Empirically supported treatments: Too little, too late: A commentary.

Abstract

The article entitled Empirically Supported Treatments in Psychology: Implications for Canadian Professional Psychology is well written and makes a number of important observations and recommendations that are important for professional psychology in Canada. However, the article raises a number of important issues that need urgent consideration if the health related(f.1) branches of professional psychology in Canada are to expand and thrive. As suggested by the title of this commentary the evidence-based movement is too little and too late. It is too little, in that considerably more, and much more complex evidence for what professional psychologists do is required. It is too late, in that both in Canada and the United States professional psychologists have suffered considerable set backs in both the economic and popularity domains.Statutory or Common law in Canada requires that, when practitioners are obtaining informed consent to embark on a procedure with a client, they must disclose the nature of the procedure, the associated risks and benefits, and the outcome expected (Evans, 1997). In addition, there is a requirement to inform clients about alternatives to treatment, including refusal of treatment, and the related risks and benefits of these alternatives. For example, suppose a practitioner proposed to treat a client for anxiety in the work setting using the counselling approach outlined by Evans, Hearn, Uhlemann, and Ivey (1998). He or she would be expected to state: the specifics of the treatment, including number of sessions; the alternatives to treatment; and the risks and benefits associated with each option and nontreatment. The latter prescription would be very difficult to comply with, simply because there is insufficient research completed to speak with any confidence on many of these requirements. This is but one example of a broad range of treatment proposals professional psychologists make to their clients daily, which are fraught with a comparable lack of research backing. A similar argument could be made from the vantage point of forensic psychologists, who must have similar research support for the conclusions they draw concerning the results of assessment and treatment. Hence, the evidence-based movement, while an important first step, does not go far enough.The evidence base for the practices of psychologists needed to be established decades ago to offset the recent, forced exodus of professional psychologists from human service settings on the one hand, and the failure of psychology to thrive, on the other hand. The public is informed daily of new procedures that have the potential to ameliorate heart disease, cancer, and a range of other disorders. Such is not the case for psychological disorders. Along with other information about psychology, the public and politicians need to hear of research about psychological interventions, if the current lack of knowledge about psychologists and what they do is to be offset. Given psychology is inherent in every aspect of human behaviour, the potential for professional psychology is vast. However, this potential has not materialized, and, if anything, advances made in professional psychology are being rolled back. Hence, the conclusion that the evidence-based movement is perhaps too late.There are two factors working against the development of an expanded evidence base for professional psychology. These factors involve economics and research strategy. Behind each announcement in the media of a medical advance is a vast amount of money, usually in the millions, if not billions of dollars by the time the procedure becomes routine. Secondly, there is a research strategy, such as that outlined by Evans (1997), which encourages both the required basic research, and the important applied research. Using such a research strategy, basic research could be translated into the day-to-day practice of psychologists with the evidence-based information required to obtain appropriate informed consent. …