Clinical Social Work and Evidence-Based Practice: An Introduction to the Special Issue

Abstract

We are very pleased to have been asked to coordinate this special issue of the Clinical Social Work Journal, oriented around the general topic of evidence-based practice (EBP). EBP has aroused considerable interest, optimism, and some controversy within our field since it was first introduced into social work by Gambrill (1999). A PsycINFO search we completed in June 2011, using ‘‘social work’’ AND ‘‘evidence-based practice’’, appearing in abstracts published during the past 5 years (2006–2010), found twice as many citations than a similar search using ‘‘social work’’ AND ‘‘psychotherapy’’ as key words. This suggests the remarkable influence the EBP process has exerted within our disciplinary literature in recent years. Working closely with this journal’s Editor, Dr. Carol Tosone, we were able to solicit the collection of papers you now find within these pages, some from proponents of EBP and others from individuals more cautious about this relatively new approach. We are grateful to these authors for providing their contributions to this topic and to Dr. Tosone for supporting this project. The impetus for our undertaking this special issue was the publication of Leichsenring and Rabung’s (2008) metaanalysis of the effectiveness of long term psychodynamic psychotherapy (LTPP) in the prestigious journal JAMA (formerly known as the Journal of the American Medical Association). These authors examined 23 different psychotherapy outcome studies that involved the provision of psychodynamic psychotherapy for at least 1 year, in the context of a published quasi-experimental or randomized clinical trial. These studies included a total over 1,000 patients who received LTPP, and the major finding was said that LTPP was significantly superior to shorter-term methods of psychotherapy. Subsequent reader responses in Letters to the Editor published in JAMA and a critical analysis (Bhar et al. 2010) indicate that this article generated considerable controversy and some of its findings were called into question. In some ways however, the accuracy of Leichsenring and Rabung’s (2008) conclusions are not as significant as is the very fact that LTPP proved to be amenable to meta-analysis, however imperfect. Coupled with the publication of a related randomized controlled trial on psychoanalytic psychotherapy for panic disorder (Milrod et al. 2007) and a systematic review on the effectiveness of long-term psychoanalytic therapy (De Maat et al. 2009), such studies put to rest the oft-heard contention that the methodological tools of outcome studies and clinical trials are inherently deficient tools to dissect and isolate the presumptively subtle effects of relationship-oriented psychotherapies (e.g., Thorpe and Baker 1959; Pharis 1976; Richardson 2001). Such outcome studies can be done well and there is a rather substantial literature in this area, studies of gradually increasing rigor and methodological sophistication. Clearly, psychodynamic psychotherapy is amenable to credible scientific appraisal, in terms of its effects, and ultimately, mechanisms of action. Any therapy that is contended to help improve client well-being is fair game for scientific investigation, to the extent it makes testable claims relating to outcomes and enhanced functioning. Of course findings obtained under carefully controlled trial conditions need to replicated under clinically representative circumstances, with heterogeneous clients and clinicians of diverse backgrounds, and steps are also being undertaken in this direction, by social workers (e.g., Roseborough 2006; B. A. Thyer (&) M. Pignotti College of Social Work, Florida State University, 296 Champions Way, Tallahassee, FL 32306, USA e-mail: Bthyer@fsu.edu