When working with a case of borderline personality disorder or an anxiety disorder, on what basis do we decide which path to follow? At this point, it is important to highlight the concept of therapist drift, because avoiding this phenomenon is one of the key elements of delivering effective treatment.
The term therapist drift refers to situations where therapists move away from evidence-based therapy and begin to apply their own methods during sessions. Even if the therapist’s intentions are good, deviating from scientifically validated approaches not only takes up more of the client’s time but also raises numerous questions about the course of treatment.
For instance: Is this ethically acceptable? Why take a different path when there already exists a method whose effectiveness has been empirically demonstrated?
Why Do We Move Away from Evidence-Based Therapy?
There are several reasons why therapists might drift away from evidence-based treatments.
The first reason is that many therapists have not received sufficient training in this area (Royal College of Psychiatrists, 2013). How many psychology programs in Turkey, for instance, include the NICE guidelines within their clinical psychology curriculum? How many psychology graduates are actually aware of the importance of evidence-based therapies? These questions are critically important when it comes to evaluating the quality of therapeutic services provided.
Another reason is working in an institutional setting that does not allow for the proper implementation of therapeutic methods. When an institution demands longer-than-necessary sessions or restricts the number of sessions allowed, this creates problems both ethically and in terms of effectiveness.
Even when therapists receive adequate and proper training, they may still drift away from evidence-based practice—and whether this occurs consciously or unconsciously, it ultimately reduces the client’s likelihood of recovery.
Three Conditions for Effective Therapy
For a given therapy to be considered effective, three conditions must be met:
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The therapy itself must work.
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The client must be actively engaged in the process.
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The therapist must deliver the therapy correctly.
The first condition—the therapy has to work—involves using structured, evidence-based treatments and techniques such as CBT, and establishing a strong therapeutic alliance. The effectiveness of properly implemented, manualized therapies has been well established (Addis & Waltz, 2002; Cukrowicz et al., 2011; Crits-Christoph et al., 1991). However, deviating from the protocol or delivering the therapy in a different way than intended significantly reduces its effectiveness.
According to the second condition, the client’s mere physical attendance at sessions is not sufficient for meaningful therapeutic progress. Active engagement and continuous effort are crucial. This means that while the therapy session may last one hour per week, the remaining 167 hours should be devoted to integrating what has been learned in therapy into daily life.
The third condition is that therapists must deliver evidence-based treatments to their clients. Therapy is most effective when these approaches are applied properly by professionals who have received the necessary training and are authorized to deliver them.
Otherwise, therapeutic effectiveness can be seriously undermined. Moreover, when a therapist claims to “practice CBT,” it is not always clear to what extent the treatment is actually being implemented accurately and in accordance with the protocol. Simply labeling a therapy as “CBT” does not guarantee that it is being delivered in the most effective or evidence-based manner. Therefore, adhering to established guidelines is essential.
Beliefs
How therapists deliver therapy is closely related to their own belief systems and attitudes. These beliefs and attitudes can shape the therapist’s emotions and behaviors during sessions.
For example, according to clinical guidelines, the therapeutic alliance is important but not a sufficient condition for effective treatment — the correct use of therapeutic techniques is far more crucial. A therapist who believes that the guidelines do not give enough importance to the therapeutic alliance may approach them with bias, which in turn can lead to therapist drift.
In addition, therapists often display a strong bias toward viewing themselves as more competent and skilled than they actually are, typically rating their abilities well above average. This overconfidence can cause therapists to drift away from evidence-based treatments and may even result in a decline in their ongoing professional development.
Therapists should also avoid weakening the exposure process during sessions in an effort to reduce clients’ anxiety. Often, this modification serves to reduce the therapist’s own anxiety rather than the client’s distress. However, for clients to benefit from therapy, it is essential that they experience and tolerate anxiety during exposure.
Engaging in behaviors that reduce anxiety can create a repetitive avoidance cycle, ultimately contributing to therapist drift.
Toward a Solution
The article Therapist Drift Redux (Waller & Turner, 2016) suggests that, to prevent therapist drift, therapists should practice cognitive-behavioral therapy (CBT) techniques on themselves. By doing so, therapists personally experience how CBT methods work in practice.
When therapists go through these processes themselves, they gain a deeper understanding of the difficulties faced by their clients. This experience helps them apply the techniques more accurately and reduces the likelihood of therapist drift.
In addition, Routine Outcome Monitoring (ROM) supports the maintenance of evidence-based standards by allowing systematic tracking of therapeutic progress, thereby helping therapists stay aligned with the principles of evidence-based practice.
References
Addis, M. E., & Waltz, J. (2002). Implicit and explicit processes in the development of therapeutic insight: Toward a theoretical integration. Cognitive Therapy and Research, 26(4), 447–458. https://doi.org/10.1023/A:1016230528956
Cukrowicz, K. C., Timmons, K. A., Sawyer, K., Caron, K. M., Gummelt, H. D., & Joiner, T. E., Jr. (2011). Improved treatment outcome associated with the shift to empirically supported treatments in a graduate training clinic. Professional Psychology: Research and Practice, 42(3), 230–237. https://doi.org/10.1037/a0022748
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., Luborsky, L., McLellan, A. T., Woody, G., Thompson, L., Gallagher, D., & Zitrin, C. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1(2), 81–91. https://doi.org/10.1080/10503309112331335511
Royal College of Psychiatrists. (2013). Whole-person care: From rhetoric to reality. Achieving parity between mental and physical health. London: Royal College of Psychiatrists.