Psychotherapy in long-term care: II. Evidence-based psychological treatments and other outcome research.

Abstract

This article is the 2nd of 2 that together examine 3 domains important to providing high-quality, evidence-based services to long-term care (LTC) facility residents: policy and advocacy, practical considerations, and outcome research. Older adults who reside in LTC facilities have a very high rate of mental health difficulties. Psychologists have been able to provide services to this population through Medicare since the late 1980s, and empirical findings on treatment approaches are important in guiding psychotherapists to more helpful intervention. The focus of this article is outcome research in LTC settings. This article emphasizes evidence-based psychological treatments (EBTs) but also examines other scientifically supported approaches and discusses the strengths and limitations of focusing on EBTs, as well as general issues in the relation between science and practice in the provision of psychotherapy in LTC settings.

New Wine in Old Bottles: The Transdiagnostic Model in the Case of Geoffrey

“…If adaptations are required, then we need to know if this is due to developmental changes, cohort differences, or the environment in which the intervention has occurred. Powers (2008b) underscores the suggestions of others regarding the needed knowledge base for the practice of empirically supported therapies in a hard-to-study setting such as an inner city outpatient center or a nursing home. This knowledge base should involve descriptive research on the incidence, prevalence, and expression of psychological difficulties in the particular settings; research on the benefits of interventions that could be applied in such settings yet are not presently empirically based; research conducted in other settings that is relevant to the type of patient of problem in that setting; and research or scholarly writings that enumerate suggestions from clinical experience as well as empirical research on the benefits of psychotherapy that qualifies as EBT.…”

“…Recently there have been at least five different, discrete research-based and evidenceoriented initiatives in the practice of psychotherapy, creating a virtual tsunami of change and specialized phrases. These include empirically supported treatments" (ESTs; Chambless & Ollendick, 2001), or what are sometimes called evidence-based psychological treatments (EBTs; Powers, 2008b); empirically supported relationships (Norcross, 2002;Norcross, Beutler, & Levant, 2005); empirically supported principles (Castonguay & Beutler, 2006); the transdiagnostic approach (Brown & Barlow, 2002) based on the tripartite model of depression and anxiety (Clark & Watson, 1991); and an integrative model, evidence-based practice" (EBP), based on the work of a Presidential Task Force of the American Psychological Association (APA, 2006) and officially endorsed by that Association. APA's (2006) EBP model integrates elements from each of the other models mentioned above.…”

“…They initiated treatment with psychoeducation on the cognitive-behavioral therapy (CBT) model, following quickly by mood ratings and behavioral activation. The were liberal and apt in their application also of evidence-based incorporative treatments (EBITs; Powers, 2008b), which extend ESTs and include treatments that meet the criteria for ESTs but also include non-psychological, practical life components such as work, medical, and housing issues (Powers, 2008a).…”

Psychotherapy in long-term care: I. Practical considerations and the link to policy and advocacy.

“…However, scientific support for the interventions used in LTC is critical to the longer term sustainability, effectiveness, and improvement of psychotherapy in this setting. Therefore, my second article (Powers, 2008) addresses the current state of research, with particular attention to the issue of empirically based treatments.…”

“…This first article will (a) briefly review policy and professional advances that have led to the opportunity for psychologists to help LTC residents and (b) examine practical considerations for providing psychotherapy in LTC with a case example included as part of this examination. My second article (Powers, 2008) will (a) direct practitioners to research, scholarship, and theoretical frameworks that can help them improve provision of psychotherapy in LTC and (b) discuss implications and future directions in LTC psychotherapy.…”