Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track.

Waller, G., & Turner, H. (2015).

Behaviour Research and Therapy, 77, 129–137.

https://doi.org/10.1016/j.brat.2015.12.005

Abstract

Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.

Highlights

• We consider the recent evidence that therapist drift is a common phenomenon in psychological therapies.

• We consider the reasons that therapist drift takes place.

• A cognitive-behavioural approach to overcoming therapist drift is outlined.

Here are some thoughts:

Therapist drift is when clinicians fail to deliver evidence-based treatments effectively, despite having the training and resources to do so.  This drift can occur consciously or unconsciously and results in patients receiving suboptimal care, reducing their chances of recovery.  Factors contributing to therapist drift include the therapist's knowledge, beliefs, emotions, personality, behaviors, and social environment.  Research indicates that therapist drift is a significant issue in delivering cognitive-behavioral therapy (CBT).  To address therapist drift, strategies incorporating a cognitive-behavioral approach may be beneficial, targeting the beliefs, emotions, and behaviors that lead therapists away from evidence-based practices. 

Bounded ethicality and ethical fading in negotiations: Understanding unintended unethical behavior.

Rees, M., Tenbrunsel, A., & Bazerman, M. (2018).

Academy of Management Perspectives, 33(1), 26–42.

https://doi.org/10.5465/amp.2017.0055

Abstract

The business scandals of the past several decades have led to the rising importance of ethics as a topic central to management scholarship. Behavioral scientists in particular have been attracted to the topic in far greater numbers, and the study of ethical decision making has emerged as a core subfield (Messick & Tenbrunsel, 1996). This paper draws on that framework and applies it to negotiations, arguing that not all unethical behavior is intentional; rather, negotiators fall prey to bounded ethicality, engaging in behavior that is contradictory to their values without realizing that they are doing so. We further argue that ethical fading—when individuals do not see the ethical implications of the situation or their action—is central to explaining why this occurs. Relying on past empirical research, we identify negotiation cues that have been linked to unethical behavior, and explore how they make a negotiator particularly vulnerable to ethical fading, resulting in subsequent unethical behavior. We discuss several opportunities for future research in the negotiation discipline and other disciplines that draw on motivated social exchange or assume intentionality, and conclude with a call for scholars to define normative standards as they pertain to negotiator ethics.

A pdf of the article is here.

Here are some thoughts:

The article explores how ethical failures in organizations often result not from intentional wrongdoing, but from cognitive limitations and unconscious biases that restrict individuals’ ability to act ethically. The authors argue that even well-intentioned people routinely engage in unethical behavior without realizing it due to bounded awareness—where individuals fail to see or act on all relevant ethical information. Factors such as implicit biases, motivated blindness, and outcome bias distort judgment and decision-making, making unethical actions seem acceptable. The article calls for greater structural and organizational changes, rather than solely relying on individual character or compliance efforts, to address these hidden ethical failures and promote more ethical behavior.

Religion, Spirituality, and Suicide

Knapp, S. (2024, September 25).

Society for the Advancement of Psychotherapy.

Article Link is here.

When evaluating suicidal patients, it is often indicated to ask them about their religious beliefs about suicide because many patients believe that their spiritual or religious beliefs1 are closely linked to their mental health (Yamada et al., 2020). For example, some patients in significant emotional distress say they would not kill themselves because their religion strongly condemns it. For them, religion includes a life-protecting belief that prohibits them from attempting suicide.  

Nonetheless, the relationship between religion, spirituality, and suicide goes deeper than just prohibitions against suicide. Instead, religious and spiritual beliefs influence how people care for themselves, interact with others, think about themselves, and interpret their life histories. For example, some people have religious or spiritual beliefs that command them to live their lives productively, express their talents and abilities, and show love for others while experiencing joy. For them, religion includes life-promoting beliefs that encourage them to flourish and thrive. 

The goals for treating suicidal patients are to keep them alive and to help them create lives worth living. While life-protecting beliefs may help keep many patients alive (at least temporarily), life-promoting beliefs help keep patients alive and also help them to create lives worth living. This article suggests ways psychologists can encourage life-promoting beliefs when working with suicidal patients.

The entire article is here.

Here are some thoughts:

The article explores the complex relationship between religious and spiritual beliefs and suicide risk. It highlights that while religious affiliation and spiritual practices can offer protective benefits against suicidal ideation and behavior, the impact varies based on individual experiences and contexts. Positive religious coping mechanisms—such as finding meaning, community support, and hope—are associated with reduced suicide risk. Conversely, negative religious coping, including feelings of punishment or abandonment by a higher power, may exacerbate distress and increase risk. The article emphasizes the importance for mental health professionals to assess and integrate clients' spiritual and religious dimensions into therapy, tailoring interventions to support each individual's unique belief system.

Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022).

Journal of Sex & Marital Therapy, 48(7), 706–727.

https://doi.org/10.1080/0092623x.2022.2046221

Abstract

In less than a decade, the western world has witnessed an unprecedented rise in the numbers of children and adolescents seeking gender transition. Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. The many risks of these interventions, including medicalizing a temporary adolescent identity, have come into a clearer focus through an awareness of detransitioners. The risks of gender-affirmative care are ethically managed through a properly conducted informed consent process. Its elements—deliberate sharing of the hoped-for benefits, known risks and long-term outcomes, and alternative treatments—must be delivered in a manner that promotes comprehension. The process is limited by: erroneous professional assumptions; poor quality of the initial evaluations; and inaccurate and incomplete information shared with patients and their parents. We discuss data on suicide and present the limitations of the Dutch studies that have been the basis for interventions. Beliefs about gender-affirmative care need to be separated from the established facts. A proper informed consent process can both prepare parents and patients for the difficult choices that they must make and can ease professionals’ ethical tensions. Even when properly accomplished, however, some clinical circumstances exist that remain quite uncertain.

Here are some thoughts:

The article critiques the prevailing standards for obtaining informed consent in the context of gender-affirming medical interventions for minors and young adults. It argues that current practices often fail to adequately ensure that patients—and in many cases, their guardians—fully understand the long-term risks, uncertainties, and implications of puberty blockers, cross-sex hormones, and surgeries. The authors contend that the developmental immaturity of children and adolescents, combined with social pressures and sometimes incomplete psychological evaluations, undermines the ethical validity of consent. They advocate for a more cautious, evidence-informed, and ethically rigorous approach that prioritizes psychological exploration and long-term outcomes over immediate affirmation and medical intervention.