Responsiveness and Clinical Judgment as an Alternative to Drifting: A Narrative Update

Abstract

This manuscript challenges the notion of “therapist drift”—the deviation from evidence-based practices due to the partial application or non-adherence to treatment protocols—proposing that such deviations often reflect good clinical judgment and a commitment to personalized patient care. Drawing on recent research, we argue against the conventional wisdom that adherence to empirically supported treatments based on narrow diagnostic criteria guarantees superior therapeutic outcomes. We highlight the “dodo bird verdict,” which suggests the equivalence of different psychotherapy approaches in effectiveness, and scrutinize the American Psychological Association’s endorsements of empirically supported treatment relationships, emphasizing the move towards personalized psychotherapy. We argue that due to validity concerns of prevalent diagnostic taxonomies and the heterogeneity of desired therapy outcomes across diverse methods and patient needs, randomized controlled trials comparing treatments for fixed diagnoses are inadequate for guiding clinical decisions. We propose adjusting therapy to the patient’s unique characteristics and desired outcomes—not strict protocol adherence—indicates responsiveness and clinical acumen, necessitating a shift toward more nuanced, patient-centered therapeutic models.