Academic journal article Journal of Psychology and Christianity

Constructing a Trail Up the Mountain of Intradisciplinary Integration

Academic journal article Journal of Psychology and Christianity

Constructing a Trail Up the Mountain of Intradisciplinary Integration

Article excerpt

Twenty years have passed since Worthington (1994) wrote an article on intradisciplinary integration. He contrasted intradisciplinary integration - creating a theory of psychotherapy - with interdisciplinary integration in which one attempted to synthesize a combination of the disciplines of psychology and theology, which had dominated the integration conversation to that time. He based the approach on clinical experience and reflections of integrationists, but not on much empirical research. The failure to recommend collecting empirical evidence of a treatment's efficacy in Worthington's "blueprint" article reflected the world of the early 1990s.

In 1994, though, managed care was in its infancy. Evidence supporting religiously accommodated psychotherapy was just beginning to accumulate. It was not until 1996 (Worthington, Kurusu, McCullough, & Sandage, 1996) when a major review considered bringing evidence together on religiously accommodated treatments. A few years later, McCullough (1999), found only five randomized clinical trials of Christian accommodative psychotherapy - all of which studied Christian cognitive-behavior therapy (CBT).

Suddenly, though, things accelerated. At first, the public pressure mounted to develop research support for the use of "empirically validated treatments" (Chambless, Sanderson, Shoham, Bennett-Johnson, Pope, CritsChristoph, et al., 1996), which gave way to the term "empirically supported treatments" (ESTs; Chambless & Hollon, 1998; Chambless & Ollendick, 2001), which was considered a more definitionally hygienic term. ESTs were defined as being at least two manual-driven randomized clinical trials (RCTs) of an approach that come from at least two independent labs and both show the treatment to be superior to controls or equal to an established different EST.

But that restrictive criterion, though still a gold standard, has yielded to "evidence-based treatments" (EBTs; American Psychological Association, 2005; Kazdin, 2008). EBTs permit the researcher to consider not only RCTs but many other forms of evidence supporting the treatment, thus providing a stronger and more well-rounded case for a treatment's use. However, the label tells the reader less about the quality of support than did designation as an EST. For example, a single case study could be considered "evidence" supporting a treatment. That imprecision of definition should send the reader scurrying to the research literature to evaluate the quality of evidence, but it rarely does. Instead, to make credible claims that a treatment is indeed a respectable EBT, the one making the claim must self-police to include a variety of types of evidence, including (in the best cases) meeting the criteria for empirically supported treatments and adducing much more evidence besides. For example, an excellent EBT would have efficacy evidence including case studies, N=l studies using multiple-baselines and A-B-designs, and RCTs from multiple independent labs. It would also have evidence of effectiveness (that is, communitybased studies; Wade, Worthington, & Vogel, 2007) and dissemination trials that described how a large system of providers might use the treatment effectively with clients in the system (McHugh & Barlow, 2010). An excellent EST would have process-related evidence of the dose-effect relationship, attribute-by-treatment studies that discovered for whom the treatment did and did not work well, and studies of what level and training of therapists could and could not deliver the treatment with expertise and benefit to clients. Excellent EBT are thought to be best practices.

However, even today, EBTs are neither universally embraced (Rotheram-Borus, Swendeman, & Chorpita, 2012) nor are they the end-all in mental health treatment. Yet, as Christian professionals (and ethically-minded lay Christian counselors), we want to provide the best treatment of people who seek our assistance. The best treatment, we think, might be to accommodate secular EBTs to match the beliefs and values of our religious clients. …

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