Talking Therapy Episode 9: Psychotherapy Fads: The Case of Trauma-Informed Therapy

Hosts:

Producer:

Alan Kian, MA, York University
---------------------------------------------------------------------------------------------------------------------------

Marvin Goldfried is a distinguished professor of psychology at Stony Brook University, where he helped to develop the graduate program in clinical psychology—he is the cofounder of the Society for the Exploration of Psychotherapy Integration. Allen Frances is a professor of psychiatry and chair emeritus at Duke, and was chair of the DSM-IV task force.

Marvin describes the evolution of his psychotherapy orientation as psychodynamic, behavioral, CBT, and eventually integrative. He practices, teaches, and supervises what works clinically using direct and indirect evidence base.

Allen describes his approach to psychotherapy as “whatever works” or “no one size fits all”. He was trained and taught at the Columbia University Psychoanalytic Center, but remains equally interested in brief, supportive, cognitive, behavioral, interpersonal, and family therapies.

Please enjoy this week’s episode!

[Edgeley]

This issue is so important! It's a real fad imo and every university is teaching it - when you look for trauma in history you will always find it!

[nikkicrane]

This was a very interesting conversation - thank you! I am a Clinical Psychology PhD student, and I found the segment of the podcast surrounding confirmatory bias particularly useful. Trauma-informed therapy was a nice example to use to explore how approaching a case from a single perspective can lead a clinician to preferentially seek out information that aligns with their hypotheses at the expense of competing information. As also discussed, this applies to clinical work more broadly (not just psychotherapy fads!). As a student in a CBT-oriented program, it made me consider how I may be falling into such traps during case conceptualization, exhibiting a cognitive bias to attend only to etiological links or mechanisms of change that fall within my theoretical orientation. This discussion was a good reminder of the importance of challenging myself to be aware of such biases and consider alternative perspectives during case conceptualization that may fall outside of my traditional CBT-framework but be equally as important.

[shannonlitke]

Thank you very much for this important and thought-provoking conversation. One aspect that I found particularly interesting was the discussion of the way in which fads in psychotherapy arise in the first place. Our conceptualization of trauma (and the emphasis placed on traumatic experiences in playing a formative role in people’s mental health difficulties) is a reflection of the current cultural moment. This point struck me as interesting, particularly considering that a diagnosis of PTSD or a trauma-related disorder is unlike any other psychiatric diagnosis with regards to stigmatization. Compared to other forms of psychopathology, trauma-related disorders are less concerned with the question of “what went wrong” (e.g., in terms of genetic pre-disposition, risk factors, etc.) and more concerned with the question of “what happened to you?” In today’s cultural moment, there is an increased emphasis on de-stigmatization of mental health concerns, as well as a shift towards explicitly acknowledging the systems-level factors responsible for suffering (e.g., systemic racism, gender-based violence, etc.). As such, the clinical urge for taking a “trauma-informed” approach is understandable in the socio-political context of our field's moment in history. Regardless, the aspect that is problematic (as is highlighted in this episode), is the risk that this form of confirmation bias leads trauma-informed clinicians to act as hammers treating every form of psychopathology as nails, when in fact, the diagnostic picture is likely far more complicated.

[joelhencken]

The main weakness in this podcast is that the participants are being reasonable. That's a hard sell. <sigh> Thank you, Drs G and F, for bringing your clear thinking and perspectives to bear on these important issues.

[lesliecunliffe]

The attempt in this discussion to highlight the dangers of operating by what Ernst Gombrich described in relation to art as 'the fallacy of the single cause' is perhaps better represented in Wittgenstein's philosophy as a unit of meaning made up from 'natural history, forms of life, and language games', that is, how biological conditions, sociocultural practices, and the role of language within those practices overlap in our everyday lives.

[williamjmccartan]

This will have to wait for tomorrow, just came up midnight, thank you both Allen and Marvin, it sounds like your profession still has a lot of work to do, to come to a consensus.

[lamentate]

This is why I'm suspicious of EMDR. Too many hack and lazy therapists looking for obvious casual mechanisms so they can use simple formula based treatments rather than doing any real work with clients.