Why I’m Not Attending the Evolution of Psychotherapy

There’s an evolution of psychotherapy happening, and the Evolution of Psychotherapy conference happening later this year is ignoring it. The omission is so glaring that I can’t in good conscience attend, despite the fact that many of my professional heroes will be presenting.

The evolution of psychotherapy in the US has not been, by and large, an evolution in technique. While there have been some advances (EMDR and EFT are examples), there’s still meaningful debate about whether these approaches are actually more effective than the models that came before. 

The biggest evolution of psychotherapy in the US has been an evolution in the people doing the work. In a relatively short period of time, the field of psychotherapy has become increasingly diverse, with many more women and people of color represented.

Given the heavily white male history of the field, I view these changes as overwhelmingly positive. It’s easier than ever for people from a wide variety of backgrounds to find a therapist who looks like them and has a deep personal understanding of their experience.  

It’s undeniable that these changes are happening. But the Evolution of Psychotherapy conference ignores them. The announced faculty for the 2020 conference remains largely the same as the 2017 conference, which was largely the same as the 2013 conference. It’s still mostly white men talking about the same topics they’ve talked about for decades. It’s not evolving with either the profession or the population it serves. 

I attended Evolution in 2013 and 2017. The conference undeniably provides an opportunity to hear from living legends in the field. I’ve had the great privilege of speaking with a number of people there whose work I deeply respect. 

But at both of those conferences, the organizers heard from many respondents about how the conference, and in particular its invited faculty, was failing to reflect the actual evolution of the field. The conference’s response appears to have been to ignore this feedback, or worse, to dismiss it as irrelevant. 

Just how dramatic has the actual evolution of psychotherapy been? Here are the numbers.

Women Are Increasingly Represented in Mental Health Care

According to the APA, in 2016 women made up 65 percent of US psychologists—an increase of 8 percent in 9 years. There’s strong evidence this trend will continue, as psychologist men age out of the workforce. In 2016, the average age of male psychologists was 54.4 years old, almost seven years older than the average female psychologist (47.6).

The number of psychologist men in the US has been relatively stable, hovering around 33,000 people. By comparison, the number of women is growing dramatically, from about 43,000 in 2007 to more than 60,000 in 2016—an increase of more than 40 percent in a decade.

In 2017, 75 percent of psychology doctorate degrees were awarded to women. Similar trends are present in the master’s level professions. A 2007 California board survey found that more than 80 percent of pre-licensed social workers and family therapists in the state were women.

Even the academic world, which has been considered slow to change, is starting to see more women hold advanced degrees. Among research psychology doctorate holders in faculty positions, 53 percent were women as of 2015. 

Ultimately, if you’re a therapist attending Evolution, you quite probably identify as a woman. But at each session you’ll be attending, your instructor quite probably identifies as a man. Among the 49 members of the Evolution faculty, 31 are men and only 18 are women. All four of those designated as co-faculty are also men. Include them, and the total faculty is 66 percent men.

A More Racially and Ethnically Representative Field

The field of psychology continues to struggle with racial and ethnic representation. According to the APA, just 16 percent of psychologists in 2016 were non-white, compared to 39 percent of the US population. 

But the field is changing. Fewer than 10 percent of mental health professionals above age 50 are non-white, while more than 20 percent of those under age 50 are non-white. And more than 30 percent of those who earned psychology doctorates in 2017 were people of color.

Moreover, most US psychotherapists aren’t psychologists. They’re counselors, social workers, and family therapists licensed at the master’s degree level. And these groups are much more representative of the US population.

Among social workers with at least a master’s degree, roughly 27 percent are people of color. If you limit the analysis to just new graduates with at least a master’s degree, this number grows to 43 percent. In California, even as far back as 2007 more than half of prelicensed social workers were non-white, as were almost 40 percent of prelicensed family therapists.

The People Are Why Psychotherapy Works

It may be tempting to dismiss discussion of the workforce and argue that the Evolution conference is about technique. But that line of thinking is precisely why therapy isn’t getting any more effective.

The pursuit of different therapy models, without attention to the people delivering those models, has kept therapy outcomes stagnant over the past 50 years, according to a presentation Scott Miller delivered at—wait for it—the 2013 Evolution conference. He made the point again in 2017, and I suspect he’ll do so again this year. 

He has cordially but unmistakably been trying to send the message that when it comes to making therapy work better, we’re barking up the wrong tree. By spending less time and effort on models and techniques, and more time on the people delivering them, we could start to make gains in effectiveness once again.

While other healthcare fields refine their work and become more effective over time, psychotherapy isn’t keeping up. And yet, we could. A 2015 thought experiment paper based on existing data showed that if an agency measured therapy outcomes with every client and regularly replaced underperforming therapists—regardless of what models those therapists were using—the agency’s overall outcomes jumped over time. 

While accepted therapy models all tend to show similar effects, there is a meaningful difference in the outcomes achieved by specific therapists. So an Evolution conference focused on models and techniques is a conference that reinforces the wrong idea that has kept the effectiveness of the profession stalled for at least two generations.

What a More Evolved Conference Could Be

Simply put, the field of psychotherapy is evolving. It is long past time for our conferences to recognize these changes. And there are some smaller conferences that more accurately reflect the profession as it is today. I was proud to present at the Diversity in Parenting conference in 2018, and this year’s third iteration of Therapy Reimagined in Los Angeles also brings in a wider range of mental health presenters and perspectives. 

Some of these presenters may be less well-known, at least for now. But they far more accurately demonstrate the evolution of psychotherapy than this year’s Evolution of Psychotherapy—which is why I will not be there.

____

Disclosure from Dr. Ben Caldwell: Scott Miller interviewed me for his blog a few years ago, and his research has a main role in my book Saving Psychotherapy. SimplePractice sponsored the 2018 Diversity in Parenting conference and is a sponsor for Therapy Reimagined.

---