On May 13th, I blogged about a change in guidelines for clinical practice in Sweden. As in many other countries, CBT enjoyed near exclusive status as “evidence-based” on most official lists of approved treatments. Billions of Swedish crowns were spent on the approach that ultimately had no effect on the outcome of people treated for depression and anxiety. As a result, guidelines for clinical practice were reviewed and expanded.
Judging by the flood of comments, the news stirred considerable debate. Indeed, the managers of several list-serves wrote to me indicating that the post had generated heated discussions among their members. Several mental professionals wrote to me directly asking for references in English. Unfortunately, none to my knowledge exist. That said, if and when one becomes available, I will post the article or link here.
In the meantime, two developments. First, the Swedish Family Therapy Association posted a link for the translation of my article, “The Road to Mastery,” which originally appeared in the May-June 2012 issue of the Psychotherapy Networker. Anyone who reads and understands Swedish, can fine the article by clicking here. I am deeply grateful for the hard work that went into translating the piece and the attention giving to the topic by the leadership of SFFT.
OK. One more important research development of which every practicing clinician should be aware. Research, like the broader world of clinical practice, goes through fads and fashions. Methods and designs “catch on,” capturing attention, and subsequently emulated by others. Currently, one of the trends is comparing a particular treatment approach to “treatment as usual.” However, as my professor and mentor Bruce Wampold observes, “design is destiny.” Said another way: how you ask is what you get.
Attend a workshop or training and you’ll often hear presenters claiming that their preferred approach has proven more effective than “treatment as usual” (TAU) in randomized clinicial trials. Sounds impressive. It is, in fact, meant to impress. And yet, “how you ask is what you get.” As the study below documents, some TAU’s are destined to fail, purposefully employing TAU’s that are not designed to be therapeutic. Importantly, when a treatment approach is compared to a “treatment-as-usual-that-is-actually-a-real-bona fide-therapeutic approach” no differences in efficacy are found.
The implication? When considering whether to adopt a new method, or when claims are made regarding the superiority of a particular approach, clinicians need to ask, “what is being compared?” A long trail of evidence documents that, in general, all approaches work well. The challenge is finding “what works” for the individual client and practitioner. Adopting new approaches, available research makes clear, is no guarantee of improved outcomes. As is made clear in The Road to Mastery, time and resources are better spent determining one’s baseline level of performance. From there, practitioners can both identify when their current skills fall short and the training necessary to improve their individual performance.
The International Center for Clinical Excellence was officially lauched at the Evolution of Psychotherapy Conference in December 2009. Since that time, membership has grown steadily. With over 3800 members, the ICCE is the largest, web-based community of behavioral health professionals dedicated to improving the quality and outcome of service delivery. The site features nearly a hundred discussion forums, taking place in a number of languages, on topics specific to treatment and research.
Many agencies and systems of care are using the site to coordinate implementation of feedback-informed treatment. Of course, those attending ICCE training events (e.g., the Advanced Intensive, Training of Trainers, and Achieving Clinical Excellence conference), use the site for both pre and post training support and continuing education.
And now, the site is being used for a new purpose: research. ICCE member and associate Wendy Amey was the first. She used the site successfully for her dissertation, surveying members about how they work with trauma. I am pleased to announce two new research projects that will access the ICCE community.
The first is being conducted by McGill University counseling psychology doctoral candidate Ionita Gabriela. Her study focuses on clinicians’ experiences with using measures to monitor client progress in the services they offer. Implementation is the challenge most clinician and agencies face when incorporating routine outcome monitoring into practice. All participants will be entered into a drawing for a $100 Amazon gift certificate. More importantly, participants will contribute to the expanding knowledge base on feedback informed treatment. Whether or not you are a member of ICCE, you can contribute by taking part in the study. Click here to send an email to Ionita to complete the interview (it only takes about 15 minutes).
The second study is being conducted by me and ICCE Associate Daryl Chow as part of ICCE’s continuing emphasis on clinical excellence. The study builds on groundbreaking research by Ronnestad and Orlinksy on the subject of therapist development. Particpants are asked to complete a brief (8-12 minutes), online survey with questions pertaining to your development as a clinician. All participants will be entered into a drawing, the winner receiving all 6 of the newly released FIT Treatment and Training Manuals (valued at $100). Again, you can participant whether or not you are currently a member of the ICCE. In fact, please ask your colleagues to participate as well! Click here to complete the secure, online survey (no identifying information will be sought).