Evidence in the Psychological Therapies: A Critical Guidance for Practitioners (Critical Guide for Practitioners)

Evidence-based practice is likely to dictate standards to which publicly- and insurance-funded psychotherapy will have to comply in future years. Evidence in the Psychological Therapies examines how the meaning of evidence might be established within psychotherapy, and illustrates how evidence could impact on practice across a range of clinical settings. Behavioral Sciences Book Cover 1 Half-Title 2 Title 4 Copyright 5 Contents 6 Figures and tables 8 Contributors 9 Figure acknowledgements 12 Chapter I Evidence in psychotherapy 13 Science and psychotherapy 13 Principles of evidence-based practice 14 Evidence and psychotherapy 17 Evidence in context 20 Evidence in evolution 21 References 22 Chapter 2 A lawyer’s view of evidence 24 Introduction 24 The context of litigation 26 Legal methods of proof 28 The scientific challenge 32 Conclusion 36 Notes 37 References 37 Chapter 3 Research, evidence and psychotherapy 39 Introduction 39 ‘Research’ and its terrors 39 Some recent discoveries and their methodologies 41 The observational study of early infant-mother relationships 41 Attachment research: the ‘Strange Situation Test’ and the ‘Adult Attachment Interview’ 42 Recent developments in neuro-science 46 Psychoanalysis and its research methods 48 Divergent and complementary goals in mental health practice 50 A concluding example: methodological pluralism in practice 54 Notes 55 References 55 Chapter 4 Randomised controlled trials 58 Evidence and treatment 59 Do we need evidence at all? 60 So why a clinical trial? 61 If we need trials, why do they have to be randomised? 64 Do trials tell me anything about my patients? 67 Trials and clinical freedom 69 Acknowledgements 70 References 70 Chapter 5 Evidence, influence or evaluation? 72 Scientific research outcomes in psychiatry as manufactured products 74 Distorting the perception of science 76 A case example of alternative values 78 Evidence-based medicine: from concept to social movement 80 What concept of evidence is appropriate to scientific psychiatry? 82 Evidence as ‘fit’ 82 Evaluating research outcomes 85 Assessing the nature of scientific research outcomes more objectively 86 Likely winners and losers from evidence-based medicine 87 Note 89 References 89 Chapter 6 Evident causes 90 Causes 90 The causal properties of post hoc reasons 92 Evidence and truth 94 He means, it means 95 Efficacy 95 A developmental narrative 96 An argument by analogy for the factors that make some therapeutic interventions preferable to others 97 Summary and conclusions 99 References 100 Chapter 7 Single case methodology and psychotherapy evaluation 101 Introduction 101 Research and clinical applications 103 Basic principles underlying single case experimental designs 106 Threats to the validity of a case study 106 Design principles 109 Repeated measurement 110 Stable baselines 111 Treatments are well specified and documented 112 Replications, reversibility and withdrawals 113 Generalisability 114 Practical considerations and examples 115 Conclusions 118 Acknowledgement 118 References 120 Chapter 8 Working hypotheses in psychoanalytic psychotherapy 123 Introduction 123 The professional worker 124 Jane’s clinical story 125 Working hypotheses 126 Working hypotheses in the individual therapy work 130 Mastery/coping 131 Clarification of meaning 132 Problem actuation 133 Resource activation 134 Conclusion 134 Note 135 References 135 Chapter 9 Hypothesis testing in cognitive-behaviour therapy 136 Internal hypothesis generation 141 Functional analysis 142 Beck’s cognitive therapy 145 Schemo-focused cognitive therapy 146 References 151 Chapter 10 Comparing models in cognitive therapy and cognitive analytic therapy 153 Introduction 153 DA writes 153 CD writes 154 DA writes 154 CD writes 155 Session 1 155 Session 2 156 Session 3 156 Session 4 156 DA writes 156 CD writes 157 DA writes 159 CD writes 160 DA writes 162 CD writes 163 DA writes 164 CD writes 164 Conclusion 165 References 165 Chapter 11 Evidence-based practice and the psychodynamic psychotherapies 166 What is evidence-based practice? 166 Standards of evidence 167 Evidence for the benefits of the psychodynamic psychotherapies 167 Which evidential criteria in psychotherapy outcome research? 168 The RCT as gold standard 170 Problems with RCTs 171 Efficacy vs effectiveness 172 The balance of disadvantage for PDP 173 Special problems of efficacy research in PDP 174 Categorising the relevant evidence 174 Problems with the use of psychiatric diagnosis 176 Limitations of the drug metaphor 177 Evaluation of long-term therapies 177 Concluding comments 178 References 179 Chapter 12 Practice-based evidence in psychotherapy 182 Fundamental questions 182 The limits of evidence-based practice 182 Outcomes which cannot be measured may have worth 184 Deciding between competing claims 185 The ethics of the trials considered in systematic reviews 185 The nature of evidence: RCTs 185 Defining psychotherapy: a broad brush? 186 Are resources being used carefully? 187 How do we assure quality? 187 Is there a strategy for linking delivery of care with assessment of need? 188 What is the expert-model for psychotherapy? 189 Pattern-matching? 190 Probabilistic? 190 Technique-oriented? 191 Oriented to meaning? 191 Problem formulation vs diagnosis 191 How do we recognise a ‘good’ service? 192 Consistent standard? 193 Expert resource for previous non-responders? 195 Self-reflexive practice? 196 Psychotherapy is vulnerable to crass interpretation of complex data 196 Bias in assessing ‘outputs’ in terms of what is easily measured 197 Dose-response models 197 Misunderstanding the nature of the ‘inputs’ 198 The four-factor model 198 CLINICAL CONDITION 198 GOALS 199 RESOURCES 199 AVAILABILITY 199 ‘DOSAGE’ IN SESSIONS/WEEK 200 RESTRICTIVENESS (HOSPITAL ETC.) 200 COST OF RESOURCES (TIME, SUPERVISION, MATERIAL RESOURCES) 200 Problems in translating research into everyday practice 200 Models do not fit practice 201 Problems in translating practice questions into research 201 Conclusions 202 Requirements for evidence-based practice and practice-based evidence 202 References 203 Chapter 13 Making a success of your psychotherapy service 206 Introduction 206 Format 206 Key concepts 207 Audit 207 Research 207 Quality standards 207 Audit cycle 208 Criteria for choosing an audit topic 208 Refining an audit topic 210 Other features of good audit 210 Results from the workshops 210 Performance foctors crucial to the success of the psychotherapy service 210 Audit topics from the workshops 214 STRUCTURE 214 PROCESS 215 OUTCOME 215 STRUCTURE 215 PROCESS 215 OUTCOME 216 Conclusion 216 Acknowledgement 217 References 217 Index 218 Research is increasingly used as the benchmark of clinical quality and evidence-based practice is likely to determine standards for psychotherapists in the future. This book explains why psychotherapeutic services should be more evidenced-based, and presents the types of evidence thought to be most relevant to psychological therapies. The potential impact of evidence on practice is illustrated across a range of clinical settings and therapeutic models. It considers how evidence can be gathered for use with different practices, from behavioral therapies to psychoanalysis. The use of evidence in different therapeutic contexts is illustrated through discussion of: the place of hypotheses in the consulting room and how they are likely to differ in different treatment models; the relationships between qualitative and quantitative research and treatment; and the contributions evidence from audits makes to the improvement of clinical services. This information can help psychotherapists, counselors, and providers become better informed about the place for evidence-based approaches. It will also assist therapists in evaluating the promise and limitations of evidence-based practice for themselves. (Contains 2 tables, 7 figures, and 107 references.) (JDM) Evidence-based practice is likely to determine standards for publicly and insurance-funded psychotherapies in the near future. How should practitioners prepare themselves for this?Evidence in the Psychological Therapies takes a critical look at the meaning of evidence. It examines which kinds of evidence are most relevant to psychological therapies, and Mow the quality of evidence can be assessed. The potential impact of evidence on practice is illustrated across a range of clinical settings and therapeutic models. The contributors include distinguished academics in law and philosophy, clinical researchers who have contributed to the evidence base for psychological therapies, and prominent therapists who have put research into practice and pioneered effective methods of audit.This accessible discussion of a topic no practitioner can ignore is recommended to all psychotherapists, including psychoanalysts, CBT therapists, psychiatrists, clinical psychologists, counsellors and those in training.