This paper describes how the trend toward emphasizing evidence-based practice and empirically supported treatments is likely to affect the practice of counseling and psychotherapy in the future. Several specific predictions are described and discussed, particularly those of Nicholas Cummings. Predictions include that evidence-based practice and general psychotherapy will diverge; eventually only evidence-based practice will be reimbursed and covered by liability insurance; and psychotherapy will become briefer and more integrated into the healthcare system.
KEYWORDS: evidence-based practice; future of psychotherapy
The field of professional psychology has been split due to the controversy over the promotion of evidence-based practice (EBP) and empirically supported treatments (ESTs) (DeAngelis, 2005). On the one hand, practitioners tend to be open to considering new ideas and methods for helping their clients, regardless of their empirical support. Therapists naturally want to offer suffering clients help, even in the absence of firm scientific support for all therapeutic approaches. On the other hand, scientifically inclined psychologists decry the proliferation of new techniques that have little if any evidence for their safety or efficacy (Lilienfeld, 2007). No professional issue is more important to practicing psychologists than the development of EBP in mental health (Prochaska & Norcross, 2007).
THE CONTROVERSY ABOUT EVIDENCE-BASED PRACTICE
The movement toward finding and listing empirically supported treatments is controversial. Some feel that the emphasis on using ESTs is misguided because it moves psychotherapy further into the medical model: "Psychology's medicalization has accelerated recently .... Psychotherapy is at risk for being medicalized out of existence" (Hunsberger, 2007, p. 614). Others assert that because there is good evidence that psychotherapy in general is helpful most of the time, "Psychologists do not have to apologize for their treatments. Nor is there an actual need to prove their effectiveness" (Fox, 2000). However, if third-party payers continue to require more accountability, psychologists probably will have to prove the effectiveness of their treatments if they expect reimbursement for their services.
Speaking of psychologists, Raymond D. Fowler, past president of the American Psychological Association, said "Our scientific base is what sets us apart from the social workers, the counselors, and the Gypsies" (quoted in Dawes, 1994, p. 21). Setting aside Fowler's slighting of counselors and others, his point that clinical psychology has a tradition of valuing the scientific method is well taken. The emphasis on establishing empirical support for psychotherapy over the past decade has lead to the development of lists of psychotherapeutic approaches that have good evidence for their effectiveness (Chambliss & Ollendick, 2001; Fisher & O'Donohue, 2006; Society of Clinical Psychology, 2009). Psychotherapists who want to practice evidence-based treatments can consult such fists, although there is no requirement that they do so.
Although similar, evidence-based practice (EBP) and empirically supported treatments (ESTs) are different. Evidence-based practice is the integration of research with clinical expertise in the context of the client's characteristics, culture, and preferences. Empirically supported treatments are treatments with at least two randomized controlled clinical trials that demonstrate their efficacy. This is a very rigorous standard, and the APA policy on evidence-based practice allows for less stringent evidence (APA Presidential Task Force on Evidence-Based Practice, 2006). Since EBP allows for various kinds of evidence besides randomized, controlled trials, it is usually considered less stringent and less controversial than ESTs.
The trend is toward requiring psychotherapists to account for their clinical and cost effectiveness. …