How the philosophy of Merleau-Ponty can help us understand the gulf between clinical experience and the doctrine of evidence-based psychotherapy.
OBJECTIVE
The aim of this paper is to examine the gulf between clinical experience and the doctrine of evidence-based psychotherapy from the perspective of the philosophy of Maurice Merleau-Ponty.


CONCLUSIONS
Evidence-based psychotherapy, which requires that psychotherapists ignore their thoughts and feelings with individual patients in favour of following standardized manuals and guidelines, is being increasingly promoted as part of evidence-based medicine (EBM). However, this represents an inappropriate extension of logical empiricist philosophy and significance testing methodology, on which evidence-based medicine is founded, to psychotherapy. It sacrifices a search for truth in psychotherapy, for an illusory search for certainty. The inevitable consequence of this is that psychotherapy becomes a commoditised pseudorelationship. Merleau-Ponty provides an alternative ontology, based on the primacy of perception, that gives an epistemological foundation for the search for truth and integration as a basis for psychotherapy. The practice of evidence-based psychotherapy raises serious ethical concerns about pseudorelationships being passed off as authentic, which could lead to missed opportunities to engage mentally ill patients in treatment and to reinforcement of their damaging sense of alienation.
Morstyn
Ron
R
Consultant Psychiatrist and Psychotherapist, Sydney, NSW, Australia. ronmorstyn@bigpond.com
D000223:Adaptation, Psychological / Q000941:ethics; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000941:ethics; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D004645:Empathy; D019348:Empiricism; D019317:Evidence-Based Medicine / Q000941:ethics*; D019983:Guideline Adherence / Q000941:ethics; D006801:Humans; D008016:Life Change Events; D008128:Logic; D008370:Manuals as Topic; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010686:Philosophy, Medical; D010817:Physician-Patient Relations / Q000941:ethics*; D011575:Psychoanalytic Therapy / Q000941:ethics* / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000941:ethics; D011936:Reality Testing; D016896:Treatment Outcome; D035502:Trust / Q000523:psychology; D035501:Uncertainty