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A Psychotherapist Reflects on Shortcomings of Evidence-Based Practice: Part One

When, 13 years later, in a political thriller against the powerful housing authority of a major US city, I finally descended into a two year schizophrenia. Reunification as a prodigal son didn’t go very well.

Suddenly I, considering myself a whistle-blower, found society hell-bent on incarcerating and making me accountable for being an eugenic failure. And my only remaining supporters, my long-lost family agreed.

My father did what he could to get me to stay an extra nine months on the most chronic of back-wards; and later to prevent me from having a car.

The car thing became a hard way to be treated, when, six months after the three month hospitalization, I was only able to find a minimum wage job with a two hour bike/train commute while in “psychosis.”

A car was key to enable me to grow out of this situation. After ten months, I was finally able to manipulate my mother into helping me. And with a car, I did improve my job performance, start back on medications and eventually escape the grasp of a company that I was later able to confirm really did cooperate with a local mob boss, just as I thought.

Though most Master’s-level clinicians of my era learned that multiculturalism was important, we also learned that if you chose a best practice orientation like Minuchin’s Structural Family Therapy, or CBT and apply the concept across cultural divides, you were okay.

In those days, we were not taught to study the cultural ethos within which the best practice was created and translate it through ourselves while considering the cultural experiences of the subject. I certainly was not blessed with such thoughtfulness from any of the mental health providers I came into contact with.

I am now left to wonder what would have happened if I received the treatment of Minuchin’s primary competitor Bowen who worked with Midwestern, white-bread schizophrenic families.

I once heard an aggressive professional teacher angrily favor Minuchin, emasculating Bowen as being over protective. This particular teacher flew in from another state, and never disclosed his Afrikaners background. It kind of made me chuckle when he yelled at me for making an insubordinate point, although perhaps a significant portion of the room was with him.

I believe this highlights the need for any mental health worker to first define themselves culturally and then assert themselves locally in this increasingly multicultural society.

In my opinion, a good theorist like Minuchin did this. By all reports, he interacted well with his local consumer base.

The positive thing I got from my Minuchin experience was a fondness for the inner-city community that supported me during my hospitalization.

I started to listen to rap music and found that people who came from different backgrounds (particularly of African American and Puerto Rican descent) could really see who I was.

I was touched by their humanity in contrast to the private school community I was raised in and where I would eventually return to face stigma.

A Silver Lining

It stands to be noted that there is a silver lining in this longitudinal study of my failure at Minuchin’s clinic.

Just as I was coming to see insulated, Caucizoidal academia as a world where the cheaters got ahead and did less work, the eating disordered unit that saved me from Minuchin drained the college fund.

Because after two stints there, the ghetto was the only place I could afford to live, it all worked out.

I moved to Camden, New Jersey and studied sociology and the neighborhood through working.

This brings me to take a peek at the massive funding for early intervention strategies for “psychosis” that are based on high fidelity to a best practice that was initially constructed to help an Ivy League nerd (Albert Ellis) overcome his awkwardness and get a date.

Watching this practice applied to where I work in Shy Town kind of tickles me. Initially, I was not selected for the project and I wrote a thank you letter schooling the project on the demands of the locale.

Later, when actually considered for a position, I could not bring myself to submit to the high level of fidelity measures with which I would be required to submit

I have spent the last eight years using my lived experience to lead groups on “psychosis” in the heart of Shy Town. Led by the most institutionalized community members, I have created my own theory based on what many community members face on the ground.

I think it is time for administrators to wake up and limit the relevance of evidence based strategies. Step inside a state hospital backward, or prison and you get a pretty good sense of where all the good intentions of counseling theorists and administrators may well lead you.

I think that most other survivors of these environments will tell you that they did not get much support from a theory in that squalor. Speaking for myself, I was only helped by people who threw the theory away and treated me like a human being. And believe me we clients can tell when people are treating us like a statistic, like we are one of their “folks.” That is not helpful.

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A Psychotherapist Reflects on Shortcomings of Evidence-Based Practice: Part One