For years, my colleagues and I have been using the phrase “practice-based evidence” to refer to clinicians’ use of real-time feedback to develop, guide, and evaluate behavioral health services. Against a tidal wave of support from professional and regulatory bodies, we argued that the “evidence-based practice”–the notion that certain treatments work best for certain diagnosis–was not supported by the evidence.
Along the way, I published, along with my colleagues, several meta-analytic studies, showing that all therapies worked about equally well (click here to access recent studies children, alcohol abuse and dependence, and post-traumatic stress disorder). The challenge, it seemed to me, was not finding what worked for a particular disorder or diagnosis, but rather what worked for a particular individual–and that required ongoing monitoring and feedback. In 2006, following years of controversy and wrangling, the American Psychological Association, finally revised the official definition to be consistent with “practice-based evidence.” You can read the definition in the May-June issue of the American Psychologist, volume 61, pages 271-285.
Now, a recent report on the Medscape journal of medicine channel provides further evidence that practice-based evidence is going mainstream. I think you’ll find the commentary interesting as it provides compelling evidence that an alternative to the dominent paradigm currently guiding professional discourse is taking hold. Watch it here.
Hi Scott-
It’s encouraging to see a psychiatrist like David Hellerstein endorsing the importance of collecting evidence from our own actual clients to determine whether we are really making a difference in our clients’ lives rather than relying on treatment guidelines and fantasizing that this is all we need to do. Unfortunately, while I share your hope about our field turning the corner, we have such a long way to go with many in the mainstream mental health culture.
A recent issue (Sept/Oct 2009) of The National Psychologist quoted the APA president, James Bray, as saying, “We have heard from the insurance industry and policy makers that we are shooting ourselves in the foot by not having treatment guidelines for psychotherapy…” While another leader emphasized linking guidelines with outcomes, we know from experience (and from that debate between Bruce Wampold and David Hollon) that for most in our field, “accountability” means using a treatment that in the hands of other clinicians and with other clients was helpful. And we know from the data that it simply isn’t anywhere near valid to do so. There is still a broad assumption that by “doing what the experts did” we can be assured of achieving similar outcomes. Wrong. The data have spoken: Know Thine Own Outcomes.