On this week’s episode, Bridger & Caleb discuss how to know what’s evidence-based grounded in an article by Henrik Berg.

What is evidence-based practice?

  • APA defines evidence-based practices as the integration of three parts:
  • Best available research
  • Clinical expertise
  • Patient characteristics, culture, and preferences 

Best Available Research 

  • Scientist-centric perspective
  • Involves the scientific method, meta-analyses, and reviews of controlled trials
  • Then see what treatment and understanding of the disorder make the most sense
  • However, the field may be too focused on this element 

Clinical Expertise 

  • Includes the amount of experience and training a person has
  • Importantly, if a therapist deviates too much from standardized treatment, it’s excluded from the data in random control trials
  • Despite the potentially positive outcome of the therapy  
  • So does that mean evidence-based practice = manualized treatment?
  • Yet, newer therapists tend to be more rule-bound
  • And experts may act more intuitively and outside of the rules
  • If clinical expertise is to be included, we can’t limit it to just those that follow the manualized treatment 
  • Otherwise, we may miss spontaneous moments of healing 

Patient Characteristics, Culture, and Preferences

  • It’s important to consider the values, preferences, beliefs, etc of the patient 
  • Further, the patient may prefer something that is not indicated as scientifically effective 
  • And preferences can’t be determined by scientific findings 
  • Resulting in a spectrum where patient preference and scientific findings are on opposite ends
  • A lot of time clinicians think something has to be ideal or “it has to work” for it be evidence-based
  • Resulting in pressure or shame when results are not ideal 
  • In reality, complexities emerge with every therapy session 
  • The melody is in the tension between the real and ideal 

The science-centric perspective

  • Published research that is meant to validate a manualized approach tends to exclude clinical approaches that are more free-flowing
  • This leads to a limited view
  • Further, the irregularities and malfunctions in the data are not explored
  • Often, the clinical expertise and patient preferences get left behind
  • However, these aspects can actually sharpen the science when taken into consideration 
  • In order to truly practice an evidence-based therapy, you have to trust your clinical intuition
  • As well as integrate patient preferences and characteristics 
  • Remember, all three pillars of what makes a practice evidence-based important 
  • And sadly, this synthesis is under-investigated 
  • Finally, the importance of EBTs seem to be oriented around a fear
  • Rather than hope or wellness-focused 

Important things to teach in the future

  • Scientific research is infinitely important 
  • But it has its limits
  • Struggling is a part of the process
  • And you may need to go outside of science 
  • Also broadening the conceptualization of what science is 
  • And be open and curious 
  • We’ll never be able to fully articulate what is happening
  • But it’s important to try 

Closing remarks

  • There are a million reasons why a scientific EBT doesn’t work
  • The answer may be within the clinician or the patient 
  • And what you do doesn’t really matter 
  • Specifically, the ideal EBT doesn’t matter in the room 
  • What matters is your experience of the EBT, the client in the room, and your clinical experience 

 

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