It is an honest but also a striking admission. “We have taken a wrong turn in mental health care research. And I too have contributed to it myself,” admits Hutschemaekers. He says the origins of the problem lie in the 1980s and 1990s. “It was during this time that we developed a different perspective on interventions in healthcare, focusing on the question: are they really effective? Suddenly, we had to have an unequivocal answer to this question, with no room for interpretation. That answer was sought in the randomised clinical trial (RCT), a study approach in which groups of clients are divided into an experimental group and a control group. This made it possible to measure the effect of specific interventions for specific problems. But by applying that scientifically sound method in mental health care, we closed our eyes to the major effect of human interaction.”
Surrounding factors
In his explanation, Hutschemaekers points to the pitfall of impact measurement. “Suppose you do an intervention on a homogeneous group with a homogeneous problem. In such cases, impact measurement usually only looks at how an intervention works for that specific problem. In the process, you wrongly assume that the person administering the intervention does not actually matter. And also that it does not matter who the person receiving the intervention is, and how they and the therapist relate to each other.”
So the problem becomes central, which is Hutschemaekers’ criticism. “Of course, it is important to solve a problem, but in mental health care, there are also surrounding factors that have an impact. Consider the therapeutic relationship and other interpersonal factors. For example, how you deal with your clients as a therapist is important, and it largely determines the outcome of a treatment. But that is hardly taken into account in current impact measurements.”
Hutschemaekers therefore argues that there should once again be more attention for the interpersonal factor. “We want to justify all interventions scientifically, and this has led us off track. What I think we need to move towards is a different way of doing science. A way in which we can combine the rigour of a randomised clinical trial with consideration for individual differences. And a way in which there is more emphasis on interpersonal relationships, which actually affect the outcome of a treatment.”
To support his argument, Hutschemaekers cites his own practical experiences as a therapist. “In my work, I treated a large number of clients, who were psychologically stuck. Time and again, I noticed that by using a scientifically sound intervention, I managed to do more with one depressed client than with another. Looking back, those differences were mainly the result of my interpersonal relationship with these clients, such as our personal interactions. We still teach our students to be as neutral as possible in contact with a client, because that supposedly maximises the effect of an intervention. However, I would like to claim that the more you as a therapist make use of your personal strengths, the better you probably can help the client.”
Power of practice
According to Hutschemaekers, it is therefore time for a revolution. “Mental health care practitioners, including myself, have been too much seduced by the power of science and not mindful enough of the power of practice. We must wake up to the fact that a mental health problem is not the same as, say, appendicitis. An appendicitis does not change when you look at it or talk to it, while a mental health problem is constantly in flux. Yet in healthcare, we have mistakenly tried to unify these different types of problems. My wish is for scientists and practitioners in mental health care to engage in more dialogue with each other. The latter group's knowledge and experiences are hugely valuable.”
Despite his observation that research in mental health care is heading in the wrong direction, Hutschemaekers is still hopeful about the future. “Lately, I have been meeting newf PhD candidates who recognise the need to devote more attention to the interpersonal factor in interventions and who develop new methods to include the interpersonal factor into research. I wish this new generation will have the space to take their ideas around this further. My hopes are pinned on them. And as a therapist, I have seen with clients that all change begins with hope. Now let that hope also be the start of a revolution for our profession.”