Treatments into Clinical Practice
The recent movement in psychology toward utilizing
empirically supported treatments (EST) has created personal and professional
challenges for many clinicians.
As insurance companies and other outside forces push for treatment
standardization and accountability, some therapists are caught in the middle,
fearing that EST constrain clinical judgment or disregard it altogether. For such therapists, the question is: how
can we make these treatment programs work for us as clinicians, rather than the
other way around? Several steps may
help us find the most effective solution.
a careful diagnostic assessment.
This step helps determine if an EST is an appropriate treatment
choice. It includes diagnosing the
presenting complaint, but also careful assessment for comorbid conditions
potentially impacting treatment.
This is important even when working in specialty clinics or with
particular patient populations – treating an adolescent with anxiety
disorder becomes a completely different endeavor when there is a comorbid
substance abuse condition. Using a
structured interview or your own clinical interview format, be sure you
are covering the full range of possibly psychopathology, as this will aid
in selection of the best possible treatment fit for your patient.
the manual you are using well.
If we do choose an EST treatment approach for patients, it is
helpful to review the manuals as well as the recent research on the
particular EST. Even the most
popular manualized treatments are under constant revision and testing from
their developers. By being
thoroughly familiar with a treatment manual as well as up-to-date on the
research, we enhance our ability to use the EST interventions effectively
the treatment your own. After
patient factors such motivation for therapy, therapist factors and
patient-therapist relationship are the most important predictors of
treatment outcome. Consulting a manual
to help select intervention strategies does not mean that what we bring
into session – sense of humor, warmth and empathy, ongoing evaluation of
patient needs – is less valuable. How
we deliver the interventions suggested in the manuals is potentially as
important as whether we deliver them. We need to use clinical judgment to best deliver a message
or strategy so that the patient can hear and integrate it.
Having a good formulation of patient diagnosis and dynamics,
understanding the EST we select well, and implementing it in a manner
consistent with therapist style and personality, will all aid in appropriately
integrating manuals into clinical practice.
It optimizes effective care to patients, who benefit from the tailoring
of generic interventions to their specific needs. Further, it still allows clinicians to respect and utilize the
training and experience they bring into treatment.
Please contact CLASP through our website at http://www.cpaclasp.org or our email at Info@cpaclasp.org if you would like
information, referrals or help in coping with personal stress and impairment.
Phoebe Moore, PhD, is a post-doctoral research fellow with
the Stanford University School of Medicine.
She can be reached by email at psm@Stanford.edu. The column editor, Kasey Saltzman, can be
reached at 401 Quarry Road, MC 5719, Stanford, CA, 94305 or by email at Kasey.Saltzman@Stanford.edu.
California Psychologist * November/December 2002