Four questions on “evidence” in evidence-based practice in psychotherapy
2017, 49 (6):
Few topics in psychotherapy are as controversial as evidence-based practices (EBP). Certain members of the general public and sometimes even professionals use the term “evidence-based” as a form of rhetoric. They reframe the definition of “evidence” in favor of their particular understanding of psychotherapy. This paper focuses on four fundamental questions about the evidence obtained in EBP in psychotherapy, trying to show the multiple framings of “evidence”. 1. Why does psychotherapy have to be based on evidence? This challenges have been present throughout the development of psychotherapy- initially in the Royal Commission’s investigation of Franz Mesmer’s animal magnetism in 1874; then Hans Eysenck’s doubts about the efficacy of psychotherapy in 1952; and in the 1980 s, the requirement of accountability and managed care in health care and the competition between psychotherapy and psychotropic drugs. With the emergence of empirically supported treatment and EBP, the challenges for psychotherapy continue. Psychotherapy must be shown to be based on evidence, and is often compared to pharmacotherapy implicitly or explicitly. Evidence for efficacy is one of the most important contributions to support and boost the development of psychotherapy. Theoretically, the role of EBP in the social sciences is similar to that of “engineering practice” in the natural sciences. Contemporary risk, audit and information strategies add to the weight of the importance of evidence. 2. What types of evidence are there? EBP’s evidence can be classified into different types, including research-based evidence and practice-based evidence; scientific evidence and local evidence; impact evidence, implementation evidence, attitudinal evidence, economic evidence, and ethical evidence; research-based, manualized, guidelines, standards, principles, databases, and so on. All researchers, practitioners, managers, and even patients are qualified to produce different kinds of evidence. 3. Which type of evidence is the best? EBP does presume that, for a given question, some available evidence may be of better quality than other evidence. Research evidence is one critical — yet not the only — contributor to EBP. Other situational information, stakeholder’s concerns, and practitioner’s experiences are also beneficial to EBP. There is no single criterion for evaluating all forms of evidence. Different types of evidence are meant to solve different questions. The best standard of assessing the quality of evidence is the degree to which the evidence can solve the real problems in real contexts. 4. How is evidence used? EBP consists of mature implementation strategies such as “AAA TIE” (Asking, Accessing, Appraising, Translating, Integrating and Evaluating). It provides an accessible way to apply the evidence to clinical situations. However, some factors, including representativeness of samples, sources of funding, and researchers’ theoretical allegiance create limitations to the process of evidence dissemination. New research designs such as practice-oriented research, trans-diagnostic and trans-treatment research, as well as cultural benchmarking research are all important means to producing more evidence that would suit the needs of practitioners.
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