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Evidence Based Practice in Psychology: A Careful Integration

By Jim Perretta, PhD, CPsych
Date: May 9, 2019

What makes a good therapist?  This important question is often posed to those who work in the mental health profession. Many different responses may arise - by therapists and clients alike.

Perhaps one of the most common responses to the question above is:  A therapist must be a good listener

While good listening skills – which include being present and attentive, and making effective clarifying and summarizing statements – are imperative to counseling, we must emphasize that listening is an important component but not the sole component.

The American Psychological Association (APA) put together a helpful Policy Statement to promote evidence-based practice in psychology. Each component of this policy statement will be reviewed below:

  1. Best Research Evidence
  2. Clinical Expertise
  3. Client Characteristics, Values, and Context. 

Feel free to view this web-link for more detailed info on this policy statement:  https://www.apa.org/practice/guidelines/evidence-based-statement

Best Research Evidence

Psychologists are trained in graduate school to develop research questions, conduct and analyze data, and follow the scientific method. Often times, they publish their Master’s and PhD theses. After graduate school, they continue to be consumers of research, even if they do not actively publish their own research currently.

Each province in Canada has a designated College of Psychologists, which regulates the profession and strives to protect the public. Part of this regulation involves each member completing continuing education in order to keep up with developments in the field. Each psychologist must demonstrate competence in specific areas before starting their practice (e.g. working with Children/Adolescents, Adults, or Older Adults). 

Not all clients with a given diagnosis will be treated the same. Clients have tremendous variability.  The APA policy statement keeps this in mind.

Clinical Expertise 

Too often, clients are treated solely based on their diagnosis. Even if the diagnosis was arrived at carefully - over several sessions of interviewing and background research – one must be careful to view the client from multiple angles. 

As an example, let’s say that a client presents with sadness, low motivation and energy, hopelessness, poor concentration and short-term memory, and social withdrawal. Multiple factors may be playing a role in this person’s clinical presentation. Our professional training colours how we assess and treat our clients. That is, a physician, dietitian, physiotherapist, social worker, or psychologist may emphasize different factors.

Psychologists are trained to assess and make referrals when appropriate. For example, possible medical causes may need to be ruled out by referral to a physician (e.g. for example, does the client above have a sleep disorder or a vitamin deficiency?) How long has the client felt this way? Is it new? What if the client was recently laid-off from work or separated from their partner? Can the client benefit from a referral to an employment agency or housing supports? Please note: this is just a short-list!

The APA policy statement emphasizes that psychologists:

a) conduct a thorough assessment

b) form an alliance (therapeutic bond) with their clients

c) arrive at a case formulation (which will be updated and revised over time)

d) check to make sure that the client is making progress.  If progress stalls, then a referral to another clinician may be needed.

Client Characteristics 

Each client has specific needs, values, and beliefs. Psychologists need to tailor their approach to their specific client. Once again, we must emphasize that the diagnosis is only one factor to consider. Here are some sample questions that need to be addressed:

a) What is the client’s age, developmental level, and cultural background?

b) What is the client’s opinion of their challenges? What do they think will help?

c) How motivated is the client to receive treatment?

d) Does the client have any social support? Do they have a supportive family and workplace? Stable housing?

e) Does the client have private funds or insurance coverage for psychotherapy through their workplace? Can a sliding-scale be offered?

f) What are the client’s strengths?

g) How has the client coped in the past?

Psychologists – like any health professional – need to help their clients clarify their goals. Clients need to be fully informed of their options so that they can give consent freely and voluntarily.

We know that outcomes in therapy are based on a variety of factors, including client choice, the quality of the bond between the client and the therapist, and the client’s level of social support and motivation to change. The specific therapeutic techniques employed are only one piece of the equation.

All in all, the APA Policy Statement on evidence-based practice in psychology is an invaluable resource for therapists and clients alike.

If you would like assistance coping with mental health concerns, call the Guelph Psychology Centre to book an appointment - 519-265-6960.

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