>FROM RESEARCH TO PRACTICE; the Science of Clinical Artistry: Research-Based Principles for Effective Practice

Article excerpt

Larry Beutler, professor of education and psychology at the University of California at Santa Barbara, is a researcher who doubles as a perpetual-motion machine. He has served as lead investigator in countless research studies and won numerous awards, including the Distinguished Research Career Award from the International Society for Psychotherapy Research. In his spare time, he has managed to write more than 200 articles and several books, as well as edit two of the most prominent journals in psychology, the Journal of Consulting and Clinical Psychology and, currently, the Journal of Clinical Psychology. But for all of his academic absorption, Beutler, a therapist himself, remains deeply attuned to the real-life, everyday concerns of clinicians.

For some time, he has been grappling with a question that nearly every working therapist asks: How can I get better treatment outcomes? One pathway may be to utilize only "empirically supported treatments" (ESTs) that have been scientifically demonstrated to work well for specific disorders; this list of mostly cognitive-behavioral approaches has been compiled and endorsed by a task force of the American Psychological Association's Division of Clinical Psychology (see "From Research to Practice," March/April 2001). A significant limitation of the EST concept, however, is that relatively few therapists have been trained in the highly structured, manualized therapies that have been sanctioned by the APA task force. If a couple seeks your help for intimacy troubles, for example, but you don't happen to be well-versed in the sole EST approved for couples' work--behavioral marital therapy--you're out of luck.

It occurred to Beutler, therefore, that it would be far more useful for therapists to have access to a set of guiding principles that would maximize the chances that clients would improve regardless of a clinician's favored theoretical orientation. Fueled by his indefatigable energy for research and aided by colleagues John Clarkin and Bruce Bongar, Beutler plumbed 2,000 psychotherapy outcome studies to determine what factors were essential to therapeutic success regardless of modality. He then developed a short list of hypotheses about what the factors might be and conducted additional studies to confirm the accuracy of his predictions.

The result is a set of empirically informed, modality-transcendent findings related to effective therapeutic decision-making for a range of common clinical problems, including depression, anxiety and substance abuse. Beutler believes that these guiding principles support a treatment planning model he calls "Systematic Treatment Selection," which allows therapists to work with maximum flexibility, creativity and effectiveness within their favored approaches and--with luck--put an end to the clash of "dueling modalities" that has plagued the field for so long. Following is a sampling of Beutler's most significant findings in four critical areas affecting treatment outcome: client prognosis, treatment context, therapeutic style and matching treatment and temperament.

Client Prognosis

Key finding: Less change can be expected when clients show low levels of distress about their problems. Beutler found that if a client isn't sufficiently bothered by a problem--or doesn't recognize it--he or she may feel little motivation to change.

Implications for therapy: When clients appear unruffled about serious difficulties, an effective early strategy may be to ratchet up their distress level, rather than immediately trying to soothe them. For instance, if a client comes into mandated therapy following a DUI arrest, yet dismissively claims he "just likes a few brews," his therapist might look for ways to heighten his concern about his alcohol consumption. If he is a runner who cares about his physical condition and appearance, she might give him factual information about the health consequences of alcohol abuse and recommend AA meetings, where the group process would be likely to further raise his level of concern. …