The antidote to noisy human performance? — Technology and Technique.

10/13/21

I talk a lot about how the field of psychotherapy hasn’t changed in the past 40 years. But what would it take to actually move the field forward? I think we can learn a few things by looking at how innovation and change happens in other fields.

On Technology.

The technology which changed the game for Cystic Fibrosis was the Compression vest. Cystic Fibrosis (CF) causes mucus build up in the lungs which makes it hard to breathe and, if untreated, leads to death. In the past, people with CF had a partner pound on their back twice a day to loosen up the mucus, every day, for their entire lives. The Compression Vest allows the person with CF to self administer a standard drumming, which means no more worrying about bothering your partner to pound and no more worrying about if they are pounding too hard or to soft. In 1996 the average life expectance of someone with CF was 10 years old. In the early 2000s, since the development of the vest, life expectancy has moved into the mid thirties.

On Technique.

The technique which changed medicine was handwashing. Igor Semmelweis M.D. “discovered” the importance of handwashing in the mid 1800s. Charged with lowering newborn deaths he noticed that children born at the midwife clinic rarely died after birth. The only difference was the midwives washed their hands before delivery, while the physicians at his hospitals did not. After he mandated handwashing at his hospital infant mortality fell from 10% to 3%.

On Noisy Human Performance.

Right now therapy outcomes are linked to therapists performance. The problem is that human performance is inconsistent. Some days we perform well, and some days we do not. What we need is some sort of technique which is so simple humans can’t mess it up (#handwashing) or some sort of technology which removes human inconsistency (#Cystic Fibrosis Vest).

We may already have those. In some ways I think The Safe and Sound Protocol, the standardized 5 hour music therapy intervention, is one of the latter. Another example of standardizing technology is neurofeedback. But whatever the new “tech” is, we need them if we want to move the field forward. We can’t rely on human performance alone.

The Conclusion — Magic Bullets.

Again and again simple techniques and technologies like these add huge gains. The techniques of the Flip Turn and the Fosbury Flop caused huge improvements in swimming and high jump. The technology of immunizations and thermometers caused huge increases in health. I think we need something similar in therapy.

But let’s also be clear, these gains will not “fix” all of our problems. Too often new interventions are touted and magic bullets. Let’s not over promise. A new pain medication is really good at making your pain go away. It’s not also going to cure cancer, end AIDS and fix world hunger. We need to have the same mindset with psychotherapeutic interventions. Which is hard because human problems, the kinds of things therapists are asked to help with, are rarely one dimensional.