Why do they call some forms of psychotherapy evidence-based? Isn’t everything in science and medicine supposed to be informed by evidence?
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A lot is cultural or a result of the space they work in.
Therapists can’t switch methods like a GP switches drugs, each method requires training. So that discourages experimentation, and switching methods. Also they’ll be less experienced at the new method, so even if it is more effective on average there may be a cost to switching.
Trials have to be large to eliminate effects of different therapists (and others involved in that patient’s care). If you had a therapist who was really good at convincing people to try new things it might be whatever arm they are on has more success despite the actual intervention being tested. So trials need to be larger, or longer, or more cross overs to remove or mitigate these, all of which makes them more expensive.
I think they’ll get there, but it will be slower, and more costly. I do think there is a risk we end up with interventions that test well. It may look a lot less like traditional psychotherapy that wasn’t based on evidence.
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