Magazine article Behavioral Healthcare Executive

What Is an Empirically Supported Clinician? If We Don't Measure Outcomes, Our Services Will Be Treated like a Commodity

Magazine article Behavioral Healthcare Executive

What Is an Empirically Supported Clinician? If We Don't Measure Outcomes, Our Services Will Be Treated like a Commodity

Article excerpt

In Garrison Keeler's fictional Lake Wobegone, all the children are above average. While this may be an amusing characterization, it is not entirely far-fetched in terms of how some groups of people assess themselves.

Take professionals, for example. People may be well aware of their personal foibles, but many embrace a new sense of above average identity upon attaining advanced education and professional credentials. The question within behavioral health is no different. How effective are clinicians as therapists? What would we do if we knew the answer?

The immediate puzzle is how we would calculate the effectiveness of therapists. In research studies that evaluate medications and psychotherapies, the gold standard is to use patient self-report questionnaires. Are these measures acceptable for real world practice?

My training as a clinician taught me to have good clinical judgment. I should be constantly evaluating how my client is responding and modifying my response. For example, if my client is developing a powerful transference relationship, then I have been trained to know what to do. If my client is stuck in negative thoughts, then I know how to address cognitive distortions and encourage behavioral activation. Measurement was never an issue.

But measurement is actually a very big issue. Are our organizations' clinical interventions valuable or worthless, objectively speaking, and as we strive to control the costs of medical care, should our services be cut?

In fact, we have a definitive answer, but most practicing clinicians have no idea what it might be because there is a wide gulf between clinical research and practice. However, the good news is that psychotherapy is remarkably efficacious.

Therapy is effective

One way to understand this is to read "The Great Psychotherapy Debate," by Bruce Wampold. Wampold's sobering message is that no model of psychotherapy is more effective than another.

So those of you who champion cognitive behavioral therapy (CBT) or psychodynamic therapy, or whatever technique you have invested in, should adopt some humility about your superior techniques. This does not mean that clinicians shouldn't continually try to improve their skills, but rather that research has not been able to sort out any clear winners.

I won't belabor the method of getting to this conclusion, but Wampold uses meta-analytic statistical analyses to determine what all of the strong clinical studies show about competing clinical approaches.

If clinicians can't proudly promote their practices on the claim that they have great expertise in CBT, and accordingly, charge ever increasing fees for services, then what is the marketing claim? …

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