Is CBT Crap?
Curt and Katie talk about evidence-based practices, clinician training, and when even the evidence base can go wrong.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Click here to scroll to the podcast transcript.Transcript
In this episode we talk about evidence based practices, clinician training and when even the evidence base can go wrong:
“I think that there are potentially swaths of people who do better with evidence based practices versus folks who need a more relational style. But I also want to potentially posit that those things aren’t mutually exclusive.” – Katie Vernoy, LMFT
- How we know better than the evidence
- The need for evidence-based practice in community mental health
- Funding, efficiency, and diagnosis
- The difference between the clientele in public mental health and private practice
- Evidence-based practices pros and cons
“The field of therapy made a choice at some point to pursue a medical model, to make this as replicable across everybody, no matter what situation that you’re practicing, and making it more about the model than about the relationship. And collectively, that seems to be the wrong choice for the field…It takes way more investment into therapist training to be really good at relating to a lot of people as yourself and owning yourself than it does to teach you a handful of skills to to utilize in these situations.” – Curt Widhalm, LMFT
- The science, the efficacy, replicability of EBPs
- The pros and cons of EBPs in community mental health
- The need to include individual factors in EBPs
- EBPs versus relational style (and how they may not be mutually exclusive)
- The question about personality characteristics of CBT therapists
- The opinion about rapport being missing from EBPs
- How training jumps to EBP, to the detriment of the relationship
- The problem with people who overuse or oversimplify the need for each orientation
- Strong clinical orientation versus the “eclectic” or “integrative” psychotherapy
- The Medical Model
- The challenge of training therapists in relational skills and how to be a better therapist, rather than teaching specific handful of skills
- The importance of proving efficacy, getting funding for services
- Treatment decision-making and collaboration in public mental health versus private practice
- The complexity of actual clients and the need for more than just one EBP to use for treatment
- The problems with new clinician training related to EBPs
“I think we don’t want to throw out evidence based practices just because they’re constraining or because they they’re too limiting on what type of problem they serve or what type of client, but instead, to be very thoughtful in how we assess what we use.” – Katie Vernoy, LMFT
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Dr. Scott Miller: Feedback Informed Treatment
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Meet the Hosts: Curt Widhalm & Katie Vernoy
Curt Widhalm, LMFT
Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
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Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy and thank you for listening. And wherever you listen to your podcast, if you wouldn’t mind going over there leaving us a rating and a review. It really helps us out. And today, the working title, at least as the recording of this episode goes, Is CBT Crap?
Katie Vernoy 0:40
Oh, dear.
Curt Widhalm 0:41
Yes, we we know better than evidence. That’s at least kind of where we’re starting this episode.
Katie Vernoy 0:48
At least that’s where it Curt is starting this episode.
Curt Widhalm 0:52
But really, where this gets sparked is in preparing for a class that I teach, and starting off the course I want you to all, all of you wonderful listeners: how many of you are in therapy, and now I really actually do want you to raise your hands…
Katie Vernoy 1:12
Not if you’re driving.
Curt Widhalm 1:14
But…
Katie Vernoy 1:15
I guess you could raise one hand.
Curt Widhalm 1:17
But now also consider how many of you consider yourselves having mental illness, and keep your hands raised if, if both are true, raise both hands.
Katie Vernoy 1:27
No. If they’re driving we don’t want them to raise both hands.
Curt Widhalm 1:31
But what really sparks this for me is part of the class that I’m teaching is on career systems, why community mental health systems are in place in the way they are. And as I was preparing the coursework for this class, it really became evident to me, because of kind of the systemic management keeping costs in check, that this was about serving clients that needed to respond to a basic set of therapeutic treatment standards that can be applied in a lot of different settings at the most reasonable cost possible. And really coming from a diagnostic aspect from the DSM of getting them to no longer meet the criteria for those symptoms in that setting. Katie is looking at me like, Where are you going with this?
Katie Vernoy 2:21
Yeah, I really am. Continue.
Curt Widhalm 2:23
But as I was going through this material, as I was preparing to present it, I thought about this, in contrast to the types of clients that I serve, which are typically self paying clients or families of self paying clients that don’t necessarily meet the stringent standards of what a DSM diagnosis would be. And how for most of them, I don’t consider them to be mentally ill. That, and I don’t find myself jumping into such strict CBT practices or evidence based practices in a lot of these cases, and that really forms a lot of how I work very relationally with my clients, and why I find myself tackling the people that I find who are wrong on the internet, tackling their arguments. And boy, there are a lot of people who are wrong on the internet when it comes to how I serve my clients.
Katie Vernoy 3:26
Okay, I’m trying to put all of that together, because you said an awful lot. So I’m going to summarize. You’re saying that in community mental health, it may make sense to have evidence based practices due to how the programs are set up?
Curt Widhalm 3:41
Due to funding, due to efficiency of services that it oftentimes from a eagle eye view of serving a broad pool of clients. It’s not necessarily about getting those clients to be cured, but to be not diagnosable.
Katie Vernoy 4:02
Okay, okay, I think we need to talk about that. But okay, I’ve got your point now. So in community mental health, public mental health, evidence based practices are put in place for the reasons that you said, in private practice, when you’re working with higher functioning clients, the ones that are coming in more for personal growth or optimizing their well being or whatever. It’s something where those don’t seem to line up.
Curt Widhalm 4:28
Yes.
Katie Vernoy 4:29
Okay, so I agree with you on the private practice thing. I don’t know that I agree with you on community mental health. I think that evidence based practices are, are good and bad in in public mental health or anywhere, because I think that they’re a way that we as a profession are able to show efficacy. There’s science. Oftentimes these are evidence based practices like EMDR, like CBT, like seeking safety, like, you know, whatever those, those evidence based practices are. They are very measurable and they are very replicable, and I don’t know if they’re more efficient. If we think about costs in public mental health, you have to pay people to get trained in these efficient in these, these evidence based practices. And you also have to pay people to do crap tons of paperwork, and do these outcome measures and that kind of stuff. And I think that there is a lot of concern in public mental health about the cultural competency that goes into some of these evidence based practices. I think oftentimes, with at least the the infrastructure that I’ve seen it is something where you give a diagnosis, because you have to have a diagnosis for insurance. You do the practice that’s either designed for you based on a, you know, computer program or what funding is there. And then you have, oftentimes, newer clinicians doing a manualized treatment and then spending a lot of time doing paperwork. So I don’t know that it’s necessarily better in public mental health. I think it or with mental illness or that kind of stuff, because I think there are individual factors that need to play in, and I think that some of some evidence based practices have that built in, and some don’t. But I do have this sense that there are, there are potentially swaths of people who do better with evidence based practices versus folks who need a more relational style. But I also want to potentially posit that those things aren’t mutually exclusive.
Curt Widhalm 6:34
I find that some of the therapists that I talk to, and I’m going to keep coming back to CBT, because these are oftentimes the people in the online forums who are: CBT is everything.
Katie Vernoy 6:46
Yes.
Curt Widhalm 6:46
So…
Katie Vernoy 6:48
They’re kind of like the EMDR is everything people.
Curt Widhalm 6:50
Not quite.
Katie Vernoy 6:52
Because EMDR is better?
Curt Widhalm 6:54
I’m not even, I’m not even going to make that claim. As somebody who believes that EMDR is one of the most magical things that has been bestowed upon the therapy world, I am not going to even say that EMDR is everything.
Katie Vernoy 7:08
Okay.
Curt Widhalm 7:09
Whereas the CBTists do. And this came up in a conversation with some of my students not so long ago that one of them in particular was pointing out like Are all CBT therapists assholes? Like is, and really, you know, it’s is part of that conversation, what she was talking about was, Can you have CBT without arrogance? That it it’s very assertive in pushing people towards goals, into very specific things, that I think that as we look at a lot of these evidence based practices in the way that people implement them, are missing what what rapport actually is. And where I thrive in the world of being relational, and really developing my flow and my relationships with my clients, and really utilizing that, as you know, being the whole person therapist in the room. That I fear that as each generation of therapists gets trained and implements these things is they jump to these EBPs, and it becomes about the model of delivery, rather than all of the relational stuff that we know that makes therapy work.
Katie Vernoy 8:33
I see what you’re saying. I think to me, there are going to be practitioners within any orientation, if we pull back and say, you know, theoretical orientation, who either over value the work? CBT is everything. EMDR fits for every type of case, you know, whatever, right? I think that there’s going to be folks who overuse and over simplified it? I think that every Well, I believe maybe you you know something that I don’t, but I think there’s going to be people in every clinical orientation who are able to do it in a relational way, who are going to be able to pres to take the tenants and fold them into the relationship and use what works. So that was one of the things I wanted to say. I think another thing I wanted to say was about this idea that people get very aligned with a certain practice, like, there are the CBT-ers, and there’s the EMDR therapists, and there’s the people who are narrative therapists, or whatever it is. There’s people who who really strongly get into a specific modality. DBT is another one, and they end up doing just that. But on the opposite end of the spectrum, I think is also a problem, because there’s, you know, like even the word eclectic. When I even in grad school.
Curt Widhalm 9:54
I hate the word eclectic.
Katie Vernoy 9:56
But I think that that’s something where the, that was very popular for a time, then became kind of a taboo word, because it sounded like you were just throwing spaghetti on the wall and calling it therapy. And so I think being thoughtful, regardless of if you have a strong theoretical orientation or evidence based practice that you use most of the time, or if you’re like me and I’m very existential relational, like it’s, it’s about being in the room and kind of using what works. I think it’s, it’s about that kind of deliberate practice, that being thoughtful and understanding that you have a person who has all of their, you know, kind of demographic, individual differences that have the whole of their life that is context. And even within CBT, that’s part of the experience, potentially, like in CBT, we’re trying to understand how they see the world. We’re trying to understand their core beliefs. We’re trying to understand them deeply, and trying to then move forward with, you know, thought, you know…
Curt Widhalm 10:59
Thought practice and repetition, day after day. And did you repeat this enough in front of the mirror? But you know part of, part of where this really breaks down and when in doubt, I’m either going to just randomly credit things to either Scott Miller or Ben Caldwell. So one of the two of them, maybe even both, have implemented me to come up with this idea all on my own right now, for the first time.
Katie Vernoy 11:24
Of course, because, because you do…
Curt Widhalm 11:24
I have never, never heard this before.
Katie Vernoy 11:26
…have your own individual thought separate from Ben and from Scott.
… 11:29
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Curt Widhalm 11:29
But really, where this, this comes down, is that therapy made a choice at some point the field of therapy, to pursue a medical model, to make this as replicable across everybody, no matter what situation that you’re practicing, and making it more about the model than about the relationship. And collectively, that seems to be the wrong choice for the field.
Katie Vernoy 11:58
Yes.
Curt Widhalm 11:59
That it takes way more investment into therapist training to be really good at relating to a lot of people as yourself and owning yourself than it does to teach you a handful of skills to to utilize in these situations.
Katie Vernoy 12:14
Over and over and over again.
Curt Widhalm 12:15
Yes, but these, the system has developed, and that’s where we are. But coming back to these models, and as much as I even am a big EMDR person, and EMDR has their eight protocols, and they have their three step process, and all of this kind of stuff, that some of us really are going to be able to implement these things better than others, and some of us are going to have better outcomes than other people when it comes to this, and that’s really about those individual factors that aren’t evidence based.
Katie Vernoy 12:48
Well, except if you do feedback informed treatment.
Curt Widhalm 12:51
Which even that is not, that’s a that’s a process about the process, and that’s only replicable to one therapist. I mean, the feedback that I would get on my sessions is not going to apply to the feedback that you get on your sessions.
Katie Vernoy 13:05
No.
Curt Widhalm 13:06
So that’s not, it’s a within-system evidence based, not across-system evidence based.
Katie Vernoy 13:12
Yeah, I think the problem with blaming it on therapy deciding that it should be a medical model, is that it’s like, I can’t think of a good metaphor right now, but it’s, it doesn’t take in the context of the larger society wanting proof that what we’re doing is worthy of government funding.
Curt Widhalm 13:32
Right. And to back this up. And we can put this in the show notes once I go back to the book, and we’ll put the book title in there, too. But I remember reading in preparation for this class, that 12% of health funding in the 90s, when the Clinton administration was looking to really address evidence based practices, 12% of health funding was directed towards mental health. Which does seem kind of disproportionate when you look at the overall things that actually do cost way more. Like, you know, not knocking our field, but I want my heart surgeon to get paid more than my therapist. Like, but, I mean, some of the really expensive medical techniques do deserve some more of this funding, but those are also one time costs.
Katie Vernoy 14:19
Yeah.
Curt Widhalm 14:21
And when you’re looking at, especially at the severely mentally ill end of things and the use of resources when they end up in the emergency room time after time that that’s really where a lot of these evidence based practices in the community level delivery of mental health treatment really do have a cost savings. But for people in Washington and whatever your state level decision making when it comes to funding on this kind of stuff, they see, let’s reduce these big costs and then don’t have these other costs that are then put into place to keep costs low, kind of dynamic scoring of how funding works.
Katie Vernoy 15:00
Yeah.
Curt Widhalm 15:01
And we’re going to have an episode here pretty quick about how to advocate on this kind of stuff. So check that out here in the next couple of weeks, too.
Katie Vernoy 15:10
I think that that that’s all, that’s all true, and I think that’s important. I think the wanting to get funding and wanting to fit into that is one aspect that I want to mention. And I think it is hard, because do we hold out for perfect, or do we get funded for what we can get funded for? And do we align with that? And to speak to that a little bit when I was, you know, a young girl in public mental health, and there was the economic crash in around 2008 or whatever it was, and kind of the follow on of flex tax money for mental health, it was kind of like, do we continue to do these open ended treatment that there was still needed to be medical necessity, but we didn’t have to have specific time limits. Oftentimes, we could consult on cases and bill for it. So cases could get expensive. We could see them more than once a week, like we could like we could do more along the lines of what we felt like was clinically appropriate, appropriate based on our own clinical perspective, versus, let’s fit them into an evidence based practice. Because really, at that point that we weren’t really talking about it. But the agency where I was working, the the vice president of programs did a miraculous thing, and was able to get more funding rather than less, by tapping into all of these different programs for prevention and earlier intervention, these evidence based practices, all that kind of stuff. And so we had to shift our practice to continue serving clients. So in in that moment, we are now advancing more of evidence based practices. We’re fitting clients into these models that potentially won’t get services otherwise. We’re still trying to get positive clinical outcomes that are getting them. But did we do a disservice to the field because we moved from more of a free flowing the clinician is able to define the treatment that they do versus the state or the county determining which type of treatment they get? I don’t know. I think that’s, that’s a hard question. But I also think that it’s, it’s something where the reason that evidence based practices were on the table was partly one of the reasons was being able to to have, like, it’s 12 weeks instead of 12 years, you know, or whatever it is. But it’s also here is where the science is. You know, this is, this seems like harder data than, hey, you know, clients generally feel better when they go to treatment.
Curt Widhalm 17:35
Again. It’s to how much,. It’s to how far along the symptom reduction chain do these EBPs really go? And I you brought up evidence or feedback informed treatment here a little bit ago that you know, one of the things that I think has really shifted over the course of mental health treatment in history is the involvement of clients in decision making, as far as treatment plan goals go. And it’s been forever and a day since I worked in any sort of agency type setting, but are clients really getting to be a part of the decision of I have reached a point of happiness, of not having the need for treatment anymore in these types of settings?
Katie Vernoy 18:26
I find that the work that I hear about in some more traditional private practices, you know, the psychodynamic, the psycho, whatever you know, psychoanalytic, you know, or even just even relational, that there is a lot less discussion overtly with clients about treatment and their treatment options. It’s more like, hey, let’s get started, and we’ll talk about things. Whereas it’s, it’s codified in public mental health, where we touch base together, we create goals together. We determine what the progress is on the goals. You know, we determine you just this is a collaborative process. And I think the difficulty, and this is, I think, where some moral injury can happen for folks in public mental health, is that it says that it’s all client focused and client informed and collaborative and all of that. But in truth, there’s very limited options. So I think that there’s there’s both. But the what the model is espousing is this is definitely a collaboration with the client, and they sign everything, they agreed everything they have the say in what their treatment looks like. Now there’s time, they may time out, whether it’s benefits through, you know, public social services, or if it’s through the model is done, and now we either have to move you to a different therapist, or move you to a different model or whatever. I mean, there are some systemic things that limit the choices, but I actually think that clients in public mental health are more aware of what their treatment involves than clients in private practice. Because oftentimes they’re coming and talking to somebody and getting consultation. It’s not, this is my treatment plan, and this is where, you know?
Curt Widhalm 20:11
I’m going to come back to this point, but I need to conceptualize that there’s a third group in here as well. And we’ll call these the non public treatment centers. So this might be a residential facility that’s private payer insurance based, or whatever else that. So if you consider private practice to be the total Wild West of where, where a lot of us who listen to our podcast and our community, you’re either wanting to move out West, or you’re out west already, or the Organ Trail of…
Katie Vernoy 20:47
But no dysentery. You can take that out if you want.
Curt Widhalm 20:56
Thinking back to the episode that we did very early on in our career, where you just kept talking about poop. We’ll have a link to that in our show notes, mtsgpodcast.com. But the Wild West is private practice. You have the government approved standards that can be done in community mental health, and then the corporate end of of the treatment world. And coming back to your your clients in community mental health were involved, I wonder, and this comes from the corporate end of things, and looking at them too, how much of this is advertising? That evidence based practices are what clients or potential clients hear about, and so that’s what they seek out. Because I get people who call me up say, I want CBT treatment for my anxiety.
Katie Vernoy 21:59
Yes.
Curt Widhalm 21:59
And they come into my office and we start doing CBT stuff, and they’re like, this really isn’t working for me. I don’t like this. So I’m wondering if what you’re talking about with the community mental health clients is that this is all that they hear about, and so that’s all that they know. And so there’s an expectation that that’s what’s going to work.
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Katie Vernoy 22:20
I don’t know. Because, I mean, in my experience, working in South Los Angeles, it wasn’t that they came in with an expectation of what treatment would be.
Curt Widhalm 22:27
Okay, whether that expectation is pre treatment or session two.
Katie Vernoy 22:31
Okay, okay. I think it would really depend clinician to clinician on how they explained in that second, first session, second session, what the options were. Because, in truth, they can opt in or out of treatment. I think they there’s potentially specific times when they can opt into a specific program or not. But I think in reality, I think you know, although goals are co-created, treatment planning is co-created. All of that. I think it is something where they may not have a choice on which evidence based practice they’re put into. And so if that’s the case, then it’s not necessarily even about expectations. It’s here, this is what we have that should work for you. Do you want to do it? And that that is there’s less of a choice because there’s not necessarily like, oh, and so then you can, you know, if you don’t like this, then you can go down the street to clinic B and get a different evidence based practice. I mean, I think it’s, it’s something where they’re opting in, they’re part of the treatment. They understand what’s expected. But I don’t know, in the same way, somebody saying, hey, I want a CBT session, if they would, you know, they can’t necessarily switch gears at that point when they find out what the treatment looks like. So, I mean, maybe, maybe you’re right. Maybe it’s just that, that that’s so prescribed, that that that model kind of works, or it doesn’t.
Curt Widhalm 24:00
Unless that model, CBT, which, according to the CBT people, CBT is everything that.
Katie Vernoy 24:05
Well, I think there is an argument that basically CBT and most models, EMDR, is very different, but many models, it’s all the same stuff, just with different names.
Curt Widhalm 24:17
I really wonder if CBT is effective, because at least it’s evidence based, because it’s so easy to research.
Katie Vernoy 24:26
Yeah, for sure.
Curt Widhalm 24:27
And so I’m wondering if part of what clients or potential clients hear is that, oh, this thing is very well researched, but it doesn’t actually play out into the world as well, that humans are a lot more complex than some of these research studies.
Katie Vernoy 24:44
Oh, well. I mean, we’re also definitely more diverse, right?
Curt Widhalm 24:48
I mean, you look at any of these studies anymore, and it’s, you know, they hit large numbers of clients, but it’s kind of like they only accept people who meet these really certain criteria, as far as diagnostics or presenting problems, and then that’s all that they work on. But for a lot of people, in their complexity, they come in with a lot bigger mix of things than just a particular issue, that makes it more complex and makes it harder to deliver these treatments to clients who are like, I have all of these different problems, as opposed to this one specific problem. But I was told that CBT is evidence based about this one specific problem without it really getting into the complexities that come along with people.
Katie Vernoy 25:38
Yes, and that’s kind of how I’ve described for clients that I’ve tried to refer for EMDR is that EMDR is really very strong for single incident trauma. Now all of the…
Curt Widhalm 25:52
I’m holding back so much.
Katie Vernoy 25:54
Well, and that’s kind of the response I get from most of the EMDR folks when I talk about that, and certainly In our conversations, as I’m learning more about EMDR, vicariously through you, is, is that, oh no, no. It can also do this. It can be that, it can be this. And I think there is, there is the complexity of human beings. I think there’s also a complexity of these treatment modalities and the practitioner. But I think it can be, it can be something where so much of this to me, the way I conceptualize it, and the reason why I don’t have, like, this is my one orientation, or this is my one certification, or whatever. Is that to me, it’s all just different tools in the tool bag. Like it’s, it’s something where, and I think that’s kind of the the idea behind what eclectic was supposed to mean. I think there’s a new, the newest, newer term is integrative. But I think there’s actually an integrative therapy at this point. So we also probably need to talk to some of our our colleagues, to get you know, clarify what integrative therapy stands for.
Curt Widhalm 26:49
Hey, modern therapists, let’s get out ahead of this. Let’s just call it hodgepodge therapy.
Katie Vernoy 26:54
But I think when we’re when we’re able to pull in these, these different ideas, and for the person that has more than just anxiety in their left nostril, but they have actually a complexity of PTSD and anxiety and depression and these, these types of situations, and that types of situations and anxiety in both nostrils, I think it’s something where being able to have more tools in your toolbox than just one evidence based practice, I think is important, because you’re going to have so many different things to be looking at.
Curt Widhalm 27:30
So I will be fair on the EMDR thing that you’re bringing up, that in my fair criticism of EMDR training is the parts that people need to go through to become trained in EMDR is good for single incident trauma, and I think that there are some clinicians who are able to expand beyond that with good consultation to beyond that. But I do firmly stand that most people where their EMDR training ends, doesn’t get into being able to address the things that would come with more advanced EMDR trainings. I don’t get that there are more levels of trainings in something like CBT. I think that…
Katie Vernoy 28:19
Well, and I don’t agree. I mean, I think if we look at CBT as a basis for a lot of different models, we’ve got TF-CBT, we have DBT, we’ve got these other models that continue to build on the evidence base of CBT, and I think they do go deeper into different types of clients and different types of complexity. And if we think about DBT as as an extension of CBT, and maybe somebody, you know, maybe all the DBT therapists will come with, like, pitchforks after me.
Curt Widhalm 28:49
Get your pitchforks here. I am in enough internet arguments to say that I would consider DBT as a separate thing, but…
Katie Vernoy 28:57
Regardless. But I think there’s, there’s an evidence base that is being built upon that is more than just kind of straight ahead, basic CBT. I think that’s continuing to grow, or continue to expand, and I think DBT therapists are closer to CBT therapists, and like narrative therapists or those types of things. I think we have, we have a field that is evolving, and the that each thing, you’re saying, Oh, well, basic, EMDR, and then there’s this other, you know, like you keep adding on EMDR. Well, yes, branding wise, they’ve kept it all within EMDR, but I think that that there is a depth in each of these things that can treat clients more holistically. And so to me, I feel like really deep practitioners, they can they can address more. But I think when we look just at the evidence based practice, especially those that are coming to newer clinicians and their manualized treatments, I think those are, that’s where I see the limitations.
Curt Widhalm 29:59
And I think that what you’re talking about is that newer clinicians are being taught here’s the model that works.
Katie Vernoy 30:05
Yes.
Curt Widhalm 30:05
And they’re not having the traditional thought of here’s how to think through why this model works, how to deliver this model that makes it work. And it keeps getting watered down in trainings as funding gets cut for trainings as the…
Katie Vernoy 30:20
So then there’s the train, the trainer, there’s almost like a telephone.
Curt Widhalm 30:23
Right. And this then becomes a problem of therapist training, that it’s not necessarily the models that are the problem. So working title is now, is CBT crap we don’t know. To you know, is the way that we train therapists crap?
Katie Vernoy 30:46
I think that’s probably fair. I think that as these models, which are evidence based, especially if those evidence bases are be or there’s continuing to expand that to have a more diverse population of people who are in these studies, I think that they’re worth looking at. Because if they’re, if they’re getting results and they’re working and they’re working better than just the relationship, because we know the relationship works, then I think they’re worth looking at. They’re worth digging into. I think when someone gets too rigidly stuck in a single model and does not look at their client as a whole person, I think that’s a problem. I think if the model is watered down, that’s a problem. And so to me, I think we don’t want to throw out evidence based practices just because they’re constraining or because they they’re too limiting on what type of problem they serve or what type of client, but instead, to be very thoughtful in how we assess what we use.
Curt Widhalm 31:44
We would love to hear your thoughts on all of this. So if you’re not already, please join us in our Facebook group, the Modern Therapist Group. We’ll post a couple of things in our show notes. You can find those on mtsgpodcast.com and our tickets are on sale for Therapy Reimagined 2019 here in October in Los Angeles area, October 18 and 19th. I am really excited about the energy of this conference, and I can’t contain myself for like five months, just like I am not great at holding my feelings forever. Really, I want everybody here to come here.
Katie Vernoy 32:26
Yes.
Curt Widhalm 32:26
With our wonderful partner in putting this on SimplePractice and just come be part of the movement. And until next time, I’m Curt Widhalm with Katie Vernoy.
… 32:39
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