What are evidence based practices?


By David Joel Miller

What are evidence-based practices?

How many evidenced based practices are there anyway and why should you care?Should you care if your counselor or therapist is using an evidence-based practice, and what are those things anyway?

The talking cure and case studies.

In the beginning of psychotherapy, it came as a shock that just talking could help someone. Freud came up with a whole lot of ideas about how and why things were creating problems for clients. If you see early childhood sexual conflicts and the unconscious as the source of the patient’s issues you go in one direction.

So as the practice of psychotherapy grew, those practitioners, often called analysts, started trying all sorts of interventions. Some worked and some didn’t and often we had no idea what worked, for whom and when.

Analytical psychotherapists started writing up case studies about clients they had treated. Then other psychotherapists tried similar interventions and often got different results.

How are we to know what works when? Is it the characteristics of the psychotherapist, the client or the intervention that is causing the results we see?

When someone else pays they care if your treatment is working.

If you are paying for your treatment then you can see whomever you want, but as there became more government and insurance funding we need a way to check and see if what others are paying for is really worth the money.

Some therapists, particularly Cognitive Behavioral Therapists, believed that if a technique is valid then it should work most of the time and no matter who did the technique. That notion has spurred a lot of research.

What we find is that the larger the group in the study the more reliable the results of the study, all other things being equal. So more and more theories have been studied in larger and larger trials. We are starting to see that some interventions work most of the time, for most people, when the therapist does them correctly.

One way to further this process has been to create a “National Registry of Evidence-Based Practices.” New interventions, treatment manuals etc. are registered here and as the research is conducted it gets added to this database.

SAMHSA (Substance Abuse and Mental Health Services Administration created a National Registry of Evidence-based Programs and Practices.  

Currently, the registry contains listings for over 300 different programs and practices that are registered and for which reports and evaluations are available. Some of these treatments are much better than others. Some treatments have a few or only one study showing they worked. Other treatments have hundreds of studies and thousands of clients and are much more recognized as worth the cost.

Over time we should be able to see what works and what does not. Understand that no treatment or intervention is guaranteed to cure every client every time. But some treatments are clearly worth their costs and others are rarely of value.

Also, consider that it matters who did the research and how many people were in the sample. A study of two friends does not mean as much as a study of 10,000 randomly selected clients. Not every counselor has the same level of skill. So in evidence-based practices, it would be reasonable to emphasize treatments that are “manualized,” meaning that there is an instruction book and we can see if the therapist is actually giving the client the treatment that is prescribed by a particular evidenced based practice.

While not all evidence-based practices are equal and some of those on our current list are sure to fade away with time, this system of asking practitioners to prove that what they are doing for or with clients is beneficial to those clients is certainly a huge step forward.

A program or practices inclusion does not necessarily mean that a practice works or that it will work all the time with every client. What it does mean is that these programs and practices have documentation to tell others how they should be conducted and research to document when and where they have been effective or not effective.

SAMHSA notes that “NREPP is not an exhaustive list of interventions, and inclusion in the registry does not constitute an endorsement.”

Whatever the drawbacks having a place where providers can go to look for programs and practices that may be helpful in designing treatment programs is hugely helpful in moving the mental health and substance abuse professions forward.

There was a time not that long ago when each place was doing their own thing sometimes with good and sometimes with poor results. We now have better ways of establishing that the treatment provided is generally effective in treating a particular condition.

Some of the programs included in the registry are expensive to get trained and certified and others are free or nearly so. Clearly, some practices were listed by their originators to sell more books and trainings; others are listed because the developer wants people to try them and to promote research. A few of the programs were developed by SAMSA or other government programs and the materials are all available to download for free.

A quick scan of the list came up with some treatments worth looking into.

Brief Marijuana Dependence Counseling

Mental Health First Aid

Seeking Safety

Take a look, and let me know what other Evidenced Based Practices you find interesting.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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