Evidence-Based Practice

The quest to determine what works in psychotherapy is a critical one. Evidence for therapeutic interventions can be defined in many ways. Building consensus on the definition of evidence and ensuring that evidence-based practice (EBP) in psychology recognizes not only the research but also the clinician's expertise and the patient's preferences, values, and culture is important to providing quality patient care and to the future of the profession of psychology. Some psychologists believe that psychological interventions should be based solely on randomized clinical trials, while others claim that other forms of evidence have their value. Regardless of their positions, most psychologists recognize that the EBP movement in U.S. society is a juggernaut, racing to achieve accountability in medicine, psychology, education, public policy, and even architecture. The zeitgeist is to require professionals to base their practice on evidence to whatever extent possible.

The American Psychological Association (APA) developed and adopted a policy statement and received a longer report on EBP in psychology at the meeting of its Council of Representatives in August 2005. The policy statement was based on the three components of the Institute of Medicine definition of EBP in medicine. Thus, the APA statement on EBP in psychology aimed to affirm the importance of attending to multiple sources of research evidence and to assert that psychological practice based on evidence is also based on clinical expertise and patient values. The statement begins, “Evidence-Based Practice in Psychology … is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.”

• 1.
  The APA policy statement has a broad view of research evidence, including multiple research designs, research in public health, health services research, and health care economics, while recognizing that there is a progression of evidence.
• 2.
  The APA policy statement explicates the competencies that make up clinical expertise. It also defines the appropriate role of clinical expertise in treatment decision making, including attention to both the multiple streams of evidence that must be integrated by clinicians and to the heuristics and biases that can affect clinical judgment.
• 3.
  The APA policy statement articulated the role of patient values in treatment decision making, including the consideration of the role of ethnicity, race, culture, language, gender, sexual orientation, religion, age, and disability status and the issues of treatment acceptability and consumer choice.

The statement concludes, Clinical decisions should be made in collaboration with the patient, based on the best clinically relevant evidence and with consideration of the probable costs, benefits, and available resources and options. It is the treating psychologist who makes the ultimate judgment regarding a particular intervention or treatment plan.