Psychotherapy, Science or Art?

Psychotherapy, Science or Art?

I wanted to add to the debate about evidence based practice (EBP) as science. I do not see EBP as a scientific approach to what works in psychotherapy, and counselling.

I understand science to be a rigorous testing of hypotheses to the point of failure or repeated confirmation. This testing of hypotheses are carried out in many laboratories or situations around the world until the scientific community can predict the outcome.

A simple example would be where scientists test a nut and bolt that keep motor car wheels from falling off in most motoring situation. They would also test a drug to ensure that when given to a person it will have the desired outcome. I won’t begin to tackle the lack of science in the use of psychotropic medication.

Scientists will not rest on their laurels. They will continue to explore and challenge hypothesis based on changing technology and new materials.

Evidence Based Practice as I understand it is based more on a narrative than a scientific approach. Much like the Diagnostic and Statistical Manual of the American Psychiatric Association Version 5 (DSMV), Clinical Outcomes in Routine Evaluation (CORE) which are not tested in the world and yet we subscribe to them routinely. Outcomes for our work are not scientifically based, each practitioner brings themselves with greater or lesser success.

I don’t want to labour the point or bore the reader. I wanted to highlight my concern that there is a view that EBP is based on science, it isn’t.

For me our work is narrative. Co-created narrative, supported narrative, deconstructed narrative, theoretical narrative. EBP as science is narrative; CBT as a cure all is narrative; we have narratives about long and short term therapy, and on it goes, none of it scientific.

This pseudo-medicalisation threatens to remove our creativity. We are artists and not scientists, at least I am. Let’s not mix the two.

How could you begin to rate a Renoir, a Bruegel, a Cezanne?

Christopher Murray artist and psychotherapist in practice in Belfast.