An item in today's New York Times "Well" blog takes a look at evidence-based treatment and the gap that still exists between research and clinical practice in the mental health field. As an example, writer Harriet Brown points to a 2009 meta-analysis on the use of cognitive behavioral therapy (CBT), a course of treatment proven effective by a substantial body of research. The study showed that CBT was rare for psychiatric patients in the United States and Great Britain. Brown writes:
"Instead, many patients are subjected to a kind of dim-sum approach — a little of this, a little of that, much of it derived more from the therapist’s biases and training than from the latest research findings. And even professionals who claim to use evidence-based treatments rarely do."
One possible explanation for this divide is that psychologists see their work as an art form --one that cannot be necessarily defined in strictly scientific terms. Dianne Chambless, a psychology professor at the University of Pennsylvania, tells Brown, "Many psychologists believe they have skills that allow them to tailor a treatment to a client that’s better than any scientist can come up with with all their data."
But the research doesn't support this theory, Brown argues. Research suggests that when clinicians do not use evidence-based treatments, the patients experience worse outcomes. Moreover, according to Dr. Carolyn Becker, a professor of psychology at Trinity University in San Antonio, therapists also often overestimate how well they are doing with a patient. Without a data-driven method for measuring and comparing progress, this isn't necessarily surprising.
At the end of her article, Brown recommends that mental health consumers do their research on prospective therapists, and offers a list of helpful questions.
Polaris Health Directions has been an advocate for the delivery of evidence-based care since its inception in 1997. With funding from the National Institutes of Health, Polaris has developed a suite of Web-based systems designed to help close that gap between research and practice. Polaris's mental health outcomes management system, for example, gives clinicians the ability to objectively determine what treatments work for whom. Aggregate reporting provides a foundation for meaningful treatment program evaluation and quality improvement initiatives.