Towards a Better Eclectic Practice (Part I): Art vs. Evidence

It has always puzzled me when I hear of new research that asserts again, that a manualized or evidenced-based treatment model produces better outcomes than an eclectic practice. I, like many if not all who are actually providing therapy find myself thinking, how could this possibly be true?

There are so many variables constantly impacting the therapeutic relationship, that defy being put in a box. Of course this includes the tricky variable of time and thus from one second to the next- everything constantly changes. How could one’s approach not be responsively flexible and eclectic?

For example:

If for the sake of my treatment modality (i.e. focusing only on the present and the immediate future when doing behavioral therapy), I steer someone away from disclosing details of past sexual abuse that are weighing on them and that they have never revealed to anyone, what kind of therapist am I? “Sorry, we can’t talk about that till session #6.”, is probably not going to go over very well. 

In the same vein, how damaging to this person would it be if upon such disclosure, I refer the person to someone who does that type of work or redirect them towards preparing for doing that work at a later date?   

What are they trying to prove? 

Ok, so funding. But let’s not sell our souls. Research that compares manualized or evidenced-based treatment approaches to eclectic approaches, misses the point and is damaging. Logic alone implies that our treatment approaches need to be as eclectic as the humans who seek us out.

Furthermore, how can one compare something that is well-defined to something that is not? Research that compares manualized or evidenced-based treatment approaches to eclectic approaches only muddies the water and leads us further from our goal: to provide effective therapy.

This problem is compounded by the likely scenario that the vast majority of people who are truly passionate about doing therapy, are doing actual therapy- not research. And with the stigma still connected to mental healthcare, our larger society has not historically cared about conducting such research. The system (of education, of government, healthcare system, etc…) is a mess.

In fairness to the few researchers out there, this is also difficult stuff to study. But we therapists know: research should focus more directly on developing evidence-based, eclectic models. Training should focus on helping therapists to learn and implement a combination of evidence-based models that in concert, produce desired outcomes.

This plays out poorly…

Since by and large this is not the case, therapists are left to just wing it. Often, this is more kindly referred to as looking at providing therapy as an art. So strengths-based! However the trouble is that beauty is in the eye of the beholder. Research shows that eclectic practice is not very effective because we therapists, in general way over-estimate our artistic abilities.

It’s understandable. Providing therapy is dynamic and challenging. We therapists are called to think in ways that defy the normal thought process. Using one’s brain and even the physical body in session in this way is more taxing than other, even highly stressful forms of work. This is why most organizations give starting therapists 4 weeks of paid vacation. Avoiding burnout is not even really realistic. Instead we must plan for it, in order to minimize its impact.

Add systemic and economic issues that result in poor training and lack of support and what kind of art is one producing? The good enough kind. And sometimes, (gasp!)… the bad kind. But our clients don’t just need protection from harm- they need more than good enough.

What do people do with good enough art? They throw it away, they sell it in a yard sale, they hang that impersonal piece on their wall in college and grow to hate it. Like the Ansel Adams print we’ve had on our wall since my husband’s bachelor days. I’ve been planning to donate that thing to the Good Will for years, but for now it’s filling a spot on our wall while we look for a piece of real art that we can now afford and that will mean something to us.

Good enough therapy is described to me way too often when a person comes to see me for the first time. “Tell me about your past experiences with therapy” is so often met with the person relaying that the therapist was very good at listening, but didn’t talk very much. So many explain that they liked the therapist, but that they didn’t really get a lot out of it. Frequently even further: I really wanted help, but it didn’t work and I was so frustrated that I stopped going. I’ve been struggling ever since. Things have gotten so bad, though- I’m willing to try again. The Ansel Adams analogy seems crass.

Let’s get on a better track.

Basic social work values dictate that we therapists must do an ongoing self-critique… always. Clients, supervisors and colleagues should be an active part of this process. This will consistently prompt us to seek out current research and training. In this vein, I’ve sought to hone my art through developing an evidence-based, eclectic practice.

It’s important that when the work is hard or overwhelming, one does not fall to good enough and rely on active listening and relationship building only. After-all, we know that the greatest potential for growth (for client and therapist!) is actually at these times. We need to prioritize taking good care of ourselves and through toiling– seek to grow.

I have been fortunate in my career to have had professors, supervisors, mentors, and most of all clients who have taught me how to accomplish these goals.

I’ve developed a dynamic, eclectic, evidence-based practice that my clients report (and with a critical eye, I observe) to be highly effective. This practice will continue to grow and change, as it should in response to an ever-changing, growing person and world. Does this mean that it cannot be measured? That it is ultimately just my own art? No. It is made up of principles that guide my work, as well as evidence-based strategies that I find essential for present day therapeutic delivery.

It is a rare talent, that doesn’t need art lessons. Even if you are a highly talented therapist – the nature of the work requires ongoing, well-informed learning and skill development.

In this series of posts, I will share with you the principles that guide my work, and discuss the evidence-based approaches that I use.

What does your practice look like? Call it art, call it eclectic practice, but let’s make it better. We need to first help ourselves and each other, in order to provide more meaningful and effective help to our clients.  

 

Bottom Line:

-We need to work together to develop and implement evidence-based, eclectic models for treatment.

-We need to address systemic and economic contributors that get in the way of therapists learning and consistently implementing evidence-based approaches.

-Read this series of posts to learn about my eclectic treatment model that is based on evidence-based approaches.

-Please contribute to the discussion by posting your thoughts and what approaches have been helpful for your clients.

 

Helpful mantras:

-Self-care always.

-Self-critique always.

-My artist’s tools are evidence-based.

 

 

Alisa Reed, LCSW-R