What exactly IS “Evidence-Based” Practice in Therapy?

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Evidence-Based practice (EBP) and/or care is a hot topic these days. As a consumer of psychological and health care services, you should understand just what this means.  In 2005, the American Psychological Association adopted the definition shared by the Institute of Medicine (2001) known as the Tri-partite model or “three-legged stool” definition of EBP (APA, 2005). The definition is “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” If you’re considering a therapist or therapy, here’s what you should know:

  1. The first leg of the stool, the best research evidence, should lie at the heart of your clinician’s decision making about your care. Your therapist should be informed about and fully understand the research findings regarding your concerns and the effectiveness of the type of therapy being considered. Think about it this way, if your medical provider said that she didn’t know the research and hadn’t looked at “what works” for your problem, and proceeded in another way, would that be okay with you?
  2. Clinical expertise, the second leg of the stool, should be carefully considered. Your therapist should be able to tell you about their own expertise with how they assess your concerns, plan, and implement your treatment. They should be forthcoming regarding how experienced they are in working with people who have similar characteristics. For example, if a therapist has experience treating anxiety and phobias in adults, this doesn’t necessarily mean that they have expertise in treating the same problems in children. If you trust a therapist without particular expertise in your concerns, and you want to stick with the therapist, they can (and should) seek consultation and guidance in extending their expertise to new situations. I once had my dentist tell me that I needed a root canal (OK - probably not the best example). She offered that it was not her specialty but that she was proficient. She readily gave me a choice of staying with her for the procedure or going to another specialist. I trusted her and elected to stick with the person and office I trusted. Just like medical providers, therapists cannot be all things to all people. So, when making your choice, it’s fair to ask about their own expertise and “scope” of practice.
  3. The third, and MOST IMPORTANT, leg of the stool is YOU – the patient’s characteristics, culture, and preferences. You are the consumer of services. You should have input and be informed about what an assessment and the proposed treatment entails. In some cases, the most effective types of treatment involve facing the fears that brought you in to see a therapist in the first place. Considering this, trust of the person with whom you’re working is important. Your therapist should be able to explain what to expect, how it might be experienced and (in general) for what length of time. In some cases, patients want to discuss how therapeutic approaches may or may not be consistent with their own culture or religious/spiritual beliefs. If certain types of treatment/therapy don’t work for you or you’d like a different approach, you should feel comfortable discussing that with your therapist.

All three legs of the stool should be solidly planted beneath your therapy – or the stool falls. If you – as the consumer – feel a leg is missing, then the therapist should be able to shore up that leg or assist you in finding a different approach or therapist.

APA (2005) https://www.apa.org/practice/guidelines/evidence-based-statement.aspx

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