The McDonaldization of psychotherapy: Processed foods, processed therapies, and economic class

Questions pertaining to “empirically supported treatments” (ESTs) frequently address concerns about “measurement” and “evidence,” but rarely frame the conversation in terms of differences in the linguistic possibilities represented in each treatment orientation and how the availability and marketing of therapeutic languages are parsed out along class lines. Moving the conversation “beyond ESTs,” the author addresses how language positions persons into a particular relationship with their experience—a way of understanding their suffering and identity—and the significance of understanding therapeutic orientations as representing an epistemological pluralism rather than existing merely on an evaluative axis related to evidence and effectiveness. Next, the intersection between language, experience, and class access to treatment orientations and discourses is considered. It is argued that the emphasis on evidence-based modalities and symptom-reduction models impacts the experiential possibilities of persons in important and often disguised ways and this has a particular bearing on persons with fewer economic resources who have access to a narrow range of therapeutic and epistemological possibilities. Linguistic options are circumscribed and pre-decided. Lastly, the author illustrates the segregations and hierarchies of therapeutic approaches available at different class designations and the marketing of evidence-based epistemologies through the cultural allure and capital of “science.” The author concludes with expressed concerns regarding present epistemological narrowness in the mental health delivery system and proposes that additional dimensions be explored in the “evidence-based” discussions.