Here you'll find reviews of the latest research on "what works" in therapy.  We scour the literature as journals are published, take out all of the math, researcher-speak, and complicated statistics, and then translate the data into clear, practical, and empirically-supported principles for clinical practice.  Previous research reviews can be found in the Talkingcure.com archives.

What Works in Therapy?

Listening to clients...no, really listening!  Studies show a 65% improvement in outcome

Evidence-based practice is, as you know, "all the rage."  Like bell-bottoms and skinny ties, listening to clients in therapy is out of fashion.  Treatment manuals and fidelity measures are "in."  Most of the push for field-wide adoption of specific treatments for specific disorders comes from the top.  Government funders, policy think tanks and professional organizations are promoting evidence-based practice as the cure-all for what ails the field--namely, a continuing lack of respect and lingering perception of mental health as the "soft" of science.  Elsewhere we review the suprising lack of evidence supporting evidence-based practice. Here we consider a different idea for addressing the call for accountability in mental health: "practice-based evidence"--that is, using data generated during treatment to inform the process and outcome of treatment.  A number of researchers have, over the last decade, been using the client's rating of the therapeutic alliance and progress in treatment as a way of improving retention and outcome in treatment.  Interestingly, such research shows that providing therapists with real-time feedback regarding the client's experience of the therapeutic alliance and outcome cuts attrition rates in half and improves outcome by as much as 65%.  By the way, such results were achieved without training therapists in any new treatment procedures or limiting the sample diagnostically.  As you know, most randomized clinical trials exclude subjects that do not meet narrow inclusion criteria thereby making the applicability of any study findings to real-world clinical settings exceptionally questionable.  Bottom line: therapists were encouraged to listen--especially when what they were doing wasn't working or did not fit for the individual client--and the hoped for improvements in retention and outcome followed. 

Click here to read an article summarizing current research on "practice-based evidence."

And now for some really good news...Arizona adopts "practice-based evidence as a "best practice"

Following a two year program of dramatic change in the Public Behavioral Health System, the Arizona Division of Behavioral Health Services has settled on two "Best Practice" initiatives for the coming year. The Best Practices Committee of this Division of the Arizona Department of Health Services formalized its commitment to the Matrix Model as part of a "Centers of Excellence " in the treatment of methamphedamine abuse and Practice Based Evidence--Client Directed Outcome-Informed clinical practice utilizing the Session Rating Scale and Outcome Rating Scale.  The initial changes in the Behavioral Health System were focused on a retreat from the "problem orientation" of the medical model. In January of 2004 the traditional problem-oriented intake assessment was replaced with a strengths-based assessment approach that emphasized format over form. Assessment is no longer filling out a form rather its purpose is to engage a consumer at a level where their needs, strengths and preferences can be understood. Gone are traditional problem directed "Treatment Plans", replaced with consumer directed goal oriented Service Plans.  In an effort to re-tool the clinical delivery system a new credentialing and privileging system was initiated. Therapists are now required to be trained as "Clinical Liaisons", a position that requires the therapist to develop an ongoing primary relationship with the consumer. Clinical Liaisons are the primary contact, intake worker, assessor, therapists and behavioral health consultant working with the consumer. Gone are Intake Specialists and referral to a diagnostic based treatment or specialist. Clinical Liaisons facilitate the consumer / family in directing their care and services.

Also developing this year is a State supported Peer Support system. The Peer training now includes the Relationship Scale and Progress Rating Scale a "relationship" oriented approach that utilizes the What's Right with You book (Duncan 2005) as a training guide. How all this fits together and the ways in which we can sometimes "Move the Mountain" if ever so slowly, will be presented at Heart & Soul 3 this coming June. For more information about what is happening the Great State of Arizona or to become an active participant in the transformation email: Dr. Bob Bohanske.