

The argument over evidence-based therapy has gone on for some time in the therapeutic community, with strong voices on both sides. At a recent Networker Symposium, Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), reportedly claimed that any clinician not using evidence-based methods should be considered guilty of an ethics violation. Yet Irvin Yalom, noted therapist, author, and lecturer in his book The Gift of Therapy has warned against the “EVT [empirically validated therapy] Bogeyman,” raising doubts about the research methods used or the applicability of this approach to in-depth therapy.

Not surprisingly, much of the impetus behind the promotion of evidence-based methods comes from insurance companies. In the name of establishing “best practices,” many of the major managed care networks are encouraging use of EBT, with practitioners regularly required to record client progress in some central data base. One company clearly states their “belief that patient outcomes are the most important indicator of quality” of the clinician’s work. It is not hard to envision a future in which authorizations for therapy and numbers of sessions approved would be made in anticipation of these “best practices.”

Whatever your position on the issue, it is clear that what has been until now an arcane discussion within the therapeutic community has finally crossed the line into the “mainstream media.” It is one thing for the issue to be debated in a clinical journal or at a professional conference; it is quite another for it to be a subject in NEWSWEEK. With all the public attention being paid to “health care reform” and the need for “greater efficiency and accountability,” it is increasing likely that counselors will soon be getting some pointed questions: How do you practice therapy? What methods do you use, and are those methods evidence-based?

We should also remember that the issue of EBT is just one of several that will soon be confronting our profession. As the major public voice for counselors in Georgia, LPCA must take an active role in making sure that the issues are clear and that the debate is thoughtful. It is equally important for all of us as members to study each issue carefully and be prepared to articulate our positions clearly to ordinary people. This is a time when our professionalism must be on public display. Each of us has a part to play. Let’s not wait until there are articles in TIME and U.S. News.