Why is Evidence-Based Treatment Important?
By Patricia Guzikowski, MA, LPC, NCC, DCC
[note: the terms therapy/psychotherapy and counseling, and therapist and counselor, are used interchangeably]
First, consider the oath that medical doctors take, the part about “first, do no harm.” At the very least, anyone working with patients who entrust their wellbeing to the practitioner is responsible to ensure that no harm comes from treatment. And by harm, I’m not talking about the negative side effects common to treatment, but about the type of harm that comes from negligence, malpractice, or just plain ignorance on the part of the practitioner.
It’s true that counselors are not medical doctors, but the professional codes of ethics that counselors are bound by very clearly state that it is the counselor’s responsibility to ensure no preventable harm comes to the client. And how do counselors know what types of harm can occur from treatment, and how to avoid them? Responsible counselors know in the same way that medical doctors and psychiatrists know—by understanding what the evidence shows and keeping current on the results of the latest treatment studies.
Just as prescription drugs carry a risk of side effects, so does psychotherapy. These treatment-associated risks cannot be completely eliminated, but can be minimized through commitment to evidence-based treatment. Sometimes counseling clients experience negative emotions, changes in their relationships, and painful insights as a part of therapy. These are the normal “side effects” of psychotherapy, and in the long run they can lead to better coping mechanisms and a mentally healthier client. In this way, they are also like prescription medications, which often cause negative side effects, but produce positive results over time.
I don’t think very many people would deny that mental health is just as important as physical health, and that the two are interrelated and interdependent. This means that therapists and counselors have a tremendous responsibility towards their client, just as medical doctors do with their patients. Since this is true, why would we accept a lower standard of care for counseling clients than for medical patients? Medical treatments are studied extensively for their effectiveness, and doctors and surgeons can are held liable for any harm they cause to patients through negligence or malpractice. We judge whether they were negligent or guilty of malpractice but measuring them against the standard of care expected in their profession.
Shouldn’t therapists and counselors also be held to a standard of care?
If you answer yes, then ask yourself against what standard of care they can be measured? We can only develop a standard of care with any level of confidence if we know which treatments are effective, which have not been shown to be effective, and which treatments actually have the potential to cause harm. How else can we know this information except by examining the evidence? By basing treatment of clients on evidence-based practices, counselors can ensure that they not only cause no preventable harm, but that they provide the best possible, most effective treatments for their clients. Isn’t that what every client and counselor want—the best possible outcomes achievable through treatment?
Without evidence-based practice, therapists are left on their own to decide what they think will be effective for their clients. What they think will be effective is largely dependent upon who they are and what they believe, not on what any actual evidence shows is effective. Without evidence-based practice, counselors will using therapeutic techniques they think are logical and reasonable to use with clients, and if there is no standard of care, it is difficult to hold them accountable if harm comes to the client. Without evidence-based practice, the default standard of care is the therapist’s good intentions, even if that therapist follows ethical guidelines of practice. Ethical guidelines do not dictate which therapeutic orientation is best for an individual counselor to use with clients.
Think back to the early days of psychiatry and psychology, when practitioners were left to use their own judgments about what was best to do with patients and clients. If you know the history, you will remember that inexcusable harm has resulted from research and dubious practices, even when the practitioners had the best of intentions. This is where the requirement for researchers to get approval from Internal Review Boards (IRB’s) before doing any research with human subjects comes from. The IRB is responsible for ensuring not only that the risks of harm to test subjects is minimized, but that the test subjects sign informed consent agreements demonstrating the risks have been explained to them and that they consent to participate in the research despite the risks it presents.
When it comes to counseling, clients do not often think about the potential risks. They come to counseling expecting relief from their symptoms, an increase in their psychological well-being, better coping skills, and other positive outcomes. Clients see their therapists as competent, knowledgeable professionals with licenses to show that clients are safe in their care. The vast majority of therapy clients do not know very much about how counselors are trained or what level of education it requires or what the different credentials after the therapists names mean (such as LPS, LCSW, NCC, and so on). All they know is that they expect their counselor to be a trusted professional and an authority on mental health problems.
As counselors, we owe it to ourselves, our profession, AND our clients to ensure that we deserve not only our clients’ trust, but the trust and respect of our peers and the public at large. How else can we ensure we are providing the best possible care to our clients, and educating future counselors to provide the best possible care, if we have no standard by which to measure quality of care?
Evidence-based practice provides a measure for quality of care. If counselors use the treatment interventions and educational practices that are shown, through empirical research, to be effective for clients, those are the interventions and practices counselors should use. And furthermore, counselors and counselor educators should reject and stop practicing interventions that are shown to be ineffective and/or potentially harmful. Therapists should also share with their clients the risks posed by treatment, and they should do so before the clients commit to counseling sessions and a treatment plan.
Not committing to evidence-based practice to provide the best possible care for clients is irresponsible and can lead to harm done to clients. Counselors who choose to remain willfully ignorant as to what the research shows about the effectiveness of their counseling techniques, or who are informed but choose to ignore the research in favor of what they feel in their hearts works, are negligent and choose to play a dangerous game with their clients’ well-being. They also undermine the trust that the public puts in the practice of therapy, and counselor educators undermine the trust of their students and deprive their students of the best possible and most effective tools of their profession.
I have often heard counselors say that their profession is more of an art than a science, and that they know through their experiences with clients what treatment methods work best. These counselors are not only wrong, but at risk of doing lasting psychological damage to their clients at worst, and at best not offering the care their clients trust them to provide.
[note: the terms therapy/psychotherapy and counseling, and therapist and counselor, are used interchangeably]
First, consider the oath that medical doctors take, the part about “first, do no harm.” At the very least, anyone working with patients who entrust their wellbeing to the practitioner is responsible to ensure that no harm comes from treatment. And by harm, I’m not talking about the negative side effects common to treatment, but about the type of harm that comes from negligence, malpractice, or just plain ignorance on the part of the practitioner.
It’s true that counselors are not medical doctors, but the professional codes of ethics that counselors are bound by very clearly state that it is the counselor’s responsibility to ensure no preventable harm comes to the client. And how do counselors know what types of harm can occur from treatment, and how to avoid them? Responsible counselors know in the same way that medical doctors and psychiatrists know—by understanding what the evidence shows and keeping current on the results of the latest treatment studies.
Just as prescription drugs carry a risk of side effects, so does psychotherapy. These treatment-associated risks cannot be completely eliminated, but can be minimized through commitment to evidence-based treatment. Sometimes counseling clients experience negative emotions, changes in their relationships, and painful insights as a part of therapy. These are the normal “side effects” of psychotherapy, and in the long run they can lead to better coping mechanisms and a mentally healthier client. In this way, they are also like prescription medications, which often cause negative side effects, but produce positive results over time.
I don’t think very many people would deny that mental health is just as important as physical health, and that the two are interrelated and interdependent. This means that therapists and counselors have a tremendous responsibility towards their client, just as medical doctors do with their patients. Since this is true, why would we accept a lower standard of care for counseling clients than for medical patients? Medical treatments are studied extensively for their effectiveness, and doctors and surgeons can are held liable for any harm they cause to patients through negligence or malpractice. We judge whether they were negligent or guilty of malpractice but measuring them against the standard of care expected in their profession.
Shouldn’t therapists and counselors also be held to a standard of care?
If you answer yes, then ask yourself against what standard of care they can be measured? We can only develop a standard of care with any level of confidence if we know which treatments are effective, which have not been shown to be effective, and which treatments actually have the potential to cause harm. How else can we know this information except by examining the evidence? By basing treatment of clients on evidence-based practices, counselors can ensure that they not only cause no preventable harm, but that they provide the best possible, most effective treatments for their clients. Isn’t that what every client and counselor want—the best possible outcomes achievable through treatment?
Without evidence-based practice, therapists are left on their own to decide what they think will be effective for their clients. What they think will be effective is largely dependent upon who they are and what they believe, not on what any actual evidence shows is effective. Without evidence-based practice, counselors will using therapeutic techniques they think are logical and reasonable to use with clients, and if there is no standard of care, it is difficult to hold them accountable if harm comes to the client. Without evidence-based practice, the default standard of care is the therapist’s good intentions, even if that therapist follows ethical guidelines of practice. Ethical guidelines do not dictate which therapeutic orientation is best for an individual counselor to use with clients.
Think back to the early days of psychiatry and psychology, when practitioners were left to use their own judgments about what was best to do with patients and clients. If you know the history, you will remember that inexcusable harm has resulted from research and dubious practices, even when the practitioners had the best of intentions. This is where the requirement for researchers to get approval from Internal Review Boards (IRB’s) before doing any research with human subjects comes from. The IRB is responsible for ensuring not only that the risks of harm to test subjects is minimized, but that the test subjects sign informed consent agreements demonstrating the risks have been explained to them and that they consent to participate in the research despite the risks it presents.
When it comes to counseling, clients do not often think about the potential risks. They come to counseling expecting relief from their symptoms, an increase in their psychological well-being, better coping skills, and other positive outcomes. Clients see their therapists as competent, knowledgeable professionals with licenses to show that clients are safe in their care. The vast majority of therapy clients do not know very much about how counselors are trained or what level of education it requires or what the different credentials after the therapists names mean (such as LPS, LCSW, NCC, and so on). All they know is that they expect their counselor to be a trusted professional and an authority on mental health problems.
As counselors, we owe it to ourselves, our profession, AND our clients to ensure that we deserve not only our clients’ trust, but the trust and respect of our peers and the public at large. How else can we ensure we are providing the best possible care to our clients, and educating future counselors to provide the best possible care, if we have no standard by which to measure quality of care?
Evidence-based practice provides a measure for quality of care. If counselors use the treatment interventions and educational practices that are shown, through empirical research, to be effective for clients, those are the interventions and practices counselors should use. And furthermore, counselors and counselor educators should reject and stop practicing interventions that are shown to be ineffective and/or potentially harmful. Therapists should also share with their clients the risks posed by treatment, and they should do so before the clients commit to counseling sessions and a treatment plan.
Not committing to evidence-based practice to provide the best possible care for clients is irresponsible and can lead to harm done to clients. Counselors who choose to remain willfully ignorant as to what the research shows about the effectiveness of their counseling techniques, or who are informed but choose to ignore the research in favor of what they feel in their hearts works, are negligent and choose to play a dangerous game with their clients’ well-being. They also undermine the trust that the public puts in the practice of therapy, and counselor educators undermine the trust of their students and deprive their students of the best possible and most effective tools of their profession.
I have often heard counselors say that their profession is more of an art than a science, and that they know through their experiences with clients what treatment methods work best. These counselors are not only wrong, but at risk of doing lasting psychological damage to their clients at worst, and at best not offering the care their clients trust them to provide.