Thread by @JonathanShedler

1/ Key sentence: "Clinicians would know which interventions had evidence-based efficacy for treating specific conditions."
The basic assumption underlying these recommendations in @TheLancetPsych is false. A DSM diagnosis does not identify homogenous group of people with same

https://twitter.com/pimcuijpers/status/1310945740550803456

2/ specific condition. It's not like aa diagnosis of influenza or diabetes which identifies a common condition likely to respond to same treatments. Ppl who meet DSM diagnostic criteria for a mental heath diagnosis, say depression, do not have same "specific" condition w/ common

3/ underlying cause that responds to same treatments. Developers of past editions of the DSM went to pains to make this clear. It was stated in DSM itself, in the preamble. DSM classification—based exclusively on overt, surface-level, readily-observable signs & symptoms (vs.

3/ underlying conditions giving rise to them)—cannot serve as guide for treatment and cannot provide a foundation for developing one. NIMH understood this when it rejected DSM as foundation for mental health research. It would be like to aspiring to provide the same treatment to

4/ everyone based because they have fever—without regard to condition causing it, which could be anything from common cold to bacterial infection to ebola—and considering this a scientific advance. Without meaningful basis for identifying "specific conditions," talk of "evidence-

5/ based efficacy for treating specific conditions" is just nonsensical. A worthy aspiration—but a dead end scientifically & clinically. Moreover, psychotherapists treat *people* not "specific conditions." For most ppl most of time who seek psychotherapy, symptoms/conditions are

6/ inextricably intertwined with who they are as people. It's not what they "have" but who they are. You can treat a bacterial infection without understanding person's subjective experience & inner world, but not their psychology—not if therapy goal is meaningful & lasting change