Friday, July 16, 2010

Empirically Supported Treatments in Psychotherapy - A Review Article

Empirically supported treatments, efficacy based therapy, evidenced-based therapy, research based approaches - nearly all of these phrases (and more) are commonly thrown around these days in counseling and psychotherapy education and journals. But are these really the best approaches? Often, they are code for cognitive behavior therapy (CBT), which is the easiest to test and therefore the primary model being researched.

This paper looks at the evidenced-based movement versus what we know actually creates change in therapy - the common factors theory (therapist, therapy, client).

This open-source review article comes from Frontiers in Psychology for Clinical Settings.

The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented.

Keywords: evidence based medicine, empirically supported treatments, psychotherapy research, common factors, efficacy, evidence based in clinical psychology, EBM, EST

Citation: Castelnuovo G (2010) Empirically supported treatments in psychotherapy: towards an evidence-based or evidence-biased psychology in clinical settings?. Front. Psychology 1:27. doi:10.3389/fpsyg.2010.00027

Received: 01 May 2010; Paper pending published: 09 May 2010; Accepted: 10 June 2010; Published online: 02 July 2010.

Copyright: © 2010 Castelnuovo. This is an open-access article subject to an exclusive license agreement between the authors and the Frontiers Research Foundation, which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.

*Correspondence: Gianluca Castelnuovo, Clinical Psychology Lab, San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Verbania, Italy; Catholic University of Milan, Milan Italy.
Here is the beginning of the article (free PDF download), where the author sets out the main issue - empirically based treatments versus the common factors (not based in any one system of therapy) that are known to be most beneficial.
Between “Common Factors” and “Empirically Supported Treatments” perspectives The fundamental questions for psychotherapy researchers have historically concerned the real effectiveness of psychotherapeutic treatments. The reply to this problem has been largely positive (Smith et al., 1980; Lambert and Bergin, 1994; Lambert, 2005) with some notable exceptions (Eysenck, 1952, 1961).

Then the focus of attention in research moved from a general demonstration of the effectiveness of psychotherapy to the particular examination, identification, and classification of specific treatments which have been shown to be effective in experimental settings for generally recognized psychopathologies. The question came back to “which treatment, prescribed by whom, and in which circumstances, is the most effective for this particular individual with this specific problem?’ (Paul, 1967, p. 111).

Among researchers and clinicians looking for significative results in psychotherapy research, two were the widespread approaches: on the one hand the “common factors perspective”, theories confirming the so-called “Dodo Solution” (Luborsky and Singer, 1975; Luborsky et al., 2002; Lambert, 2005), on the other hand the development of so-called “Empirically Supported Treatments”, which are based on the “Evidence Based Medicine” philosophy (Herbert, 2003; Morrison et al., 2003; Karver et al., 2005; Joyce et al., 2006).

In Lambert’s opinion (2005), “common factors are those dimensions of the treatment setting (therapist, therapy, client) that are not specific to any particular technique. Research on the broader concept of common factors investigates causal mechanisms such as expectation for improvement, therapist confidence, and a therapeutic relationship that is characterized by trust, warmth, understanding, acceptance, kindness, and human wisdom. But also can be expanded to include some mechanisms that are often regarded as unique to a particular form of treatment such as exposure to anxiety-provoking stimuli, encouragement to participate in other risk-taking behavior (facing rather than avoiding situations that make the patient uncomfortable), and encouraging client efforts at mastery such as practicing and rehearsing behaviors. Such a view of common factors recognizes that while specific theories of psychotherapy may emphasize systematic in vivo or in vitro exposure to frightening situations, or social-skills training, nearly all therapies encourage people to review and discuss the things they fear and face rather than avoid such situations. Common factors, no matter how unimportant they may be from the point of view of a particular theory (theoretically inert or trivial) are central to nearly all psychological interventions in practice, if not, theory” (p. 856, 2005).

For a more in-depth analysis of “common factors perspective” please consider (Castelnuovo et al., 2004b, 2005). One comprehensive example of application of this approach is the Karver et al. (2005) model.

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