Attending to the Omissions: A Historical Examination of Evidence-Based Practice Movements.

Evidence-based practice and empirically supported treatment movements are potent forces that affect the practice of psychology today and have the potential to mandate the types of treatments psychologists conduct. The histories of these movements reveal that certain aspects of therapy valued by psychologists have been ignored. It is shown that the evidence-based movements (a) overemphasize treatments and treatment differences and (b) ignore aspects of psychotherapy that have been shown to be related to outcome, such as variation among psychologists, the relationship, and other common factors. It is important that psychologists understand the development of these movements so that they can be critical consumers of research and can effectively influence the future course of events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

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)     

Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues.

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. (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)     

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)     

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)     

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)     

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)     

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)     

Cultural adaptation of treatments: A resource for considering culture in evidence-based practice.

There is a growing interest in whether and how to adapt psychotherapies to take into account the cultural, linguistic, and socioeconomic context of diverse ethnocultural groups. At the root of the debate is the issue of whether evidence-based treatments (EBTs) developed within a particular linguistic and cultural context are appropriate for ethnocultural groups that do not share the same language, cultural values, or both. There is considerable evidence that culture and context influence almost every aspect of the diagnostic and treatment process. Yet, there are concerns about fidelity of interventions, and some have questioned whether tinkering with well-established EBTs is warranted. We present arguments in favor of the cultural compatibility and universalistic hypotheses. Next, we review the available published frameworks for cultural adaptations of EBTs and offer examples from the literature on the process and outcome of different approaches used. Conceptual models for adapting existing interventions and emerging evidence that adapted intervention leads to positive outcomes suggest that there are tools for engaging in evidence-based psychological practices with ethnocultural youth. Recommendations for future directions are provided. (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)     

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)     

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)     

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