What the hell even is “evidence-based” care?
Since graduate school, the term “evidence-based” has irked me. This term is designated for therapeutic modalities that are SPECIFICALLY supported by randomized controlled trials, but what this term suggests at face value is that any other modality does not have research or evidence to back it up, which is highly untrue. There are a number of different research methodologies, such as qualitative approaches, case studies, longitudinal studies, and more, that are just as important and valid.
But the reality is that it’s impossible for a randomized controlled trial—or even research as a whole—to accurately and completely capture the complexity of the human experience. The irony is that a part of this lies with the fact that humans are conducting the research, and we can’t separate research from the biases and the harmful systems we live in, with, and uphold.
Research overwhelmingly centers White folx. For example, Cognitive Behavioral Therapy (CBT) is considered the so-called “gold-standard of evidence-based care,” and a hallmark of this approach is to challenge “irrational thinking.” So, when a woman of color’s son was unjustly arrested for shoplifting, and she started to exhibit anxiety/PTSD-like symptoms when entering grocery stores, a CBT therapist might try to challenge this supposedly “irrational thinking.” For the record, I’m not making this up; this is how a colleague approached a real client.
But how is it “irrational” to respond to a very real threat that many people of color—especially Black folx—face daily? People of color and other minorities have come to realize that many of these “evidence-based” approaches don’t work for us and, quite frankly, often gaslight us.When “evidence-based” modalities are actively harming minorities, insurance companies shouldn’t be forcing us into an “evidence-based” box, refusing to pay for care if we don’t comply.
Additionally, in recent years, we’ve seen a surge of “non-traditional” therapeutic modalities, such as yoga, meditation, and somatic practices to name a few. However, research has historically been used to paint these techniques as “woo woo” or “savage.”
These modalities are only now considered acceptable after White folx—often White cis men—appropriated these ancient healing traditions, commodified them, and slapped their name on it to reap profit. A White person has now deemed this approach valid; therefore, it must be valid.
And of course, we have to consider how capitalism influences research and follow the money. Who funds the research? What monetary gain do these funders receive? And when findings threaten profit, who decides they’re “too risky” to publish? In academia, there is immense pressure to secure grants and produce publications that keep the university funded. When careers are on the line, the system incentivizes selectively reporting favorable findings or burying the ones that don’t fit. And I don’t fault researchers for that; I fault the system that makes it necessary to survive.
Now, I’m not saying to throw the baby out with the bathwater.
It’s not to say that science and research aren’t important; it can be a powerful tool when it’s done ethically, equitably, and with a critical lens. For example, Jonathan Shedler’s1 meta-analysis shows how these so-called “evidence-based” modalities only show an initial short-term improvement, while these supposedly “non evidence-based” modalities demonstrate continued long-term benefits. There is also a lot of wisdom from the field of psychology—even if a lot of this wisdom is credited to indigenous communities.
What I championing for is for us to question everything.
Just like homosexuality was questioned as a diagnosis or the sexist underpinnings of “hysteria” were questioned. But we can’t just wait till “evidence” emerges for us to start questioning things, and we need to question so much more than we are now. Because if we don’t, and we continue to subscribe to the narratives handed down to us without critically looking at them, we are going to keep inflicting harm under the guise of “helping.”
1 Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378