What is evidence-based practice in psychology?
When searching for a therapist and therapy, you may come across the terms “evidence-based practice” and “evidence-based treatment”. The term “evidence-based” is being used across many disciplines (such as healthcare and education), and understandably so – clients want to know there is research and expertise to back up claims about effective services and care. In the field of professional psychology, the term “evidence-based practice in psychology” has been defined by the American Psychological Association as follows:
“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.” (American Psychological Association, 2006)
In other words, the practice of psychotherapy should involve providing clinical services that are informed by research, clinical training (under the supervision of experienced licensed practitioners), and a complex understanding of the human condition as individuals and as cultural beings.
What’s the difference between “evidence-based practice” and “empirically supported treatments”?
Many people equate evidence-based practice with “empirically supported treatments (ESTs)”, but evidence-based practice is broader than therapy techniques or manualized treatments that have been tested for specific disorders under very fixed research conditions (APA, 2006). Evidence-based practice does include empirically supported treatments and manualized treatments, but clients need to understand that evidence-based practice is not limited to manualized treatments. In addition, implementing manualized treatments requires a clinical expertise that includes a few components:
- Solid understanding of psychological theories of change;
- Critical review of research – e.g., what are the demographics and characteristics of each study sample? Are the client’s background, experience, and presenting concerns similar to the people studied in the research?
- Deep appreciation and knowledge of integrating cultural context into treatment; and
- Experienced application of therapy techniques in a flexible manner based on individual and cultural characteristics.
Thus, therapists who use empirically supported treatments should apply the techniques in a manner that considers both the client’s individual characteristics (personality, history) and their cultural characteristics. (This is one reason it may be challenging to apply self-help books to oneself – the clinical expertise and support of a therapist can facilitate change more effectively.)
A variety of therapy approaches are evidence-based
Most commonly, you will find psychotherapists (and mental health websites) defining evidence-based practice as including only cognitive behavioral therapy (CBT) and behavioral therapy approaches, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT). However, that would be an inaccurate representation of evidence-based therapy practices – for instance, other approaches whose effectiveness are supported by research include humanistic (Cain, et al., 2016) and psychodynamic therapies (both time-limited and longer-term therapies; Shedler, 2010; Driessen et al., 2015). Psychodynamic approaches are often erroneously dismissed and excluded from “evidence-based therapies”; this is primarily because psychodynamic approaches tend to focus more on the therapeutic relationship and interpersonal dynamics as agents of change (which are harder to teach and operationalize in quantitative studies) and less so on specific step-by-step techniques. In fact, many psychotherapy approaches include overlapping foundational concepts that are effective in treating various psychological issues (Boswell et al., 2010; Levenson, 2003).
Regardless of specific therapy approach, evidence-based practice should integrate the context of human experience. For instance, Bronfenbrenner’s (1994) ecological models of human development consider the environment around individuals, ranging from microsystems (e.g., family) to macrosystems (e.g., cultural customs). Research studies for psychotherapy treatments may not account for many of the factors in individuals’ environments, so therapists need a strong foundation in knowledge and skills regarding socio-cultural issues, such as socioeconomic class, race, ethnicity, gender, sexual orientation, religion/spirituality, immigration status, and dis/ability.
Evidence-based practice is a broad term that includes a variety of therapy approaches, including cognitive behavioral therapies, behavioral therapies, humanistic, and psychodynamic therapies. Some approaches are more effective in treating certain concerns than others, and the trained therapist should determine if their approach is a good fit for the client and their presenting concerns. All therapy approaches should integrate consideration of individual characteristics, cultural characteristics, and systemic issues, such as institutional sexism, environmental racism, etc. Ultimately, psychotherapists should stay abreast of the latest research on treatments for various mental health conditions and participate regularly in professional development opportunities — such as consultation groups or continuing education training — to hone their clinical skills.
American Psychological Association. (2006). Evidence- based practice in psychology. American Psychologist, 61(4), 271-285.
Boswell, J.F., Nelson, D. L., Nordberg, S.S., Mcaleavey, A.A., & Castonguay, L.G. (2010). Competency in integrative psychotherapy: perspectives on training and supervision. Psychotherapy: Theory, Research, Practice, Training, 47, 3-11
Bronfenbrenner, U. (1994). Ecological Models of Human Development. In International Encyclopedia of Education, Vol. 3, 2nd Ed. Oxford: Elsevier.
Cain, D.J., Keenan, K., Rubin, S. (Eds.) (2016). Humanistic Psychotherapies: Handbook of Research and Practice (2nd ed.). Washington, DC: American Psychological Association.
Driessen, E., Hegelmaier, L.M., Abbass, A.A., Barber, J.P., Dekker, J.J.M., Van, H.L., Jansma, E.P., & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review, 42, 1-15.
Levenson, H. (2003). Time-Limited Dynamic Psychotherapy: An Integrationist Perspective. Journal of Psychotherapy Integration, 13, 300-333.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109.