In today’s mental health landscape, “evidence-based treatment” (EBT) is often presented as the gold standard of psychotherapy. The phrase carries an air of scientific authority, promising structure, predictability, and measurable outcomes. But what does evidenced-based treatment mean, and do you want it?
EBT refers to interventions that have been researched in clinical studies, randomized control trials, and peer-reviewed research. As a relational psychoanalyst, I find myself cringing when I hear EBT used as shorthand for what makes therapy effective. Patients want certainty that when they invest their time and money into treatment, they will manifest their desired results. While it makes sense to fantasize about certainty, especially when you're feeling desperate and experiencing emotional pain, the desire for expeditious, predictable outcomes is unlikely to be gratified.
The Problem with Standardization in Therapy
To be clear, I’m not against research, and I’m empathetic to the desperate earning for relief through the right kind of help. I have no quarrel with data that suggests CBT helps with phobias or that DBT reduces self-harm. The core premise of CBT, that thoughts, feelings, and behaviors are connected, is one I fully accept. The clinical application is where I deviate. Unfortunately, standardized CBT treatments are often time-limited, generic, and underwhelming in their efficacy. To reduce therapy to a set of techniques that can be tested and replicated in the same way as a pharmaceutical trial would be conducted is to misunderstand the essence of psychotherapy itself.
Psychotherapy is not a pill. It is a relationship. It is a process. It is a conversation that unfolds between two unique people with their own stories, perceptions, and relational patterns. The idea that we should apply the same scripted interventions to each person, based on what has been deemed “effective” in a controlled study seems unrealistic and misguided. Reframing phenomenological experience as diagnostic categories or labels that seem more trite than authentic feels eerie.
What Can’t Be Measured is Often What Heals
The most transformative moments in therapy defy measurement. When patients talk with me about what has helped them most in our work or in prior therapies, they mention the relationship, they mention tender moments of connection, of feeling seen, or reimagining the world or themselves. No one mentions worksheets. While therapeutic tools are useful for symptom relief, they are parts of the therapy that don’t represent the whole. A wholistic therapy journey integrates personal elements that are effective in healing because they cannot be standardized.
The Risk of Reducing Therapy to a Treatment Model
When therapy becomes too focused on symptom reduction, it risks becoming just another consumer service—a transactional process where the therapist functions as a technician, delivering a set of interventions to a passive recipient. But therapy is not about symptom management alone; it is about meaning-making. It is about expanding one’s capacity for thinking, feeling, and relating. If we reduce therapy to an algorithm, we rob it of its most profound potential: the ability to transform in ways that are unpredictable, deeply personal, and utterly unmeasurable.
What Works is What’s Alive
The best therapy is alive and evolving. It is shaped by the unique chemistry between therapist and client, by the unconscious material that emerges, by the words that are spoken, and by the silences that are endured. It requires a willingness to wonder and doubt, to sit in discomfort, to resist the urge to force insight or resolution too soon.
So, spare me from evidence-based treatment if it means reducing therapy to something rote, mechanical, and devoid of deep human complexity. Give me a therapy that breathes. A therapy that allows for mystery. One that is liberated from a prescribed agenda. Give me a therapy that recognizes that the most important changes cannot always be quantified—but they can absolutely be felt.
Would you like to talk about what a deeper, relational approach to therapy could look like for you? Reach out. Let’s have a conversation.
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