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What is the purpose of collecting evidence to inform clinical practice in psychology concerning the effects of psychological or other interventions?

What is the purpose of collecting evidence to inform clinical practice in psychology concerning the effects of psychological or other interventions?

To quote Paul’s (1967) article that has been cited 330 times before November 4, 2008, it is to determine the answer to the question: “What treatment, by whom, is most effective for this individual with that specific problem, under which set of circumstances?” (p. 111). Another answer is pitched at a systemic level, rather than concerning individuals. That is, research evidence can inform health-care professionals and consumers about psychological and behavioral interventions that are more effective than pharmacological treatments, and to improve the overall quality and cost-effectiveness of psychological health service provision (American Psychological Association [APA] Presidential Task Force on Evidence-Based Practice, 2006). The most general answer is that research evidence can be used to improve outcomes for clients, service providers, and society in general. The debate about what counts as evidence of effectiveness in answering this question has attracted considerable controversy (Goodheart, Kazdin, & Sternberg, 2006; Norcross, Beutler, & Levant, 2005). At one end of a spectrum, evidence from research on psychological treatments can be emphasized. Research-oriented psychologists have promoted the importance of scientific evidence in the concept of empirically supported treatment. Empirically supported treatments (ESTs) are those that have been sufficiently subjected to scientific research and have been shown to produce beneficial effects in wellcontrolled studies (i.e., efficacious), in more natural clinical environments (i.e., effective), and are the most cost-effective (i.e., efficient) (Chambless & Hollon, 1998). The effective and efficient criteria of Chambless and Hollon (1998) have been amalgamated under the term “clinical utility” (APA Presidential Task Force on Evidence-Based Practice, 2006; Barlow, Levitt, & Bufka, 1999). At the other end of the spectrum are psychologists who value clinical expertise as the source of evidence more highly, and they can rate subjective impressions and skills acquired in practice as providing personal evidence for guiding treatment (Hunsberger, 2007). Kazdin (2008) has asserted that the schism between clinical researchers and practitioners on the issue of evidence is deepening. Part of the problem, which suggests at least part of the solution, is that research had concentrated on empirical evidence of treatment efficacy, but more needs c01 20 April 2012; 12:43:29 3 Hersen, Michel, and Peter Sturmey. Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders, John Wiley & Sons, Incorporated, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ashford-ebooks/detail.action?docID=817355. Created from ashford-ebooks on 2017-11-07 11:30:44. Copyright © 2012. John Wiley & Sons, Incorporated. All rights reserved. to be conducted to elucidate the relevant parameters of clinical experience. In a separate dimension from the evidence– experience spectrum have been concerns about designing interventions that take into account the uniqueness of the individual client. Each of us can be seen as a unique mix of levels of variables such as sex, age, socioeconomic and social status, race, nationality, language, spiritual beliefs or personal philosophies, values, preferences, level of education, as well as number of symptoms, diagnoses (comorbidities), or problem behavior excesses and deficits that may bring us into professional contact with clinical psychologists. The extent to which there can be prior evidence from research or clinical experience to guide individual’s interventions when these variables are taken into account is questionable, and so these individual differences add to the mix of factors when psychologists deliberate on treatment recommendations with an individual client. Recognizing each of these three factors as necessary considerations in intervention selection, the APA Presidential Task Force on Evidence-Based Practice (2006, p. 273) provided its definition: “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” The task force acknowledged the similarity of its definition to that of Sackett, Straus, Richardson, Rosenberg, and Haynes (2000) when they defined evidence-based practice in medicine as “the integration of best research evidence with clinical expertise and patient values” (p. 1). Available research evidence is the base or starting point for EBPP. So, in recommending a particular intervention from a number of available ESTs, the psychologist, using clinical expertise with collaboration from the client, weighs up the options so that the best treatment for that client can be selected. As we understand it, clinical expertise is not to be considered as an equal consideration to research evidence, as some psychologists have implied (Hunsberger, 2007). Like client preferences, the psychologist’s expertise plays an essential part in sifting among ESTs the clinician has located from searching the evidence. Best research evidence is operationalized as ESTs. Treatment guidelines can be developed following review of ESTs for particular populations and diagnoses or problem behaviors.

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