Thread by @PsiANorg

🧵1) Allan Scholom wrote a brilliant chapter in our recent book from @routledgemh called "The psycho-politics of evidence-based practice."

We ought to be wary and critical anytime we see the "evidence based practice" (EBP) label parading around our field for many reasons:

2) Scholom details how the rise in "evidence based" / EBPs coincided, not coincidentally, with the neoliberal turn in economic and political policy of the last 40 years—cheapening & limiting health care services and concentrating power & money in the health care industry.

3) "EBP, when equivalent to short-term, manualized treatment, serves...as a vehicle to curtail services and thereby increase the profit of health insurance and drug industries...Thus, EBP provides a 'scientific' rationale for providing less service while garnering greater profit"

4) He cites @JonathanShedler for pointing out that evidence based therapies "are ineffective for most people most of the time" (and even those 'benefits' don't last) and studies showing 78% of newly reviewed EBP's involve a conflict of interest (eg. financial, research, etc)

5) We exist in a constellation of collective fantasies: that our government is here to protect us, that this cheapened form of science will save us, that our professional orgs (APA) will help us, that if only we work harder and improve our individual faults will we be saved.

6) (He also points out here that "CBT fits the neoliberal paradigm economically....Moreover, it is consistent with neoliberal ideology that values the triumph, however illusory, of individual control over relationship and interdependence.")

7) "EBP is based upon virtually non-existent or corrupted science. At the same time, it was used as a rationale for carrying out the cost cutting/austerity aims of the government and the profit requirements of the health insurance, hospital, and drug industries."

8) Simply put, "while EBP masquerades under the banner of accountability, it is actually a disguise for austerity."

9) "Thus, the 'science as salvation' fantasy moves us toward participation in our ow exploitation, via our embrace of the defensive, surface level, less painful truth. The deeper truth, that we are being done in by the neoliberal system itself, remains split off."

10) Scholom calls for many changes. First, to empathize with our patients (and ourselves) as we all experience the alienation and isolation of an economic and political system that commoditizes and cheapens human suffering to be managed instead of healed or minimized.

11) And to, like our psychoanalytic forebears, see our work as political and social, not simply intrapersonal. And to awaken from the fantasy that these systems of power, from the APA to the government, work for their proximity to power, not for the 99%.

12) To awaken from this fantasy is very painful—we lose our chance to identify with that kind of safety, protection, hopefulness, power, etc.—but it is necessary to uncover the more freeing truths about the world we live in.