Dear Editor: In response to the authors of the letter “Prioritizing the development of evidence-based therapists over the deployment of evidence-based therapies” regarding our previous publication1, we agree that there are common factors that cut across modalities of psychotherapy, often reflected in therapeutic alliance, and this is not a novel observation; it was well described by Jerome Frank2 in his classic text, Persuasion and Healing, more than 50 years ago. The citations that the letter authors provide for evidence-based therapists and for the trumping value of the therapeutic alliance over other aspects of psychotherapy are books rather than peer-reviewed journals with level 1 evidence. The move toward manualised treatments in psychotherapy reflects a drive for standards, accountability, measurement, and reproducibility. As clinicians, we understand and adhere to the art of medicine, which involves adapting available evidence-based treatment to the unique needs and preferences of patients. We are uncertain how the proposed “evidence-based therapists” would be credentialed with regard to their therapeutic alliance skills, which are acknowledged to vary across clinicians. As for the assertion that “developing clinicians who are adept at mentalizing and sustaining therapy relationships would likely accomplish more than the deployment of brand-name therapy,” we encourage the authors to test the hypothesis and generate the evidence to support it.
David Gratzer, MD
The Scarborough Hospital Toronto, Ontario
Department of Psychiatry, University of Toronto, Toronto, Ontario
David Goldbloom, MD
Centre for Addiction and Mental Health, Toronto, Ontario
Department of Psychiatry, University of Toronto, Toronto, Ontario
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Contributor Information
David Gratzer, The Scarborough Hospital Toronto, Ontario; Department of Psychiatry, University of Toronto, Toronto, Ontario.
David Goldbloom, Centre for Addiction and Mental Health, Toronto, Ontario; Department of Psychiatry, University of Toronto, Toronto, Ontario.
References
- 1. Gratzer D, Goldbloom D. Making evidence-based psychotherapy more accessible in Canada. Can J Psychiatry. 2016;61(10):618–623. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Frank JD. Persuasion and healing: a comparative study of psychotherapy. Baltimore (MD): Johns Hopkins University Press; 1961. [Google Scholar]