Evidence-based practice in psychology.

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evidence missing from evidence-based practice.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based practice. First, the task force report did not operationalize "evidence." Second, the task force report did not address the crucial problem of iatrogenic treatments. Third, the task force report said little about the necessity for ongoing objective evaluation of clinical cases, which is critical to ethically responsible services. Current debate centers on how research findings should be factored into interventions, not on whether it is necessary to do so. Rather than waiting for the resolution of competing views on the matter, psychologists bear an ethical obligation to offer evidence-informed services. Three critical steps that were largely neglected by the task force report can go far toward helping psychologists honor that commitment: (a) providing a clearer operationalization of scientific evidence, (b) using current research to rule out the use of potentially harmful methods, and (c) using objective criteria to evaluate all of their cases on an ongoing basis. These steps, in turn, clarify the menu of options available to therapists, help protect clients from harm, and offer the advantage of allowing clinicians to contribute to the growing body of knowledge about what does and does not work in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification and elaboration on evidence-based practice in psychology.

Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The goal of the task force was to create a scheme that would suggest how evidence should be used to design and offer services that will benefit patients and to assure the public and the health care system that psychologists are providing evidence-based services. There were and will continue to be many scientific and philosophical issues inherent in any such enterprise, and agreement by all psychologists with every aspect of EBPP may not be possible. Nevertheless, the APA's EBPP policy and the report that accompanied it are remarkably inclusive of various perspectives while remaining unambiguous about the need to use evidence in a way that leads to effective services. What is needed at this point are clinically relevant evidence and investigations of how such evidence can be used to best benefit those served by psychological interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is evidence-based practice diverse enough? Philosophy of science considerations.

In its policy rationale for evidence-based practice in psychology (EBPP), the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) claims to have constituted itself with "scientists and practitioners from a wide range of perspectives and traditions, reflecting the diverse perspectives within the field" (p. 273). We applaud this attention to diversity but contend that an entire perspective of the debate was omitted in the Task Force's newly approved policy and its underlying report. The failure to consider a philosophy of science perspective led the Task Force to make a number of epistemological assumptions that are not based on evidence or rationale and that thus violate the very spirit of evidence-based decision making. In this comment, we reveal a few of these assumptions and discuss their detrimental consequences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Missing mechanism information.

The first recommendation Kazdin (see record 2008-03389-001) made for advancing the psychotherapy research knowledge base, improving patient care, and reducing the gulf between research and practice was to study the mechanisms of therapeutic change. He noted, “The study of mechanisms of change has received the least attention even though understanding mechanisms may well be the best long-term investment for improving clinical practice and patient care” (p. 151). He clarified what he meant by mechanism by stipulating what it was and what it was not, and he provided examples. The point of this comment is to note that Kazdin (2008) omitted mention of an extensive and rapidly expanding literature on parallel distributed processing– connectionist neural network (PDP-CNN) models of cognition, affect, and behavior that provides psychologically relevant information on causal mechanisms. Kazdin’s (2008) conclusion that learning more about causal mechanisms may best provide long term benefits to the science and practice of clinical psychology, including substantially mending the research–practice schism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging science and practice to improve patient care.

Replies to the comments by Tyron (see record 2009-06923-008), Silverstein and Auerbach (see record 2009-06923-009), and Raps (see record 2009-06923-010) on the authors original article (see record 2008-03389-001). I was very pleased to read these comments about the priority of bridging research and clinical practice and to have the benefit of further perspectives on how this goal might be achieved. The article to which these comments were addressed suggested changes in both clinical research and practice that might develop or strengthen such a bridge. Suggestions for clinical research included evaluating the mechanisms of change in psychotherapy so we know what is critical to include in practice, evaluating who responds to treatment in ways that can be integrated into practice, and increasing the use of qualitative research. Suggestions for practice included using systematic measures to evaluate patient progress, codifying the experiences of practitioners so they contribute to our accumulated knowledge base, and promoting direct collaborations of researchers and practitioners. The above commentaries emphasized specific points about research on mechanisms, qualitative research methods, and the challenges of providing treatments given the nature and scope of the problems that clients present. These commentaries add to the discussion in novel ways and also illustrate the obstacles that may compete with bridging. (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)     

When we research “conditions–treatments,” is there a misnomer?

Kazdin (see record 2008-03389-001) is to be commended for his analysis of some current issues surrounding research and clinical practice. He described many important considerations and variables that impact the execution and usefulness of research. However, a critical conceptual issue was left unaddressed, one that is rarely addressed in these pages or elsewhere. In looking at questions of conditions and treatments, we need to pay attention to what we mean by “conditions.” How the clinician or researcher judges whether treatment has been successful depends in large part on his or her sense of the underlying condition being treated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Lesbian and gay psychology: Theory, research, and clinical applications.

Reviews the book, Lesbian and gay psychology: Theory, research, and clinical applications by Beverly Greene and Gregory M. Herek (1994). This volume is a collection of theoretical, research, and clinical articles which share in common only their focus of a psychological approach to gay and lesbian issues. Particularly admirable is the handling of a variety of lesbian issues including sexual pride and shame, physical appearance, and feminist politics of sexual orientation. There are also good articles on stereotypes and attitudes toward lesbians and gay men. This volume moves the psychological study of lesbian and gay issues beyond being merely gay affirmative into looking at hard issues, and reconnecting gay studies with the larger body of psychological theory, research, and clinical practice. As a psychological potpourri of articles, it suggests what can be accomplished in lesbian and gay psychology. (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)     

Introduction to the special section on developing guidelines for the evidence-based assessment (EBA) of adult disorders.

The goal of this special section is to encourage greater awareness of evidence-based assessment (EBA) in the development of a scientifically supported clinical psychology. In this introductory article, the authors describe the elements that authors in this special section were asked to consider in their focused reviews (including the scope of available psychometric evidence, advancements in psychopathology research, and evidence of attention to factors such as gender, age, and ethnicity in measure validation). The authors then present central issues evident in the articles that deal with anxiety, depression, personality disorders, and couple distress and in the accompanying commentaries. The authors conclude by presenting key themes emerging from the articles in this special section, including gaps in psychometric information, limited information about the utility of assessment, the discrepancy between recommended EBAs and current training and practice, and the need for further data on the process of clinical assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of From research to clinical practice.

Reviews the book, From research to clinical practice, edited by George Stricker and Robert H. Keisner (1985). The intended audience for this edited volume "will probably be practicing psychotherapists...[with] a minimum knowledge of the research area but a ready familiarity with clinical concepts" (p. xv). In addition, the editors suggest to the chapter authors that a successful chapter should provide new meaning for the term "scientist professional" by providing a feedback loop between research and practice. The authors also state that the theoretical focus of this volume is psychodynamic. The book is divided into four areas each preceded by a brief overview. The following areas are covered: Basic issues, social psychology, developmental psychology, and special topics. Overall, I found the chapters to be informative and well written. I think some practitioners may find this book overly academic in tone and may question whether enough of the chapters are sufficiently relevant to busy, practicing clinicians. This is not a book on spotting golden research nuggets between the covers of the volume. Instead, this book requires careful mining of considerable content in order to find sparkling applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In defense of clinical judgment, credentialed clinicians, and reflective practice.

Although clinical psychology is rightly characterized by its commitment to science, the author argues that clinical practice cannot rely entirely or primarily on scientific evidence and empirically supported treatments. Too many of the problems that clinicians encounter will invariably fall outside the purview of scientific evidence. Whether grounded in questions of value or the particularities of human experience, clinicians inevitably deal with uncertainty and cannot avoid clinical judgment. An overly narrow and hyperskeptical approach to clinical practice would impoverish clinical training and would both disenfranchise and impose excessive restrictions on conscientious clinicians. A more inclusive definition of evidence-based practice is necessary, one that values scientific and clinical evidence and reasoning equally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychologists for evidence-based school practice: Lessons learned and challenges ahead.

The evidence-based practice (EBP) movement has the potential to significantly advance the quality of psychological and educational services provided by psychologists working in schools. Training psychologists in EBP has challenged the profession and caused faculty in graduate programs to reevaluate and retool professional training curricula and instructional practices. Four domains of challenges in graduate training are identified: (a) integrating the EBP knowledge base into the curriculum, (b) expanding models of research training, (c) expanding training in prevention science, and (d) expanding training in problem-solving consultation and school contextual issues. For each of these, the author discusses the range and scope of the challenge and possible solutions for advancing graduate training in psychology relevant to school practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The power of multiple methods and evidence sources: Raising the profile of Canadian counselling psychology research.

In counselling psychology, research and practice are viewed as mutually informative, and Canadian counselling psychologists conduct research in a wide range of areas, utilizing a wide range of research methods. However, there are few Canadian publications that give prominence to counselling psychology scholarly work. Over the past decade, two trends have become more prominent in the practice of counselling psychology: evidence-based practice and outcome-focused intervention. Traditionally, empirical evidence for the efficacy of practice interventions has come from randomized controlled trials. This fails to reflect the diversity of methods and practice that Canadian counselling psychologists utilize. To address this discrepancy, in this article we provide some alternate ways for obtaining empirical support for the predictive efficacy of counselling interventions. We conclude by addressing some challenges currently facing counselling psychologists in Canada (i.e., publication venues, funding for research, the connection between research and practice, preparation of students) and describing some ways for raising the profile of counselling psychology research and practice in Canada. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using qualitative research to strengthen clinical practice.

Does qualitative research have the potential to be useful to practitioners? How might it improve the practice of professional psychology for clients and for practitioners? This article describes the qualitative research paradigm, discusses how it can be adapted to clinical practice, and provides an example of a qualitative study that practitioners can easily accomplish. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research and practice in health psychology.

The task force on research and practice in health psychology responded to three presentations on important issues. It was posited that clinical health psychology may represent the ideal specialty for scientist-practitioner training. There are exciting, important questions regarding health problems, health policy, and health treatment systems needing interdisciplinary research. Health psychologists are uniquely prepared to take a leadership role due to their training in both research and service delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strengthening the scientific foundations of professional psychology: Time for the next steps.

The field of professional psychology has been tremendously successful, although it has also been characterized by many competing preparadigmatic theoretical orientations, which have led to a great deal of contention as well as conflicting views regarding psychological development, functioning, and behavior change. There is now widespread agreement regarding scientific explanations of many psychological processes, however, and, consequently, it is time to update the basic conceptual frameworks used for professional psychology education and practice. Replacing the traditional reliance on an array of theoretical orientations with a science-based biopsychosocial framework would resolve many of the contradictions and conflicts that characterized the preparadigmatic era and would also provide a common perspective for unifying psychologists around a shared approach to practice, research, and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling psychology in clinical health psychology: The impact of specialty perspective.

Not all clinical health psychologists are trained as clinical psychologists. A significant minority is trained and identifies as counseling psychologists. As a field, it is important to understand how the specialty-specific values, training context, scholarship, and parameters of practice of counseling psychology contribute to clinical health psychology. In this article, we (a) identify the core values and training context of counseling psychology, (b) review the scholarly history of clinical health psychology by counseling psychologists, (c) present the parameters of practice of clinical health psychology as identified from the extant counseling psychology literature, and (d) examine American Psychological Association membership status to investigate joint membership in the Division of Health Psychology and the Society of Counseling Psychology. Conclusions indicate that (a) an identifiable set of core values guides the training of counseling psychologists, (b) scholarly literature by counseling psychologists has contributed to the growth and development of clinical health psychology, and (c) parameters of practice reflect the specialty-specific perspective of counseling psychology. As professional psychology continues to grow as a health care profession, clinical health psychology will benefit from the knowledge, values, attitudes, competencies, and practice parameters of counseling psychology, and counseling psychology will benefit from recognizing what it brings to the practice of clinical health psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Challenges in clinical practice.

Reviews the book, Challenges in clinical practice edited by Pollack, Otto, and Rosenbau (see record 1996-97898-000). This textbook addresses the interface of pharmacological and psychological approaches to treating human behavior. It seems to strike the difficult balance between providing sufficient scientific and clinical underpinnings in a "reader friendly" format, without speaking down to the audience. In general, this book is sufficiently comprehensive and written in a clear style. It may be helpful for psychiatrists as well as psychologists, though general practitioners might have some difficulty keeping up. However, an attempt to further dilute it would probably have detracted from its strengths. This was an ambitious effort by the authors. One hopes that such work will enhance future efforts to bridge the gap between two fields that are in need of a new training model that will help in the development of a much more powerful model for the comprehensive delivery of mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)