Evidence-Based Practice: Beyond Empirically Supported Treatments.

Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical experience, and their clinical judgment about the case at hand. Some shortcomings of ESTs are reviewed, and a form of evidence for psychotherapy practice is presented that entails the accumulation of systematic case studies published online. Practitioners can contribute to such a database and be guided in their practice by those cases most relevant to their clients' problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychotherapy integration: Closing the gap between research and practice.

Over the past several decades, the field of psychotherapy has become more receptive to the idea of integration. For the most part, efforts have been made to find commonalities and complementarities across different theoretical orientations. When the Society for the Exploration of Psychotherapy Integration (SEPI) was formed in 1983, its stated goals were for the integration of different approaches to therapy, but also for the integration of research and practice. This article comments on the long-standing gap between practice and research, and offers ways in which this gap may be closed. Moreover, in light of increasing demands for accountability, it is maintained that empirical pragmatism needs to be the integrative theme of the 21st century. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing paradigms from empirically supported treatment to evidence-based practice: A cultural perspective.

Psychotherapy research guidelines have a profound impact on research, training, and practice, and they also influence reimbursement decisions that can have ethical and legal consequences. Furthermore, research guidelines have implications for the treatment of culturally diverse groups. Unfortunately, these implications have often been overlooked. Therefore, this article contrasts the impact of two prominent research guidelines on the development of culturally sensitive psychotherapies: (a) empirically supported treatments (ESTs) developed in 1995 by the American Psychological Association’s (APA) Division 12 (Society of Clinical Psychology; Task Force on Promotion and Dissemination of Psychological Procedures, 1995), and (b) evidence-based practice in psychology (EBPP) developed by the APA (Task Force on Promotion and Dissemination of Psychological Procedures,2006) Presidential Task Force on Evidence-Based Practice. Although overall we believe that EBPP is more responsive to the needs and characteristics of culturally diverse groups, ESTs also have many strengths. As the cultural implications of research guidelines are better understood, researchers and clinicians will be able to more effectively advance the development of culturally sensitive evidenced-based psychological treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What Works in Psychotherapy and How Do We Know?: What Evidence-Based Practice Has to Offer.

Evidence-based practice may be insufficiently understood by dynamically oriented therapists and analysts. It includes the integration of the best available research evidence, clinical expertise, and considered attention to a patient's personal attributes, sociocultural characteristics, and unique dynamics. These 3 streams of knowledge inform clinical practice. Advocates of a manual approach to treatment have challenged clinicians to rethink the importance of what they consider salient in their therapeutic endeavors. This article demonstrates the relevance of an evidence-based practice perspective for dynamically oriented clinicians. An American Psychological Association task force has been established to develop and elaborate the view of current clinical practice so that it can be disseminated to clinicians and to the public as a policy statement that governs clinicians' thinking and work. The goal is to provide knowledgeable, reasonable, and responsible high-quality health care to those who need it based on these developed practice principles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responses of practicing psychologists to a web site developed to promote empirically supported treatments.

Increased adoption of empirically supported treatments (ESTs) has been hindered in part by inadequate and inconvenient access to EST information and training. To improve diffusion of ESTs, the authors developed a Web application to provide practitioners with concise information by disorder on ESTs. The resulting site, therapyadvisor.com, was evaluated by 239 practicing psychologists to assess the usefulness of the site and explore possible interactions of EST attitudes on ratings of usefulness and impact. Two thirds of participants indicated using ESTs in practice, and limited time and resources were cited as primary barriers to EST adoption. The Web application was rated positively by most participants and was reported to increase awareness of and commitment to try ESTs among approximately 60% of participants. The results of this project support the feasibility of a Web application to increase diffusion and promote further adoption of ESTs. Technological and e-learning advances are promising directions for encouraging the adoption of ESTs specifically and evidence-based practice generally, particularly among busy practitioners who have inadequate time and resources for more traditional forms of dissemination and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: The evidence-based treatment debate: Toward a dialectical rapprochement.

In this commentary on Zeldow's (2009) “In Defense of Clinical Judgment, Credentialed Clinicians, and Reflective Practice,” the dialectical method is presented as a conceptual model and strategy for reconciling the division between clinical practitioners and clinical scientists in their acceptance of the need for empirically based psychological treatments and practices. Recommendations are made for (a) better integrating practitioners in the conduct of science, (b) confronting unhelpful attitudes of scientific chauvinism and imperialism, and (c) recognizing the contributions of both microlevel (process) and macrolevel (outcome) phenomena in psychotherapeutic practice and its scientific investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond “ESTs”: Problematic assumptions in the pursuit of evidence-based practice.

There has been much confusion in the literature of psychotherapy between the broad concept of evidence-based practice and the narrower set of criteria that have been employed in designating certain treatments as “empirically validated” or “empirically supported.” In contrast to the appropriate concern with examining the evidence for the efficacy of various approaches to therapy and for the theoretical assumptions that underlie them, the “empirically supported treatments” movement has been characterized more by ideology and faulty assumptions than by good science. This paper examines in detail the scientific and logical limitations of the “EST” movement and aims to place the empirical investigation of theory and practice in psychotherapy on a sounder basis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Evidence-based Psychotherapy: Where Theory and Practice Meet.

Reviews the book, Evidence-based Psychotherapy: Where Theory and Practice Meet edited by Carol D. Goodheart, Alan E. Kazdin, and Robert J. Sternberg (see record 2006-02969-000). The distinguished editors and authors of Evidence-Based Psychotherapy: Where Theory and Practice Meet have created an intellectual atmosphere in the book that paves the way for generative development of evidence-based practice (EBP) in psychotherapy in the future. The book is organized into three sections: 1) "The Practice Perspective," 2) "The Research Perspective," and 3) "Training, Policy, and Cautions." This book is an important addition to the debate on EBP in psychotherapy and highlights issues that extend well beyond the role of psychotherapy in EBP. It is highly recommended for practitioners and researchers alike and is likely to invite thoughtful questioning and reflection on core assumptions at both ends of the spectrum. Moreover, the book would serve as a useful primer on the issues germane to EBP in psychotherapy training for graduate students and psychiatric residents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of play therapy: Elevating credibility through play therapy research.

Elevating credibility in play therapy through research has been a difficult task. This difficulty is represented well in the Myth of Sisyphus (wherein Sisyphus is cursed with the mandate of rolling a large boulder up a hill, only to have it roll back down every time he approaches the top of the hill). Play therapy, in some form, has been in mental health clinics, clinician’s offices, and in journals for more than a century—yet empirical research on play therapy has consistently lagged behind practice. Also, we have several decades of research supporting the use of play therapy in addressing many common childhood problems, yet there is little recognition of play therapy as an “empirically supported treatment.” To stretch the Myth of Sisyphus just a bit, if we are to see the effort to develop empirical support for play therapy as our task, we need to look carefully at who is pushing the boulder, what strategies are being used to get the boulder up the hill, and how we will we know when we’ve reached the top of the hill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing Evidence-Based Practice: The Role of Case-Based Research.

How can practitioners engage in evidence-based practice when the evidence for effectiveness of psychological treatments comes from randomized controlled trials using patient populations different from those encountered in everyday settings and treatment manuals that seem oversimplified and inflexible? The authors argue that important evidence about best practice comes from case-based research, which builds knowledge in a clinically useful manner and complements what is achieved by multivariate research methods. A multidimensional model of the research process is provided that includes clinical practice and case-based research as significant contributors. The authors summarize the principles of case-based research and provide examples of recent technical advances. Finally, the authors suggest ways in which practitioners can apply the case-based approach in researching and publishing their own cases, perhaps in collaboration with university-based researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoothing the trail for dissemination of evidence-based practices for youth: Flexibility within fidelity.

The role and implementation of evidence-based practice and empirically supported treatments has been hotly contested among researchers and practitioners. Using examples of and from various empirically supported treatments the authors offer suggestions for smoothing the pathway for dissemination of evidence-based practice with children and adolescents. The authors underscore that mediational analyses, treatment process studies, and the continued creation of flexible treatment manuals are important components of successful dissemination. Flexibility within fidelity is proposed as the preferred perspective that eases the transition and dissemination of empirically supported treatments from research clinics to service clinics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing key challenges in evidence-based practice in psychology.

With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research literature can be generalized to typical clinical practice, and how effective evidence-based treatments are in clinical practice. On the basis of recent evidence-based initiatives and treatment research, there is a solid scientific basis for EBPP, although much more research is necessary on the treatment of relatively mild, but common, clinical conditions and on the transporting of evidence-based treatments into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-Based Practice: Promoting Evidence-Based Interventions in School Psychology.

We present an overview of issues related to evidence-based practice and the role that the school psychology profession can play in developing and disseminating evidence-based interventions (EBIs). Historical problems relating to and the recurring debate about the integration of research into practice are presented as a context for the current challenges faced by those engaged in the EBI movement in psychology and education. Potential solutions to the problems posed by the adoption of EBIs in practice are presented within the context of the directions to be taken by the Task Force on Evidence-Based Interventions in School Psychology (Task Force). Five assumptions are presented that can guide the Task Force in addressing the integration of EBIs in practice. These assumptions are followed by five recommendations that can be translated into action plans to be adopted by the Task Force for the promotion of EBIs in practice. The action plans are conceptualized as a shared responsibility of school psychology researchers, trainers, and practitioners. Future directions and implications for policy among groups with a common agenda for promoting EBIs are also presented. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Improved treatment outcome associated with the shift to empirically supported treatments in an outpatient clinic is maintained over a ten-year period.

Recent years have seen an increase in emphasis on the use of psychological treatments that are supported by empirical data, as advocates have argued these treatments lead to better patient outcomes. We have previously shown that a shift to use of empirically supported treatments in a training clinic led to significant improvement in patient outcomes over four years (Cukrowicz et al., 2005). In the current study, we examined whether average patient outcomes at termination continued to be favorable over the six-year period following the initial shift. We examined data from 549 patients (M age = 25.78, SD = 10.08; 322 females and 227 males) treated prior to and after the shift to empirically supported treatments, all of whom were rated after termination using the Clinical Global Impression rating scale to track their improvement during treatment. The current study found that improvements in patient outcomes continued over the six-year follow-up period. Patients treated during the follow-up period had superior outcomes when compared to those treated following the initial shift to empirically supported treatments (effect size = .28, p     

Introduction to special issue.

Recent years have witnessed the emergence of two powerful, and seemingly contradictory, visions of what most fundamentally causes change in psychotherapy. One of these visions emphasizes the primacy of therapist technique. According to this viewpoint, it is the specific methods used by the psychotherapist that account for, by far, most of the variance in treatment outcome. This viewpoint is seen most notably in what have been termed the empirically supported treatments (EST) and evidence-based practices (EBP) movements. The second vision instead focuses on the patient-therapist relationship and so-called therapist-offered relationship qualities as the sine qua non of therapeutic effectiveness. Advocates of this viewpoint underscore research on the importance of relational qualities such as the therapeutic working alliance (or cohesion in groups) and therapist-offered conditions. While acknowledging the value of both visions noted above, this special issue of Psychotherapy is based on the notion that what matters most in psychotherapeutic treatments is the interplay of the two, of techniques and the therapeutic relationship. Technical factors and relational factors are indelible elements in each and every psychotherapy encounter, and the articles in this special issue explore and seek to uncover why this is so. The articles, in addition, seek to describe the complex ways in which technique and relationship interact with one another in different treatments, at different points in treatment, and in conjunction with still other variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case studies within a mixed methods paradigm: Toward a resolution of the alienation between researcher and practitioner in psychotherapy research.

This article addresses the long-standing divide between researchers and practitioners in the field of psychotherapy, regarding what really works in treatment and the extent to which interventions should be governed by outcomes generated in a “laboratory atmosphere.” This alienation has its roots in a positivist paradigm, which is epistemologically incomplete because it fails to provide for context-based practical knowledge. In other fields of evaluation research, it has been superseded by a mixed methods paradigm, which embraces pragmatism and multiplicity. On the basis of this paradigm, we propose and illustrate new scientific standards for research on the evaluation of psychotherapeutic treatments. These include the requirement that projects should comprise several parallel studies that involve randomized controlled trials, qualitative examinations of the implementation of treatment programs, and systematic case studies. The uniqueness of this article is that it contributes a guideline for involving a set of complementary publications, including a review that offers an overall synthesis of the findings from different methodological approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care.

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients.

Reviews the book, Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients edited by John C. Norcross (see record 2003-02805-000). As quoted from the fly leaf, "the work represents the culmination of three years of systematic analysis by the APA's Division of Psychotherapy (29) Task Force on Empirically Supported Therapy Relationships." Clearly, the task force was appointed in part--and acknowledged in the Introduction--as a response to the Society of Clinical Psychology's (12) Task Force on Empirically Validated Therapies (see Chambless & Hollon, 1998), which emphasized techniques in therapy. Norcross, the chair of the Division 29 Task Force and editor of this volume, discusses the inevitable questions regarding the differences between the goals of the two task forces. He views the current work as an extension and enlargement of the "attempt to apply psychological science to the identification and promulgation of effective psychotherapy." The 21 substantive chapters of the book are written by distinguished researchers of the therapeutic process. Fifty-five authors contributed to the volume. The chapters cover a wide-ranging and diverse field of topics including empathy, resistance, feedback, repairing alliance ruptures, countertransference, self-disclosure, religion and spirituality, and cultural diversity. The organization of the contents is of interest, as they are divided into General Elements of the Relationship and Customizing the Relationship to the Individual Patient. The choice of which chapters fit the categories appears somewhat arbitrary and perhaps forced. But the import of the volume is the thoroughness that the authors have brought to their particular topics. The book contains a number of resource gems, such as tables of references on outcome as related to resistance, interpretation, and therapist positive regard. That said, the book is not without some weaknesses. There is a dearth of reports of case studies, and cases that are presented are scattered sparsely throughout the text. The research must necessarily continue in order to provide a better understanding of interpersonal relationships within the context of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using qualitative research to develop culturally competent evidence-based practice.

Kazdin (see record 2008-03389-001) pointed out that the requirement for evidence-based practice (EBP) has made the long-standing gap between research and practice in clinical psychology even more salient. He offered several strategies for bridging this gap: investigating mechanisms and moderators of therapeutic change, and qualitative research. We agree that qualitative research can be useful in bridging the gap between research and clinical practice (Silverstein & Auerbach, 2007; Silverstein, Auerbach, & Levant, 2006). In this comment we discuss using qualitative research to develop EBP that is culturally competent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)