Best Practices: A Critical Yet Inclusive Vision for the Counseling Profession

Article excerpt

The concept of best practices (BPs), often used interchangeably with evidence-based practices (EBPs), concerns the application of optimal counseling practices--those supported by the best available scientific evidence as well as clinical expertise (Marotta & Watts, 2007; Norcross, 2010). As the term EBP suggests, the notion of BP generally, although not exclusively, carries the expectation that practices designated as "best" will have been vetted through empirical support. Thus, as the EBP concept has gained prominence, the mental health research and practice landscape has become increasingly dominated by the search for and promotion of empirically substantiated interventions, treatments, or therapies, an endeavor commonly known as the empirically supported treatment (EST) movement (Wampold & Bhati, 2004).

Driven by the growing demand for proof of service effectiveness, the EST and EBP movements have deeply affected counseling and other mental health professions, influencing the type and quantity of services that are reimbursed by third-party payers, practiced in agencies and other counseling settings, and included in educational curricula (Norcross, 2002). Within the counseling community, these developments have generated important and impassioned debate concerning the relative appropriateness and value of the BP movement, with positions ranging from avid support (Sexton, as cited in Marotta & Watts, 2007) to ardent opposition (Hansen, 2006). In this article, we provide a brief summary of the EST movement; review accompanying issues and criticisms; and discuss the implications of BPs for the long-term survival of various dimensions of counselor identity, including multiculturalism, developmentalism, social justice, and a holistic wellness perspective. Ultimately, our aim is to further clarify a balanced and inclusive conception of BP that we hope helps to reconcile contemporary pressures to provide evidence-based services with counselors' need to feel confident that they can retain their core values while serving clients in the most effective manner possible.

* Overview of the BPs Controversy

Proponents of EBPs claim that a problem of accountability is created by the "institutionalization of untested psychological theory as fact" (Sexton, as cited in Marotta & Watts, 2007, p. 493) as well as the lack of standardization in clinical practice (O'Donohue & Fisher, 2006). Scholars promoting EBPs further contend that implementing standards of evidence is a critical means of ensuring the quality and reliability of counseling services. Although providing some form of evidence for the effectiveness of the services a counselor delivers is undoubtedly a laudable goal and an ethical imperative for some scholars, other scholars have argued on conceptual, cultural, and methodological grounds against the criteria that have been used to define evidence and designate EBPs (Atkinson, Bui, & Mori, 2001; Seligman, 1995; Westen, Novotny, & Thompson-Brenner, 2004). It has been further argued that the EST and EBP movements represent an attempt to legislate a narrow, medicalized approach to counseling research and practice that relies excessively on traditional experimental research methods and easily measured outcomes, as well as places undue emphasis on treatment models at the expense of factors such as the "person of the counselor," the counseling relationship, and clients' nondiagnostic characteristics (Hansen, 2006; Wampold, 2001). Scholars of varying theoretical orientations (Hansen, 2006; West & Bubenzer, as cited in Marotta & Watts, 2007; Norcross, 2010) have further cautioned that once proclaimed "best," institutionally dominant forms of knowledge and practice will marginalize alternative (namely, humanistic, constructivist, and multicultural) theoretical perspectives and therapeutic modalities, to the detriment of the counseling profession. These scholars fear that interventions that are privileged as "evidence-based" will largely determine what treatments are reimbursed, funded for further research, taught in practitioner education programs, and subsequently implemented. …