Psychotherapy Outcome Debate: Diversity Implications

I have written about many concerns about certain trends in the outcome research literature in psychotherapy that are attempting to exclusively use research based upon a narrow definition of science to evaluate psychotherapy. However, maybe the most egregious concern about this approach is the lack of sensitivity to diversity. It is not that these approaches do not try to find what are “effective” approaches to therapy with various cultural groups; instead, it is that it mandates that all cultural groups should seek the same outcome in therapy.

Many critiques of psychotherapy have been written from the perspective of demonstrating that much of the field of psychology was build upon a White male ideology. This still exists and it remains relevant in this debate. A narrow definition of science, and the therapies which are best supported by research based upon a narrow definition of science, tend to reflect a strong White male bias. White males typically, though not always, have a strong tendency toward valuing or privileging rational, linear thinking. Some therapy approaches, most notably cognitive behavioral therapy, also tend toward this type of thinking.

Many cultural groups value a more inclusive ways of knowing and being in the world than the rational, linear approach to living. For example, women tend to prefer approaches to knowing and being that are inclusive of emotional, relational, and intuitive ways of knowing. Similarly, many cultural groups, including Latino/a, African American, and many Eastern cultures, value cultural and narrative ways of knowing. These other ways of knowing and being do not necessarily devalue rational or linear ways of knowing, but they suggest they are not the only ways of approaching life and often not even the most valuable.

If we privilege an approach to science, psychotherapy, and evaluating psychotherapy that is biased toward White male ways of knowing, we are sanctioning these as “better” and often pathologizing other choices on how to approach living. It is my belief that basing outcome research in a narrowly defined epistemology, such as those represented in the narrow definitions of sciences, is a form of racism or, more specifically, a racial microaggression. The only way we can promote a culturally sensitive psychology is to do so in a way that values various ways of living, including those not espoused by the dominant culture. This is not to suggest there are not some ways of living that are not unhealthy across cultures, but rather to emphasize that there are many healthy ways of living. Until we can develop a psychology, and accompanying psychological science, that deeply recognizing this, we will constantly remain in danger of using psychology in a way that is, essentially, racist, sexist, and homophobic. This is true even if on the surface it is espoused that these cultural groups are valued. It is very different to just value cultural groups than to also value the accompanying ways of being that are often predominant in these groups.