Could it be that we’ve gone too far in stripping the spirit and soul out of therapy and have created a new altar of empirical science at which to worship?
An interesting article. After 40 years, I see psychotherapy as both an art and a science. It's fascinating to learn about neuroscience, but clinical judgment always comes first. When I began, mental health was in its early stages. Now, it’s like a toddler. Psychotherapy is an ongoing process and can never be fully mastered. The science is also very complex. There is always more to learn and discover. I believe it’s important for both therapists and clients to trust themselves. If something doesn’t feel right, it probably isn’t right for the client.
Hallelujah and thank you so much - finally a response to the never ending having to prove empirically the journey our clients experience! The recent HAP conference panel offered that EMDR because of the extensive training requirements and costs have lagged behind in international sectors - I accept the premise but not the truth - in my experience the life enhancing offerings of the 60+ EMDR trained clinicians I’ve worked with, in a CMHC environment, has been remarkable- and the work of Thomas Zimmerman and the amazing resource Rotem and his crew have offered in the Learning Community supporting thousands of dedicated humanists-clinicians is the truth.
This is very well said, and thank you for speaking to this. I’m a clinical psychologist, and much of the focus in my dissertation was to push back against the framing of psychology as a science that fits in the medical model. I’m all for the pursuit of knowledge and research, but what they don’t acknowledge is that much of what is accepted as empirically supported are done so because they are just easier to study. My background is in existential phenomenology. Phenomenology, by its definition, can’t be studied in mass with a double blind study of thousands of people. So because we can’t study it in that manner, it no longer can be respected in the same manner? Our pursuit of acceptance in the medical world has taken from us our essence; working with people not diseases or disorders. I’ve long thought we need to place ourselves in a different category adjacent to the medical model. We’re not medical. We just can’t be. We need to stop pretending otherwise.
Yes! We have such a challenge in actuality scientifically measuring mental wellness. Also, how do we possibly manage for variables? How can we separate the relationship from the intervention when researching? And no two treatment relationships are the same so how can we measure for that scientifically? Are we studying long enough? Why might people report relief if indeed there wasn’t relief or the relief didn’t last? Is symptom relief really wellness? What about Psychoanalytic patients who are seeking a feeling of being alive, liberated, connected more than to never have a bad dream again? We do ourselves a great disservice trying to measure that which cannot properly objectively be measured.
I dunno, I don’t think IFS is a good example of a contemporary non-western approach to understanding the human mind. It strikes me as pretty solidly part of the west’s approach to understanding the mind and soul.
For example, it feels very Christian to me. The three main parts that the self has to grapple with — managers, firefighters, exiles — map pretty well onto the three parts of the trinity.
I don’t think it’s a decolonial, anti-racist approach to psychotherapy at all. Most psychotherapies that one can be certified for in Canada or America aren’t.
Some Western forms of spirituality and religion consider the self/soul to be the sum of different parts.
Also, I think the focus on empirically proving the basic concepts of IFS (that parts exist, how they can be interacted with, etc) is not what’s being asked.
I get the impression from the article and the conversations surrounding it that what’s important is to use science to create a body of evidence that can demonstrate that IFS helps people, and does not harm people.
Even better would be to narrow down what issues it is better at helping people with, and what issues it is terrible at helping people with.
Learning these things is very important for clients. When clients know about a modality’s benefits, effectiveness, and limitations, they are able to give informed consent to treatment.
And measuring a treatment’s effectiveness is very possible. Did clients feel they improved? In what ways? This can even be measured qualitatively.
I like to think that psychotherapy is an art that is guided by evidence and that is open to using the scientific method to improve its treatments for clients.
I really appreciate your nuanced and incisive articles on both IFS and EMDR. It seems that almost any approach, including the current emphasis on neuroplasticity, can be imbued with cult-like attributes by zealous followers who seem unable to think for themselves. IFS is not the Holy Grail, especially for people with OSDD and DID, and I was very cumfortable watching a group of non-dissociative people discuss the characteristics of their "systems" in a recent YouTube video. To be honest, it seems that these individuals manifest a performative aspect as well, and in my opinion, many of us who function relatively covertly find this very disturbing. Thanks for sharing your insights as a clinician: it validated my doubt and discomfort with several facets of these popular modalities.
Thank you for this important critique. I read the article last week and felt so much of which you speak in your assessment. I thank you for expressing so eloquently what I don’t have the experience to say confidently but intuitively felt as I read that article. Ugg… we have so far to go but onward we must!
Reducing therapy to what can be measured risks mistaking credibility for care. When empirical standards become gatekeeping tools rather than guides, lived experience, cultural knowledge, and clinician responsiveness get sidelined. Healing happens in relationship, judgment, timing, and context, none of which can be fully protocolized. Treating therapy as exclusively scientific protects institutions more than it protects people, and it often distances the field from the very suffering it claims to address.
When I quit CBT after 2 years, I felt worse off than when I started. I came to the conclusion that therapy wasn’t “built” for men. That it’s merely for validation, not real solutions. Nearly a decade later, I started IFS. And it clicked. A year later, every facet of my life is better. My marriage, my career, my relationship with myself. Everything. My story is not an anomaly. There are thousands of IFS success stories, just like mine. So…obviously it’s doing something.
Thank you for this. I am a psychologist of 30 years and IFS has pulled a lot together for me. I too have concerns about the business aspect of it and the way anyone can train in it and get certified (I think this is a big part of a potential problem) working with dissociation and trauma is nuanced in many ways I can’t imagine being even a doctoral graduate and having the experience needed to do IFS or other trauma treatments without ongoing supervision and training. However IFS in many ways is one of the few decolonized approaches to therapy and I’ve found the most success with this on attachment based injuries and other complex nuanced traumas. I cannot imagine using it with active symptoms of PTSD caused by a single traumatic event.
I’ve been a psychotherapist for over 45 years and I am trained in IFS beginning in 2006, though I have never seen it as the "one true path" that some of my colleagues do, and I have never accepted the idea that our parts are literal sentient beings that live inside us. Nonetheless for me it has been personally transformative in many ways.
Anyway, I think this piece is incredibly thoughtful, balanced, and well written. Thank you!
I appreciate this critique so much Jamie, and as a former (and in many ways ongoing and lifetime) student of yours, I appreciate so much your ability to hold opposing views in tension, to remind us how to notice subtleties and the good that can coexist with the bad. Our world is becoming increasingly polarized and binary, and we are encouraged to make blanket statements and overarching judgments on things, people, ideas, that leave behind nuance and deep critical thinking. I appreciate how your framing challenges that and models a way forward. Thank you for all you do for our therapeutic community, we need your voice more than ever. And by the way, I say this as a psychologist, and I share your concerns about my profession’s questionable leadership. Sadly those concerns are nothing new, APA has been on the wrong side of history at pretty much every major juncture so it’s not surprising to see their spineless capitulation on DEI, though through my stupidity, like Charlie Brown and the football, I feel shocked anew every fucking time.
I love how well you concisely you were able to put this into words. It's such a difficult, nuanced conversation to have. I feel like we keep getting stuck in these black and white overcorrections or "going too far" in one direction or the other in the field. Thanks for writing this.
Hot Take: Some people don’t need therapists, they need practitioners. To me the difference is that a therapist talks with/through issues, while practitioners show you a healthy set of practices to add to your life, in hopes that it will provide some stability in certain areas.
For me personally, I’ve been saved by practitioners and almost ruined by the former. All nervous systems are triggered different, just have to find what works for you. I wanted to mention this, because I think some people don’t realize there is this other option. Many times they have the titles/qualifications, just different approaches to healing.
Thanks this is really great- and I think the same analysis applies to all of the critique around polyvagal and certain trauma theories. I’m curious about your take on that.
Thank you for an excellent critique. Some decades ago, in the US, we made an unholy alliance with the medical model and its co-partner, the insurance industry, because we wanted to get paid, and most people who wanted therapy couldn’t afford it. Consequently, we end up making normalizing judgments in order to fit our client’s experiences into a DSM diagnosis. As a result, an insurance company can refuse to pay if our work is deemed to not be “medically necessary.” So we deal with that as best we can.
I do have an issue with IFS’s insistence that everyone has a core Self, as I think that is a spiritual belief, and I try my best not to impose spiritual beliefs on my clients.
I do think this quote from narrative therapy co-founder Michael White is relevant to this discussion.
“I agree with Karl Tom’s opinion that those people who are practicing therapy, along with the persons who seek therapy, are the primary or basic researchers, and that those people who collect data in a more formal way are the secondary or supportive researchers. I've always been interested in primary research, and find the continual demands from secondary researchers that primary researchers justify their existence to be quite tedious.
“If the secondary researchers in our field could go further in relinquishing the moral high ground, and in revisioning research along the lines of recent developments in cthnomethodology— which would include the rendering transparent of the socially-constructed nature of their enterprise - then what secondary researchers do might become more relevant to what primary researchers do. I am sure that they could then have a very enriching collaboration. In saying this, I don't want to totalize secondary research. There are already some very sparkling developments
One other thought. I see therapy as a glorious thing, and have dedicated 40 years to its pursuit. However, I think it’s a mistake to not understand that it is a dangerous process. If it “works” your life will change. Doors will open, but other doors will close. People in our lives will see us differently, and some won’t like what they see. As a result, some important relationships will likely be damaged, or fall away. Old struggles that seem inevitable and life-killing will lose their power, but new challenges will appear in their place. We may have more flexibility, and may be able to see them as life-giving challenges, but that doesn’t in any way mean moving through them will be easy.
An interesting article. After 40 years, I see psychotherapy as both an art and a science. It's fascinating to learn about neuroscience, but clinical judgment always comes first. When I began, mental health was in its early stages. Now, it’s like a toddler. Psychotherapy is an ongoing process and can never be fully mastered. The science is also very complex. There is always more to learn and discover. I believe it’s important for both therapists and clients to trust themselves. If something doesn’t feel right, it probably isn’t right for the client.
Thank you
Hallelujah and thank you so much - finally a response to the never ending having to prove empirically the journey our clients experience! The recent HAP conference panel offered that EMDR because of the extensive training requirements and costs have lagged behind in international sectors - I accept the premise but not the truth - in my experience the life enhancing offerings of the 60+ EMDR trained clinicians I’ve worked with, in a CMHC environment, has been remarkable- and the work of Thomas Zimmerman and the amazing resource Rotem and his crew have offered in the Learning Community supporting thousands of dedicated humanists-clinicians is the truth.
This is very well said, and thank you for speaking to this. I’m a clinical psychologist, and much of the focus in my dissertation was to push back against the framing of psychology as a science that fits in the medical model. I’m all for the pursuit of knowledge and research, but what they don’t acknowledge is that much of what is accepted as empirically supported are done so because they are just easier to study. My background is in existential phenomenology. Phenomenology, by its definition, can’t be studied in mass with a double blind study of thousands of people. So because we can’t study it in that manner, it no longer can be respected in the same manner? Our pursuit of acceptance in the medical world has taken from us our essence; working with people not diseases or disorders. I’ve long thought we need to place ourselves in a different category adjacent to the medical model. We’re not medical. We just can’t be. We need to stop pretending otherwise.
Exactly! I’m working on a post about this very topic myself. I
Yay!!!
Yes! We have such a challenge in actuality scientifically measuring mental wellness. Also, how do we possibly manage for variables? How can we separate the relationship from the intervention when researching? And no two treatment relationships are the same so how can we measure for that scientifically? Are we studying long enough? Why might people report relief if indeed there wasn’t relief or the relief didn’t last? Is symptom relief really wellness? What about Psychoanalytic patients who are seeking a feeling of being alive, liberated, connected more than to never have a bad dream again? We do ourselves a great disservice trying to measure that which cannot properly objectively be measured.
I dunno, I don’t think IFS is a good example of a contemporary non-western approach to understanding the human mind. It strikes me as pretty solidly part of the west’s approach to understanding the mind and soul.
For example, it feels very Christian to me. The three main parts that the self has to grapple with — managers, firefighters, exiles — map pretty well onto the three parts of the trinity.
I don’t think it’s a decolonial, anti-racist approach to psychotherapy at all. Most psychotherapies that one can be certified for in Canada or America aren’t.
Some Western forms of spirituality and religion consider the self/soul to be the sum of different parts.
Also, I think the focus on empirically proving the basic concepts of IFS (that parts exist, how they can be interacted with, etc) is not what’s being asked.
I get the impression from the article and the conversations surrounding it that what’s important is to use science to create a body of evidence that can demonstrate that IFS helps people, and does not harm people.
Even better would be to narrow down what issues it is better at helping people with, and what issues it is terrible at helping people with.
Learning these things is very important for clients. When clients know about a modality’s benefits, effectiveness, and limitations, they are able to give informed consent to treatment.
And measuring a treatment’s effectiveness is very possible. Did clients feel they improved? In what ways? This can even be measured qualitatively.
I like to think that psychotherapy is an art that is guided by evidence and that is open to using the scientific method to improve its treatments for clients.
I really appreciate your nuanced and incisive articles on both IFS and EMDR. It seems that almost any approach, including the current emphasis on neuroplasticity, can be imbued with cult-like attributes by zealous followers who seem unable to think for themselves. IFS is not the Holy Grail, especially for people with OSDD and DID, and I was very cumfortable watching a group of non-dissociative people discuss the characteristics of their "systems" in a recent YouTube video. To be honest, it seems that these individuals manifest a performative aspect as well, and in my opinion, many of us who function relatively covertly find this very disturbing. Thanks for sharing your insights as a clinician: it validated my doubt and discomfort with several facets of these popular modalities.
Thank you for this important critique. I read the article last week and felt so much of which you speak in your assessment. I thank you for expressing so eloquently what I don’t have the experience to say confidently but intuitively felt as I read that article. Ugg… we have so far to go but onward we must!
Reducing therapy to what can be measured risks mistaking credibility for care. When empirical standards become gatekeeping tools rather than guides, lived experience, cultural knowledge, and clinician responsiveness get sidelined. Healing happens in relationship, judgment, timing, and context, none of which can be fully protocolized. Treating therapy as exclusively scientific protects institutions more than it protects people, and it often distances the field from the very suffering it claims to address.
When I quit CBT after 2 years, I felt worse off than when I started. I came to the conclusion that therapy wasn’t “built” for men. That it’s merely for validation, not real solutions. Nearly a decade later, I started IFS. And it clicked. A year later, every facet of my life is better. My marriage, my career, my relationship with myself. Everything. My story is not an anomaly. There are thousands of IFS success stories, just like mine. So…obviously it’s doing something.
Thank you for this. I am a psychologist of 30 years and IFS has pulled a lot together for me. I too have concerns about the business aspect of it and the way anyone can train in it and get certified (I think this is a big part of a potential problem) working with dissociation and trauma is nuanced in many ways I can’t imagine being even a doctoral graduate and having the experience needed to do IFS or other trauma treatments without ongoing supervision and training. However IFS in many ways is one of the few decolonized approaches to therapy and I’ve found the most success with this on attachment based injuries and other complex nuanced traumas. I cannot imagine using it with active symptoms of PTSD caused by a single traumatic event.
I’ve been a psychotherapist for over 45 years and I am trained in IFS beginning in 2006, though I have never seen it as the "one true path" that some of my colleagues do, and I have never accepted the idea that our parts are literal sentient beings that live inside us. Nonetheless for me it has been personally transformative in many ways.
Anyway, I think this piece is incredibly thoughtful, balanced, and well written. Thank you!
I appreciate this critique so much Jamie, and as a former (and in many ways ongoing and lifetime) student of yours, I appreciate so much your ability to hold opposing views in tension, to remind us how to notice subtleties and the good that can coexist with the bad. Our world is becoming increasingly polarized and binary, and we are encouraged to make blanket statements and overarching judgments on things, people, ideas, that leave behind nuance and deep critical thinking. I appreciate how your framing challenges that and models a way forward. Thank you for all you do for our therapeutic community, we need your voice more than ever. And by the way, I say this as a psychologist, and I share your concerns about my profession’s questionable leadership. Sadly those concerns are nothing new, APA has been on the wrong side of history at pretty much every major juncture so it’s not surprising to see their spineless capitulation on DEI, though through my stupidity, like Charlie Brown and the football, I feel shocked anew every fucking time.
I love how well you concisely you were able to put this into words. It's such a difficult, nuanced conversation to have. I feel like we keep getting stuck in these black and white overcorrections or "going too far" in one direction or the other in the field. Thanks for writing this.
Hot Take: Some people don’t need therapists, they need practitioners. To me the difference is that a therapist talks with/through issues, while practitioners show you a healthy set of practices to add to your life, in hopes that it will provide some stability in certain areas.
For me personally, I’ve been saved by practitioners and almost ruined by the former. All nervous systems are triggered different, just have to find what works for you. I wanted to mention this, because I think some people don’t realize there is this other option. Many times they have the titles/qualifications, just different approaches to healing.
Thanks this is really great- and I think the same analysis applies to all of the critique around polyvagal and certain trauma theories. I’m curious about your take on that.
Thanks for writing this. Agree, agree, agree.
Thank you for an excellent critique. Some decades ago, in the US, we made an unholy alliance with the medical model and its co-partner, the insurance industry, because we wanted to get paid, and most people who wanted therapy couldn’t afford it. Consequently, we end up making normalizing judgments in order to fit our client’s experiences into a DSM diagnosis. As a result, an insurance company can refuse to pay if our work is deemed to not be “medically necessary.” So we deal with that as best we can.
I do have an issue with IFS’s insistence that everyone has a core Self, as I think that is a spiritual belief, and I try my best not to impose spiritual beliefs on my clients.
I do think this quote from narrative therapy co-founder Michael White is relevant to this discussion.
“I agree with Karl Tom’s opinion that those people who are practicing therapy, along with the persons who seek therapy, are the primary or basic researchers, and that those people who collect data in a more formal way are the secondary or supportive researchers. I've always been interested in primary research, and find the continual demands from secondary researchers that primary researchers justify their existence to be quite tedious.
“If the secondary researchers in our field could go further in relinquishing the moral high ground, and in revisioning research along the lines of recent developments in cthnomethodology— which would include the rendering transparent of the socially-constructed nature of their enterprise - then what secondary researchers do might become more relevant to what primary researchers do. I am sure that they could then have a very enriching collaboration. In saying this, I don't want to totalize secondary research. There are already some very sparkling developments
in secondary research in this field.”
One other thought. I see therapy as a glorious thing, and have dedicated 40 years to its pursuit. However, I think it’s a mistake to not understand that it is a dangerous process. If it “works” your life will change. Doors will open, but other doors will close. People in our lives will see us differently, and some won’t like what they see. As a result, some important relationships will likely be damaged, or fall away. Old struggles that seem inevitable and life-killing will lose their power, but new challenges will appear in their place. We may have more flexibility, and may be able to see them as life-giving challenges, but that doesn’t in any way mean moving through them will be easy.