Psychotherapy from the Margins: How the Pressure to Adopt Evidence-Based-Treatments Conflicts with Social Justice-Oriented Practice

Abstract

This article posits that the current interest in Empirically-Validated-Treatment (EVT) leads to a culture within psychology and counseling that presents cognitive-behavioral orientation (CBT) as the only legitimate approach to psychotherapy. This can be problematic not only because it narrows the scope of what is considered legitimate evidence of effectiveness, but also because CBT, like most Western approaches to psychotherapy, locates the origin of, and solution to, mental illness within the individual. On the other hand, social justice-oriented practice addresses how inequality, discrimination, oppression, and other societal-level forces contribute to mental illness at the individual level. Using a case example as an anchor for the ideas presented, I discuss how narrow definitions of empirical evidence have been used to justify the marginalization of multiple theoretical orientations, which in turn has led to therapies that can reinforce the marginalization of disadvantaged clients. I argue that this trend within the fields of clinical and counseling psychology reflects a wider trend in the United States and other Western cultures of xenophobia and fear of globalization. Those privileged by hierarchies of power are motivated to find uniformity and the appearance of a superior, more “correct” way of being, and to then attempt to control the lives of people who do not fit this way of being. Complexity and diversity, on the other hand, are experienced as threatening and alienating. Within psychotherapy too, CBT provides an appearance of universality in treatment that can be very appealing, yet social justice advocates have been very skeptical of claims of universality. I conclude with a discussion of how the narrowing of theoretical approaches may harm the fields of clinical and counseling psychology, and psychotherapy clients. I discuss what psychologists and counselors can do to counter this trend by taking action in professional organizations, academia, and in the therapy room.