Heather says:

I bought this book as a text for a course, and it was required. It really isn’t too bad for a text.
Rating: 4 / 5

David C. Young says:

“Few topics in mental health are as incendiary, consequential, and timely as evidence-based practices. [Note: "practices", not "treatments"] Yet, this multifaceted and complex topic has been reduced to simplistic and polarized arguments; regrettably, more heat than light has been shed on the topic.”

John C. Norcross, Larry E. Beutler, Ronald F. Levant, eds., “Preface”,

“Evidence-Based Practices in Mental Health” is THE overview of Psychology’s War: the war over what is & isn’t effective, and so what should & shouldn’t be done in psychotherapy. The three editors, each of whom come from a different major army in what they call the “Culture Wars of EBPs [Evidence-Based Practices]“, have enlisted over 40 researchers/clinicians to respond. In areas I know, the editors have certainly picked the best researchers/clinicians. As the editors say,

“Mental health professionals have become polarized on EBPs and separated into rival camps, with differing language systems and conflicting values.”

And that’s putting it very mildly.

“Evidence-Based Practices” presents quite-diverse positions on nine crucial questions:

What qualifies as evidence of effective practice?

What qualifies as research on which to judge effective practice?

Does manualization improve therapy outcomes?

Are research patients and clinical trials representative of clinical practice?

What should be validated? (Or what aspect of psychotherapy should we be researching, e.g., a technique, a relationship quality, a client characteristic, etc.?)

What else materially influences what is represented and published as evidence?

Do therapies designated as “empirically supported treatments” for specific disorders produce outcomes superior to non-”empirically supported treatment” therapies?

How well do both “evidence-based practices” and “treatment as usual” satisfactorily address the various dimensions of diversity?

Are efficacious laboratory-validated treatments readily transportable to clinical practice?

For each question, experts stake out their differing positions. For example, on “What should be validated?”, leading researchers/clinicians take five different positions: treatment method, psychotherapist, therapy relationship, active client & principles of change. On “What qualifies as research on which to judge effective practice?, researchers/clinicians explain & defend six positions: case studies, single-participant design research, qualitative research, change process research, effectiveness research and randomized clinical trials.

After all the different answers to a question, each researcher/clinician is asked a series of questions about that topic: “Dialogue: Convergence and Contention”. For example, in the 5-positioned response to “What should be validated?”, three “misconceptions” about Empirically-Supported Treatments (ESTs) were presented for five different responses: “EST advocates ignore contributions of the psychotherapist”, “EST advocates hold that the therapeutic relationship is not important” and “EST advocates hold that clients are passive recipients of treatments”.

Reading all the answers to each question gives a clear, vivid summary of this war’s key aspects. More than urgent, at times, these conflicts, these different positions can be painful & fear-provoking. But always, I find, they’re important, even vital to know.

The three editors are self-proclaimed believers in both science & clinical practice, and they say they’re all biased toward “informed pluralism”. So their shared goal is to find peaceful & productive coexistences & interactions between these different, highly conflicted understandings & approaches:

“Mental health professionals comprise a nation of differences. Those differences do not necessarily make us weak; differences can serve as sources of creativity, strength, and progress if constructively harnessed. In the view of Feyerabend, a philosopher of science, the interplay between tenacity and proliferation is an essential feature in the development of science. It is not the puzzle-solving activity that is responsible for the growth in the development of science, but the active interplay of various tenaciously held views. In the words of Dante (Paradisio, Canto VI), “Of diverse voices is sweet music made.” But diverse voices can also sound like nails on a blackboard if they are dissynchronous and out of harmony.”

As a clinician working with difficult & complex, multi-problemed clients & families, I absolutely agree. Yet in reading this book, while it was extremely valuable & informative, I found that the editors goal of co-existence and pluralism, sadly, often seemed “a custom more honour’d in the breach than the observance.”

(Yes, I know I’m misusing that Hamlet quotation.)

Still, for my fellow clinicians, I strongly recommend this book. You’ll be a much wiser consumer of research & practices, and you’ll be much more aware of the full range of needed possibilities.

Disclosure: I was first trained by several students -psychotherapists & researchers – who studied and worked with Carl Rogers. Rogers more-or-less began systematic research into the effectiveness of psychotherapy. Obviously, his focus was investigating the client/therapist relationship. Since that time, a quarter century ago, I’ve become a family therapist, and I also use many cognitive-behavioral therapies & DSM diagnoses. Yet I’ve always thought of myself as, foundationally, a client-centered family therapist – less in what I do than in how I do it.

Evidence-supported treatments (ESTs) currently dominate high-powered academic psychology, which gets most of the research funding. More, ESTs have also won the public-relations war hands-down. Yes, I was trained on client-centered research & the primacy of the client/therapist relationship. But after years of reading little else but EST research & practice, I discovered that I’d slipped, clinically, in the non-EST’s which, research strongly suggests, are at least if not more important & effective than specific treatments for specific diagnoses. (See,especially, the 2nd edition (2010), The Heart and Soul of Change: Delivering What Works in Therapy and the earlier, Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients.) I’d become steadily more skillful in diagnosis & treatment procedures. But in turning away from non-EST research and its clinical implications, I had not kept up with important research advances in areas such as eliciting & incorporating client skills, getting feedback on the quality of my client/therapist relationship, qualities to develop as the therapist, and more.

Is “Evidence-Based Practices” heavy into statistics? No, at least not for me. And my statistics training – never my strongest suit – is several decades past. These summaries are clearly written with the general mental health audience in mind, though for psychologists in particular. This means that some understanding of basic research terms is helpful. But even if you’ve forgotten everything from your graduate research class, a dictionary should suffice to refresh your memory, at least enough to read these summaries.

As clinicians, all this research-focus may seem far from our central concern: becoming better at helping clients heal. But in my experience, “Evidence-Based Practices in Mental Health” turned out to be highly relevant in pointing out what I and, more importantly, what my clients most needed. I believe you’ll find “Evidence-Based Practices” an important corrective, and a guide back to a more balanced, more truly scientific and effective approach to psychotherapy.
Rating: 5 / 5