One Size Doesn’t Fit All When It Comes to Treatment

Close up of person meditatingI first met Albert Ellis, the founder of Rational Emotive Behavior Therapy (REBT), about 35 years ago. Soon after I became an Associate Fellow and a Supervisor with the Albert Ellis Institute in New York City, and was a died-in-the-wool devotee for decades.

Al was open to all of us adding or subtracting a variety of techniques, whether meditation, homeopathy, yoga philosophy, or anything else, as he had already incorporated disparate ideas from areas as diverse as Buddhism and behaviorism. He wanted each therapist to put his or her own stamp on their ways of working, although I believe he assumed we would all keep the REBT skeleton beneath whatever robes we draped it in.

Rigid, dogmatic thinking was not the coin of his realm. In fact, he loved to engage in lively discussions of all therapeutic techniques and was happy to incorporate anything he believed would help shift a client to becoming more unconditionally self-accepting.

Of course, like any parent, he was proud and delighted when his baby, REBT (the precursor of cognitive behavioral therapy [CBT]), would be “proven” to be effective in alleviating depression, anxiety, anger issues, or anything else, as it was with 40-plus years’ worth of studies.

This plethora of evidence-based practice studies that have lauded the effects of REBT and CBT is what led to the Swedish government’s decision to invest heavily in training clinicians to provide CBT to people with depression and anxiety and spend no money on training or treatment in other modalities. Naturally, the Swedish government was a bit shocked when a recent study showed that training therapists in and treating clients with CBT had little or no effect.

In response to these findings, Scott D. Miller, Ph.D. wrote: “The widespread adoption of the method has had no effect whatsoever on the outcome of people disabled by depression and anxiety.  Moreover, a significant number of people who were not disabled at the time they were treated with CBT became disabled.”

Apparently, this has not deterred the American Psychological Association from resurrecting its plan to draft and promulgate a series of guidelines pushing specific treatments for different mental health issues.

Dr. Miller and his colleagues at the International Center for Clinical Excellence have analyzed many studies showing little difference between treatment approaches in terms of outcome. They argue that all approaches work almost as well, and efforts to target specific treatments for each psychiatric diagnosis are not an effective use of time and money.

Dr. Miller recently talked about what works in behavioral health and recommended shifting the focus to designing client-tailored services rather than spending so much energy on examining specific treatment models and techniques. Meanwhile, Sweden has decided to end the exclusive use of CBT for the treatment of anxiety and depression, realizing that people need to have therapy choices.

As a holistic psychotherapist for almost 40 years, I think it is obvious when treatment is working: people self-report feeling better. They engage in life more fully, sleep better, take better care of themselves, and have more satisfying relationships and more meaningful life experiences.

As much as it can be wonderfully useful to study psychological modalities, theories, and philosophies, at the end of the day it all boils down to whether the person has been helped or not. Using evidence-based practice studies as a Procrustean bed will only cause pain and prolong suffering, just as the original one tried to stretch or shrink people to fit its specifications.

Source:
Miller, S. D. (May 13, 2012). Revolution in Swedish mental health practice: The cognitive behavioral therapy monopoly gives way. Retrieved from http://www.scottdmiller.com/?q=node%2F160&goback=%2Egde_53475_member_125725759

Related articles:
What is CBT?
Deep Breathing and Guided Imagery
When Someone Really Listens, We Heal

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Nicole Urdang, MS, NCC, DHM, LMHC, therapist in Buffalo, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • PAUL

    PAUL

    July 3rd, 2012 at 4:06 PM

    As much as I am surprised to hear CBT didn’t help, it is imperative that practitioners and more importantly the clients have a choice when it comes to methods and techniques used for treatment.I do not want the government telling me which one is best,I want to listen to my mind and body and take the decision!

  • Nicole

    Nicole

    July 4th, 2012 at 3:46 AM

    Hi Paul,
    Thanks for taking the time to comment.
    I couldn’t agree with you more.
    One of the reasons I was drawn to create my own holistic psychotherapy model is exactly that: each person is unique and deserves to be treated with respect. One size fits all approaches ignore that reality.
    In addition, I am loath to have the government do anything that infringes on my right to choose what is best for me.
    Happy trails.

  • Stacey R

    Stacey R

    July 4th, 2012 at 4:31 AM

    I have never been a fan of those people who are so strict in their beliefs that they honestly feel that it’s their way or no way.
    If a patient is obviously not getting better from having this sort of treatment then why would you not start over and look for something else that would work?
    I get it that this may be a theory near and dear to many hearts, and yes I am sure that there have been numerous people who have benefitted form its implementation.
    But there are also others for whom it might not work and who would benenfit from other treatment modalities.

  • Victoria

    Victoria

    July 4th, 2012 at 5:50 AM

    Just like with any other disorder and illness, what helps one person may not be the cure all for the next. Even those of us without a PhD after our names are smart enough to know that.

  • Nicole

    Nicole

    July 4th, 2012 at 7:56 AM

    Hi Victoria and Stacey,
    Thanks for your thoughts.
    I want to share one of my favorite quotes with you, as it seems to apply to this topic:
    A foolish consistency is the hobgoblin of little minds.
    Emerson

  • bob d

    bob d

    July 5th, 2012 at 4:19 AM

    great quote Nicole

  • ronald

    ronald

    July 5th, 2012 at 8:59 AM

    no rigid form of treatment can be great for the practitioner or for the client..a great treatment technique would be one wherein suitable methods can be added or modified to best help the client because really,no two people are alike and a set rule-book will only be awesome in theory.

  • Nicole

    Nicole

    July 5th, 2012 at 12:18 PM

    Thanks Bob!

  • Nicole

    Nicole

    July 5th, 2012 at 12:25 PM

    Hi Ronald,
    Yes, a set rule book is only awesome in theory.
    It’s also very comforting (especially to those in managed care) to think there’s one right answer. Unfortunately, life isn’t that simple.

  • Lola

    Lola

    July 5th, 2012 at 3:28 PM

    That “one size fits all” tag has never really fit me just right. No matter what anyone says, everything needs to be catered to meet your own specific needs, and no two people are the same, so why should we ever think that one size fits all, or one form of treatment or therapy fits all, when obviously life is not like that?

  • MOODY

    MOODY

    July 6th, 2012 at 4:26 AM

    But if this works for the majority of patients, then why not continue to use it for the most part and then adapt when it looks like that will be the only solution or resolution?

  • Mary S

    Mary S

    December 25th, 2016 at 8:17 PM

    Moody,
    Your statement, “But if this works for the majority of patients, then why not continue to use it for the most part?” seems reasonable on first thought. But when one looks at what is actually done in clinical trials, then lots of ifs, ands, and buts emerge. For example, a treatment might be declared effective for a certain condition based on the average outcome being higher for the treatment group than for the comparison group — but this could happen when just a few individuals have large improvement from the treatment, but many individuals worsen with the treatment. These details are often not reported. So caution is always needed — the therapist and client need to be very alert to signs of getting worse as well as improving.

  • Nicole

    Nicole

    July 6th, 2012 at 9:57 AM

    Hi Moody,
    I agree with you.
    It’s all about the therapist’s ability to see if it’s not working and their comfort with other modalities, so they can use those when appropriate.
    I find I use a wide variety of approaches with everyone, as people are always changing and growing, and benefit from one thing one day and something else the next.
    Thanks for charing your thoughts.

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