Evidence-based practice: Beyond empirically supported treatments.

Abstract

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.

Competing Models of Evidence and Corroborating Research Strategies: Shaping the Landscape of Psychotherapy Research in the Era of Evidence-Based Practice

“…Controversies still continue. Humanistic and psychodynamic therapists, as well as practitioners in private settings as a group, are strongly opposed to this model of evidence (e.g., Bohart et al, 1998;Karon, 1995;Messer, 2004;Tavris, 2003). Alternative models have been proposed in response, which we will turn to next.…”

“…Indeed, 60 to 90% of the ESTs on the list are cognitive-behavioral treatments. None of these research decisions reflect psychotherapy as practiced in real clinical settings (Addis, Wade, & Hatgis, 1999;Messer, 2004). Moreover, the inclusion and exclusion criteria used in RCTs are so stringent that only a handful of patients are admitted to a study.…”

“…They are also complementary, in that each view sheds light on different aspects of psychotherapy; each presents a unique way of integrating and synthesizing research findings. The tension between different views may be a natural and inescapable one arising from the lengthy schism between research and practice in psychotherapy, as well as divergent views of science held in different theoretical approaches (Kazdin, 2008;Messer, 2004;Reed, Kihlstrom, & Messer, 2006). Although these four models of evidence encompass a wide range of research, there are important areas that are not covered by them.…”

How the Case of Vumile Contributes to the Evidence Base for Cognitive Therapy with Social Phobia as an Empirically Grounded Clinical Intervention

“…These contrasting agendas were already being discussed by researchers on personality using the terms "nomothetic" and "idiographic" a century ago (Allport, 1963). The conflict between them is particularly pertinent to psychotherapy outcome research where critics have expressed concern that the recent focus on terms like "empirically supported treatments" (ESTs) and "evidence-based practice" (EBP) has led to excessive emphasis on the nomothetic pole, with a corresponding neglect of factors which reflect unique characteristics of the therapy situation, the interpersonal relationship between client and therapist, the personal attributes of the therapist, and the experience of the client (Wampold & Bhati, 2004;Messer, 2004).…”

Developing a research framework to inform an evidence base for person-centered medicine: keeping the person at the centre

“…There is often a disjuncture, for example, between treatment studies using methodologies such as randomised control trials (RCT's) (usually considered the gold standard research methodology) and the practitioner's experience. RCTs typically involve the use of participant selection based on membership of a singular diagnostic category despite it being rare for a clinician to come across individuals who can be so neatly categorised [5,6]. Moreover, in achieving the controlled conditions central to the RCTs notion of internal validity, there is also a large range of other participant exclusion criteria that eliminate on average two-thirds of clients who might attend for treatment [6].…”