Evidence-Based Psychotherapy: Where Practice and Research Meet


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Balanced appraisal given of evidence-based practice
(December 2007 Issue)

“Evidence-Based Psychotherapy:
Where Practice and Research Meet”
By Carol D. Goodheart, Alan E. Kazdin and Robert J. Sternberg
American Psychological Association
Washington, D.C., 2006

By James K. Luiselli, Ed.D., ABPP, BCBA

The American Psychological Association defines evidence-based practice (EBP) as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, values and preferences." EBP has its origins in medical health care and has achieved widespread endorsement by many psychologists. However, as revealed in this book, there is considerable controversy about EBP, its formulation and the legitimacy of research informing clinical standards.

The book is comprised of 11 chapters that address practice, research and policy development aspects of EBP. Implicit within the message of each chapter is that psychological practice should be founded on science. The chapters also acknowledge that acquiring scientific evidence and applying it to psychotherapy is fraught with uncertainty. This balanced appraisal is laudable and a strength of the book.

Several chapters trace the "EBP movement" to changes in organized health care, cost containment by third-party payers and increased regulation of mental health services. Readers will quickly glean how these forces have promoted so called "efficacy research" that is disseminated to, if not imposed upon, "real world" practitioners. There is good debate throughout the book about the merits and outcome from these influences.

EBP is driven by randomized controlled trials of therapeutic procedures to determine what does and does not "work" for specific clinical disorders. This inquiry is the basis for practice guidelines and resulting "manualized" treatment. But can these research findings be adopted seamlessly by office clinicians? The book leans toward "no" as the answer but not without careful discussion about how the situation can be improved.

Acknowledging that EBP is here to stay, several chapters detail areas of success, one example being the cognitive-behavioral treatment of panic disorder at community mental health centers. Issues integral to clinical practice such as therapist-client alliance, psychoeducational counseling, theoretical pluralism and therapeutic goal-setting are considered relative to implementing EBP. These and related matters should be of interest to clinicians both persuaded by and critical of EBP.

To some, EBP is but one of many "buzz words" that so frequently litter our profession. Thankfully, Goodheart, Kazdin, and Sternberg dispel this assumption with a well crafted, generous book. Its success rests with the authoritative writing in each chapter, the broad selection of topics and the scholarly coverage of what can be an elusive subject. I learned much about EBP by reading the book and recommend it enthusiastically to students of psychology, mental health professionals and research scientists.

James K. Luiselli, Ed.D., ABPP, BCBA, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.