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A view from across the pond
Johanna Sartori is a British Association for Counselling and Psychotherapy-accredited counselor/psychotherapist working in private practice in London. To contact her, email firstname.lastname@example.org.
Share your view on evidence-based practice.
My thoughts are that any profession from medicine to management benefits from collecting, reviewing and sharing evidence. What worries me about therapy in the United Kingdom right now — and from what I read, it seems this is further along in the U.S. — is that the pressure for diagnosis, treatment plan and quantifiable results means that public funds are diverted nearly entirely toward CBT (cognitive behavior therapy). The benefit of more relational-based therapy is best studied by qualitative rather than quantitative research, and this does not fit with the general payment-by-results policy. Yet it is the nuance of the therapeutic relationship that we learn time and time again is crucial to any benefit being realized. In essence, I think evidence-based counseling is a good thing, but it needs to be expanded to take in different research methods and different therapy models. This takes time and effort, and we ought to be working together to start producing this.
Explain how the situation stands in the United Kingdom.
The current situation in the U.K. means that a choice in talking therapies is only available to those with enough money to pay for private therapy. Otherwise, the National Health Service (NHS) offers a very limited range of services based around CBT. I feel strongly that public money should be made available to facilitate NHS patients working with the many existing experienced and professional practitioners in private practice, but that we in return have to demonstrate our efficacy. Given that there are thousands of private practitioners doing good work throughout the U.K., it seems to be a fantastic opportunity to agree [on] an acceptable way of monitoring this and learning from the aggregate data. I know from discussions on LinkedIn that Clinical Outcomes in Routine Evaluation (CORE) is used by many practitioners, and I think there are opportunities to share findings from this. CORE measures the experience of the client, and if used at the assessment and ending sessions, shows the increase in well-being resulting from therapy.
Are there any drawbacks to evidence-based practice?
The drawback I see is that a conviction that “evidence is king” appears to override the need to examine that evidence. Public funds in the U.K. are channeled into the Improving Access to Psychological Therapies Programme (IAPT), mainly because it demonstrates outcome through regular reporting. However, if you look closely at what that evidence actually says, you see that IAPT services do not actually demonstrate good results. Waiting times for some are over three months, a course of treatment may be as little as two sessions and success rates overall are as low as 15 percent. Despite this, because these services are measurable, they are approved by the National Centre for Clinical Excellence and publicly funded.
— Lynne Shallcross
A practitioner’s take
American Counseling Association member Jason Menegio is a counselor and evidence-based practice specialist working at a nonprofit organization in Greensboro, N.C. To contact him, email email@example.com.
What does your work encompass?
My primary responsibilities are to research and oversee the implementation of evidence-based and emerging best practices in assigned service areas including, but not limited to, providing training, monitoring, mentoring and continuing education. I also ensure that each individual who receives services has access to treatment/services/supports that are based on an evidence-based practice or emerging best practice, which is the basis for all service provision.
Why is evidence-based practice important?
Learning what treatments are effective and evidenced and backed up by research helps to guide our treatment decisions and to promote the overall well-being of clients being served, as evidenced by improved outcome measures. In other words, evidence-based practice helps to ensure that clients are getting the best service possible.
What are some of the benefits to evidence-based practice?
Some of the primary advantages include its ability to be data-driven, and [it] can be evaluated for its degree of effectiveness. It exposes potential gaps [in] what was studied and what needs further research. And it identifies effective interventions based on reviews of multiple rigorous studies rather than on subjective interpretations of the reviewer or clinician.