Evidence-Based Practice Versus Practice-Based Evidence

The rationale for the existence of any profession is that there exists a knowledge base that can be applied to practice. In psychotherapy, a controversy has emerged about the use of scientific evidence to inform practice. Evidence-based practice (EBP) has gained a major foothold in both clinical social work and clinical psychology. It requires the integration of the best research evidence with our clinical expertise and our client's unique values and circumstances. The process includes translating client need into researchable questions, finding evidence on these questions, and integrating that knowledge with client values and practitioner expertise. A critical assumption of EBP is that we should consider the results of research on what works best for a given target behavior or client goal. The proponents of the alternative perspective (PBE) have challenged this assumption by reference to a body of research that suggests that all bone fide treatments are equally effective. The critical predictors of outcome, according to these individuals, are the common factors, such as the therapeutic alliance between client and practitioner, the extent of the practitioner's allegiance to the chosen treatment approach, and the extent of the client's hope for change. When these variables are positive, the argument goes, it really does not matter whether depression is treated with cognitive-behavioral methods or psychodynamic methods or something else. More than anything else, this is at the heart of the debate between these two perspectives on the use of evidence to inform psychotherapy. This roundtable will examine several questions related to this debate and will offer a dialogue on the implications of this debate for practice and education. First, what are the areas of consensus and difference between evidence-based practice and practice-based evidence? One presenter will briefly introduce the steps in evidence-based practice while a second presenter will do the same for practice-based evidence. A third presenter will summarize the commonalities and differences between the two. Second, what does science tell us about the critical debate about the assertion of equivalence in outcome between bona fide treatments? Two presenters will briefly summarize this research, one with an emphasis on each side of the argument. Third, what does scientific evidence tell us about the importance of the common factors? Two presenters will briefly summarize the research on this question, one with an emphasis on each side of this debate. The second part of this roundtable will provide an exploration of the lessons we can learn from this body of knowledge that can improve the practice of psychotherapy and the education of practitioners in the future. An attempt at a creative synthesis of the two perspectives will be undertaken. From this should emerge guidance for practice and education. Two additional presenters will cover this theme. This will be followed by a general dialogue from all panel members and the audience.