While historians and social commentators debate the extent to which experts have been trusted in our society, both currently and in the past, there certainly appears to be a decline in trust of experts and people in positions of authority. Healthcare professionals appear to be one group that increasingly finds their authority and expertise questioned. The questions and concerns raised about big pharma, the corporatization of healthcare, and some of the responses to the pandemic are examples of this trend. Clearly there have always been people who have doubted the expertise of healthcare professionals for many decades, including mental health professionals, but these doubts appear on the rise.
Sadly, there are many examples of instances in which the expert judgment of mental health professionals has been extremely faulty. A painful historical example is the theory that “the refrigerator mother” who was purportedly cold and distant, was the cause of autism. This theory was advanced by well respected experts including Leo Kanner and Bruno Bettelheim (1). Moreover, theories that postulated that children were born a “blank slate” and were totally shaped by their environment (as advanced by behaviorists such as Watson and Skinner) and a number of Freud’s theories and concepts, are just a few more examples that reinforce this point.
Sadly, this problem appears to have continued to the present day. A recent article in the flagship journal of the American Psychological Association, the “American Psychologist” (2) details a meta analysis of over 1000 studies that have examined the treatment of depression. One of the more unnerving conclusions is that the models of therapy developed 50+ years ago are just as effective as all of the newer models of therapy. This finding flies in the face of many of the claims of the proponents of different models, who tout the unique benefits of their approach.
An additional factor that likely contributes to questions about the validity of mental health treatment is the proliferation of treatment models or approaches to therapy, which has occurred at an extremely rapid rate. Scott Miller, (3) a psychologist whose work has focused on psychotherapy outcomes (the benefits of therapy and the factors that account for therapy’s positive benefits) as rather ruefully noted that the number of therapy models has increased from approximately 60, in the 1970s, to over 400 (and this was in 2013 so I am confident that the number of models have only increased). While proponents of various models are very likely to stress the unique benefits of their approach, a cursory review of the literature on psychotherapy outcome calls this into question. Specifically, there is not compelling evidence for the clear superiority of one treatment approach over others. In fact the claims and assertions of more exuberant proponents of various models can sound more like hype than anything else.
An additional example of the challenges faced by consumers of mental health services and practitioners is that many treatments are identified as evidence based, which is loosely defined as having research based evidence to support their efficacy. A 2015 list of evidence based treatments compiled by Division 12 of the American Psychological Association identified 89 specific treatment models/
Fortunately, there is strong evidence that psychotherapy is helpful for many people (5). The proponents of common factor theory, who assert that it is the common ingredients that are present across therapy models that account for the greatest proportion of psychotherapy’s benefits rather than the specific treatment model, appear to have a good deal of support for their claims. Common factors include empathy and a strong working relationship between therapist and client. A number of well respected researchers have argued (based on their research) that the key ingredient of successful therapy is a good working relationship between therapist and client, the therapeutic alliance. Strong and consistent evidence for the common factors model, and especially for the importance of the therapeutic alliance, can be found in the work of John Norcorss, Michael Lambert and others (6). In fact arguments for the common factors model go back decades (7).
I would argue that we (mental health professionals) would be better served by increased humility about our work, and particularly about the treatment models that we use and favor. This argument clearly applies to medical practitioners, and the claims made about medication treatment. For example, there is strong evidence that psychotherapy is as effective as medication for the treatment of depression (2), but listening to the claims made about medication this is far from obvious. Less certainty that we have the right answers for our clients problems, and a greater openness to discussing the limitations of our understanding of what is helpful, and a willingness to consider alternative perspectives to our own, appears to be called for. Hopefully, greater humility will lessen the distrust of mental health providers as experts.
References:
- This Wikipedia article provides a fairly clear summary of the refrigerator model of autism. https://en.wikipedia.org/wiki/Refrigerator_mother_theory
- American Psychologist article on depression: Cuijpers, P. “How to improve outcomes of psychological treatment of depression: lessons from the next-level meta-analytic research.” The American Psychologist, December 2024, Volume 79, Number 9.
- Miller, Scott. The evolution of psychotherapy: an oxymoron. A paper presented in December 2013: https://www.scottdmiller.com/wp-content/uploads/2016/09/Evolution-of-Psychotherapy-An-Oxymoron.pdf
- Evidence based treatments identified by Division 12 of the American Psychological Association, from 2015, https://div12.org/treatments/
- There is extensive research on the general benefits of psychotherapy. This is noted in a summary statement by the American Psychological association: https://www.apa.org/news/press/releases/2012/08/psychotherapy-effective and detailed in the recent meta-analysis conducted by the National Institute of Health: https://pmc.ncbi.nlm.nih.gov/articles/PMC9832112/
- See the work of John Norcross, Michael Lambert and others. This research is summarized in this APA article: https://www.apa.org/monitor/2019/11/ce-corner-relationships
- See the article by Sol Garfield from 1973, in the Journal of Consulting and Clinical Psychologist, 1973, Vol. 41, No. 1, 9-1, for a discussion of common factors theory and its earliest proponents: https://psycnet.apa.org/fulltext/1974-11549-001.pdf