Monitoring the Counseling Relationship and Client Progress as Alternatives to Prescriptive Empirically Supported Therapies

Many insurance companies and professional organizations have increasingly stipulated that mental health professionals use interventions that have been classified as empirically supported therapies (ESTs). Though the EST movement aims to provide clinicians with straightforward, evidence-based interventions for making treatment planning decisions, there are several practical and scientific barriers to the wholesale implementation of ESTs by mental health counselors. These barriers will be discussed, and two alternative strategies—cultivation of the counseling relationship and routine outcomes monitoring—will be presented as evidence-based alternatives to prescriptive ESTs.

Limitations of Randomized Control Designs in Psychotherapy Research

Despite the growing influence of lists of empirically supported therapies (ESTs) there are concerns about the design and conduct of this body of research. These concerns include limitations inherent in the requirements of randomized control trials (RCTs) that favor those psychotherapies that define problems and outcome in terms of uncomplicated symptoms. Additional concerns have to do with criteria for patient selection, lack of integration with research on psychotherapy process and effectiveness studies, limited outcome criteria, and lack of controls for experimenter bias. RCT designs have an important place in outcome research; however it is important to recognize that these designs also place restrictions on what and how psychotherapy can be studied. There is a need for large scale psychotherapy outcome research based on designs that allow for inclusion of process variables and the study of the effects of those idiographic approaches to therapy that do not lend themselves to RCT designs. Interpretative phenomenological analysis may provide a useful method for the evaluation of the effectiveness of idiographic approaches to psychotherapy where outcome is not understood solely in terms of symptom reduction.

Cultural Considerations in Evidence-Based Couple Therapy

This chapter considers issues of culture in couple therapy while examining the current movement toward empirically supported therapies (ESTs). Culture is distinguished from the related but distinct concepts of race, ethnicity, and nationality, and the value of studying culture directly is discussed. Several concerns and criticisms of empirically supported therapy criteria related to diverse couples are presented including a lack of inclusion in studies, the valuing of internal over external validity, and unexamined assumptions of universality. Cultural assumptions behind evidence-based treatments are examined with hypotheses about cultural congruency for diverse groups. Existing scholarly works on cultural aspects of the therapy approaches are highlighted. The clear need to build on existing theoretical and case-based knowledge related to culture in empirical ways is discussed.

Novel Unsupported and Empirically Supported Therapies: Patterns of Usage Among Licensed Clinical Social Workers

Background: While considerable attention has been focused in recent years on evidence-based practice, less attention has been placed on clinical social workers’ choice to use ineffective or harmful interventions, referred to in the present paper as Novel Unsupported Therapies (NUSTs). Method: The present study surveyed 400 Licensed Clinical Social Workers (LCSWs) across the United States in order to determine the extent of their usage of NUSTs, as well as their usage of conventional therapies that lacked support and empirically supported therapies (ESTs). Reasons for selecting interventions were also assessed. Results: While the vast majority (97.5%) reported using some form of EST, 75% of our sample also reported using at least one NUST. Logistic regression analysis revealed that NUST usage was related to female gender and trauma specialization. A split plot ANOVA revealed that respondents rated positive clinical experience higher than published research as a reason for selecting an intervention. LCSWs with a CBT theoretical orientation rated research evidence more highly than those of other theoretical orientations. However, even within the group of LCSWs with a CBT orientation, clinical experience was rated more highly than research evidence. Conclusions: Implications for practice are discussed.