Novel and Empirically Supported Therapies: Patterns of Usage Among LCSWs

Background and Purpose

Concern has been expressed about the degree of empirical support of interventions used by licensed clinical social workers (LCSWs) or lack thereof. However, no recent study other than the pilot study the present study builds on (Pignotti & Thyer, 2009) has surveyed LCSWs regarding their use of specific novel interventions that lack empirical support. The purpose of the present study was to determine the types of interventions currently being used by LCSWs, the relative importance of reasons given for choosing interventions and their relationship to theoretical orientation, attitudes towards evidence-based practice, and the relationship between choosing interventions and demographics.

Methods

The survey was conducted by randomly selecting a sample of LCSWs located in the United States who published their electronic mail addresses online in a database linked to the NASW website, http://www.helppro.com. A total of 894 LCSWs were invited to participate and 400 from 39 different states responded, resulting in a 45% response rate. The survey included demographics; theoretical orientation; interventions used in practice; reasons for choosing interventions, and attitudes towards evidence based practice were assessed with the Evidence Based Practice Attitudes Scale (EBPAS; Aarons, 2004). Following an expert review, interventions were placed into the following categories: 1) novel unsupported; 2) conventional unsupported; or 3) empirically supported. Our hypotheses were: 1) our sample as a whole would rate clinical experience more highly than published research as a reason for selecting interventions; and 2) participants with a cognitive-behavioral (CB) orientation would rate published research more highly as a reason than those of other orientations.

Results

Our sample was 77% female with an average age of 53 (SD=10) with 19 years practice experience (SD=10) and 86% in private practice. A CB theoretical orientation was reported by 30% and 75% used at least one novel unsupported intervention. Alpha for the EBPAS was .82 with a mean of 54, above the midpoint of 45.

Our first hypothesis was supported. Participants rated clinical experience (M=6.40, SD=.88) more highly than published research (M=4.76, SD=1.53) F=291.08 p<.001 d=1.39

Our second hypothesis was also supported. Participants with a theoretical orientation of CB (M=5.20, SD=1.54) rated favorable research published in peer reviewed journals more highly than participants of other theoretical orientations (M=4.57, SD=1.49) t=3.51 p<.01 d=.42.

Conclusions and Implications:

Although respondents do appear to be using therapies that have empirical support, three-quarters were also using interventions that did not and choices appear to be based more upon clinical experience than empirical evidence. These results indicate that clinical social workers may benefit from learning more about the pitfalls of choosing interventions based on experience, rather than research evidence. Future research should explore relationship with EBP using measures of behaviors as well as attitudes.

Reference:

Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice scale (EBPAS). Mental Health Services Research, 6, 61-74.

Pignotti, M. & Thyer, B. A. (2009). The use of novel unsupported and empirically supported therapies by licensed clinical social workers. Social Work Research, 33, 5-17.