TL;DR➡️➡️For the field of talk therapy to evolve, its influencers (researchers, clinicians) need to (1) move away from promoting their “preferred” therapy orientation models, (2) move away from trying to fit the mental health industry into the medical model industry, (3) invest in mental health “wellness” facilities that are distinct from medical treatment settings, (4) develop a different payor/diagnosis system, and (5) listen more deeply to what consumers want from psychotherapy and psychotropic medication management experiences.

Human emotion, behavior, and brains are complex. The environments we inhabit and the attachment systems we are raised in are just as complex. They vary from person to person, culture to culture, and generation to generation. My simple-minded, rule-of-thumb (that I know is not technically accurate): ALL PROBLEMS IN HUMAN SUFFERING ARE 50% GENES 50% ENVIRONMENT. I am in awe of epigenetic researchers who devote their careers to answering gene X environment questions.

🙏As a psychologist who is highly trained in “talk/behavioral” interventions to treat human suffering, I hope that our field can invest in research and scientists who are committed to arriving at personalized, nuanced, and orientation “agnostic” approaches to psychological wellbeing.

🙌I appreciate the PBT (process-based therapy) research conducted by Steve Hayes, Stefan G. Hofmann, and Joseph Ciarrochi because it lays the groundwork for the “4th wave” that I hope our field will move toward. I applaud the courage PBT researchers have in challenging the Western science/normative/medical model/symptom approach that our field has been ascribing to for some time.

🙌I also fully support organizations like Linda Michaels’ Psychotherapy Action Network (PsiAN) which are committed to preserving the legacy of depth-oriented interventions. PsiAN has conducted research to explore what consumers want from therapy. It is important to consult with consumers about their preferences because CONSUMER BUY-IN IS KEY TO TREATMENT OUTCOMES. Doing what works (even if there is placebo effect involved), for each unique person/family, is where we should place our focus.

📢Providers need to collaborate with their clients as the ULTIMATE experts. They know their inner worlds, their family systems, their lived experiences, their bodies, and their environments more intimately than any outside professional.

📢At its core, the spirit of the EBP (evidence-based practice) movement in the field of talk therapy has been good. However, the term “EBP” has lost some of its credibility over the years because it is overused/misused for branding and third-party payor purposes.

📢The continuous iterations of the DSM/ICD and how third-party payors use these systems to deny coverage need a major overhaul. Z/V codes should be covered. Couples and family therapy interventions should be covered. Longer-term, intensive, relationally-oriented therapies should be covered (this includes gold-standard DBT AND psychodynamic therapies). Neuropsychological evaluations (particularly for children) should be covered. CONSUMERS SHOULD NOT HAVE TO BEND OVER BACKWARDS TO GET INSURANCE COMPANIES TO ABIDE BY MENTAL HEALTH PARITY LAWS.

📢The environments in which people are treated for mental health issues MATTER! When I was a postdoctoral intern at the Ann Arbor VA in 2010, the mental health clinic had been based in the basement of the hospital for many years. It was finally being “promoted” to a higher, newly renovated floor during my time there. For many years, the providers and patients were meeting in rooms with no windows or natural light. The setting within which consumers receive mental healthcare needs to provide a background sense of safety and calm for interventions to take hold. Typical mental healthcare settings don’t provide the level of environmental “holding” to support providers and consumers while they engage in sensitive and emotional work. This is why I have made a professional choice to maintain a physical office space to meet with clients (despite the overhead expense). I am a better provider because I have a personal therapy office that I have been able to nurture and create as a safe space for myself and my clients.

📢EBP has become a short-hand way to communicate “I provide ACT/DBT/CBT interventions.” (I’m guilty of often using this short-hand). In truth, although my “on-the-surface” therapy-room behaviors appear heavily ACT/DBT/CBT based, a peak into my “behind-the-scenes-therapist-brain” would reveal how I am also conceptualizing my cases from family systems, child development/attachment, big “T” little “t” trauma, and psychodynamic perspectives in addition to behavioral ones.

📢Psychotherapy Action Network (PsiAN) advocates for psychodynamic and depth-oriented therapies to be included as EBPs given the available research AND consumers’ expressed desire for depth-oriented and relational therapy experiences. Personalized, individualized care is what consumers need AND want.

📢I encourage all mental health providers, researchers, and training programs to cease the in-fighting and competing for their preferred “EBP” to be the “right/best” one

📢I encourage all mental health providers, researchers, and training programs to get involved in advocacy and mental health parity causes.

📢📢📢MENTAL HEALTH PROVIDERS AND RESEARCHERS: Let’s move forward and model for the public high emotional intelligence, interpersonal, and psychological flexibility skills. It’s time for us to put our heads and hearts together to do better by and for consumers.