Evidence-Based Psychotherapy: History

  • The phrase “evidence-based” wasn’t used until the 1980s
  • “Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (8:27)
  • Further work was done by the APA to make evidence-based psychotherapy the standard 

Academic Idealism vs Clinical Application

  • Ideally, this should be a very collaborative experience 
  • Based on the previous definition, this would require the therapist to be aware of a large number of components
  • Including the ability to inform the client of the current research. 
  • Also, this may create a power dynamic that can be contradictory 
  • Because the client sees the therapist as the professional they should listen to 
  • “I agree with the posturing of collaboration being kind of open. But then, immediately when you start looking at the application and embodiment of this posture, evidence-based therapies and psychotherapies coming from a medically-oriented paradigm gets muddy very quickly” (17:31)

Evidence-Based Psychotherapy: Advantages

  • EBTs are important because they can provide a template that can be built upon and tailored to each client
  • Additionally, therapists that use EBTs can save time and resources
  • EBTs are associated with more accountability
  • And enhancing the health and well-being of the public
  • Keep in mind, however, that if the research goal was to prove these advantages, the results could be problematic. 

Evidence-Based Psychotherapy: Challenges

“Sometimes we can’t quantify what it takes to treat a human.”

  • Predominately left-brained
  • It’s possible that therapists adhere less to EBTs over time
  • Additionally, therapists  may not be up to date on current research 
  • The outcomes of trials differed from real-world clinical practices
  • Because the controlled trials didn’t account for certain dynamics or co-morbidities 
  • Contrary to the trials’ focus, people may be coming to therapy to do more than just eliminate their symptoms
  • “Reliance on scientific research is problematic; as for many practices, the level of evidence required to be considered “evidence-based” is lacking or unattainable” (30:13)

Evidence-Based Psychotherapy: Misconceptions

  • EBTs are not “cookbook instructions” for therapists to practice 
  • But are more of a “map of potential routes” for the therapist to take 
  • Many think psychotherapy provided can never meet EBT standards

Evidence-Based Psychotherapy: Implementation and Application

“The art of therapy does not have to be in contradiction with the science of therapy.”

  • Objective perfection in psychotherapy is nearly impossible and likely unhelpful.
  • Rather, let’s aim for subjective curiosity and an invitation to practice in an evidence-based way.
  • Structured curiosity takes the posture of “yes and…”
  • It allows you to transcend and include, to go from left to right, from fidelity to flexibility.
  • The focus of Evidence-Based Psychotherapy may be shifting away from the product and toward the process 
  • There are various factors associated with optimal implementation:

    • Relationships 

      • A positive therapeutic relationship significantly contributes to the healing process
      • But, be wary of providing treatment that revolves around the therapists’ goals 
      • Additionally, there is no one-size-fits-all approach 
      • Therapist centric vs client centric 

    • Fidelity 

      • High fidelity is associated with good therapeutic outcomes 
      • Importantly, the core components of the EBT are implemented 
      • Yet, rigid application of fidelity reduces the usability of a particular psychotherapy

    • Flexibility

      • Flexible implementation is necessary 
      • This means deviating from the protocol in some ways 
      • Remember, it’s always client-dependent.

    • Context

      • The authenticity of the provider is important
      • Also, the applicability to the client

    • Provider 

      • The provider needs to consider what the client needs 
      • Additionally, connection needs continued learning 
      • Embracing curiosity and creativity is essential to the longevity of the practitioner’s spirit

Season 2 Articles

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Credits 

Executive Directors: Jennifer and Ryan Savage, Melissa Bentinnedi, Bridger Falkenstein
Hosts: Bridger Falkenstein, Caleb Boston, and  Melissa Benintendi
Filmographer: Tyler Wassam
Podcast Editor: Jamie Eggert
Original Music Composers: Bridger Falkenstein and Caleb Boston
Show Notes: Jamie Eggert & Jordan Murray

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