An Appeal for Nondogmatic Executives in Our Oft-Dogmatic Field

Our field would benefit from less dogmatic thinking. Dogma thrives on the strength of tradition and authority. Ideas seem self-evident or beyond debate to dogmatic believers. While religious dogma may come to mind first, scientific thinking can succumb as well. We have an early history of Freudian dogma, but this way of thinking permeates several parts of our field today.

Dogmatic thinkers can be quite knowledgeable and sophisticated. Executives can give in to such thinking, but a business focus on competition and success can push against rigid, dogmatic thinking. We especially need nondogmatic executives. Leaders who are tied to tradition and authority may be less innovative, less flexible, less able to manage effectively in times of change.

Dogmatic Thinkers in Our Midst

What are some current examples of dogma? While the treatment of substance use disorders is evolving and often based on validated therapeutic approaches, there is a long history of SUD programs offering services that are non-professional and time-honored. People have designed programs to mirror what worked for them. The authority of personal experience is felt to be weightier than any clinical research.

This same mentality existed in the early days of psychotherapy. Therapists accepted the psychodynamic model as authoritative despite a lack of research evidence. Alternative dogmas became available through authority figures like Rogers, Perls, and Ellis. Psychotherapy research changed this. Yet it must be asked, why is CBT seen by many today as the gold standard? Is this what the evidence tells us?

Many CBT supporters approach research evidence with a type of compartmentalized thinking. They struggle not with a lack of evidence for CBT, but with the inconvenient truth that all major approaches to psychotherapy possess evidence of efficacy. They celebrate CBT’s superiority wearing blinders. Digital CBT programs are leading the way today in promoting this presumed superiority. It defies facts.

The biomedical model is not immune to such thinking. Our field has many useful medications, but this offers no guarantee of a biological basis for these disorders. Some fervently believe in such origins. They embrace a reductionist version of the biomedical model with biology the presumed cause of all illness. However, the model is an orientation to research, not a commitment to biological causation.

Concerns about the growing dogmatic status of the biomedical model led George Engel to formulate the biopsychosocial model in the 1970s. He noted that the biomedical model had dogmatic-like influence through authority and tradition. Yet debates regarding biology will likely conclude with two realities. A biological basis will be found for some disorders, not all.

Challenges Beyond the Constraints of Dogma

How should executives enter this fray? Above it. Dogma will not solve most problems. Some major challenges, like ensuring access to effective treatment, demand new approaches. For example, many people with opiate addictions lack access to effective medications (i.e., MAT). In terms of therapy, we praise empirically proven treatments yet overlook the need to identify empirically effective therapists.

Dogmatic devotion should be resisted, whether it appears as an exclusive commitment to the biomedical model, a belief in the absolute superiority of CBT, or an embrace of tradition over evidence. We need leaders who are nondogmatic and able to use good judgment about getting people access to quality care. Closing the treatment gap (i.e., those needing vs. getting care) should be a top priority.

Dogmatic thinking is also slow to change, and we need executives prepared for a rapidly changing landscape. Let us not waste time clinging to dogmatic approaches awaiting obsolescence. We also need to keep an open mind about where and how care is provided. Might future therapists see their patients in the primary care setting? Might they have 10-minute interventions? Might they promote digital care?

The 50-minute session is a tradition for a certain time and place. How many minutes are essential? Any dramatic changes like this will need the input of experts who must have a sense of urgency. We work in an evolving healthcare context, and we must adapt, reshape our services, and improve access. Let us better serve patients, as well as the multitudes with unrecognized and/or untreated behavioral needs.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.