EVIDENCE-BASED PSYCHOSOCIAL INTERVENTIONS: NOVEL CHALLENGES FOR TRAINING AND IMPLEMENTATION.

Abstract

The Institute of Medicine’s (IOM) report on psychosocial interventions challenges us to think not only about the way we study and deliver these important treatments, but also the way we teach and implement them. The report’s emphasis on protecting consumers by ensuring that effective psychosocial interventions are delivered in forms that closely approximate the ones for which the evidence exists has major implications for recruitment and training of faculty, didactic and supervisory teaching methods, competency standards held by national accreditation organizations, and research training. We briefly outline each of these issues below. Perhaps, the real game-changing suggestion of the report is that psychosocial interventions be delivered, taught, and researched using an “elements approach.” In its most radical form, this model, which is somewhat analogous to dimensional model of psychopathology taken by the NIMH’s Research Domain Criteria (RDoC), identifies elements that are both effective and common to multiple types of psychotherapy so that these elements can be studied, taught, and delivered a la carte. This is an exciting and challenging way to conceptualize psychosocial interventions that would require an entirely new approach to training. Curricula would cease to consist of separate courses and supervisors for each type of treatment, instead of employing a single “psychosocial interventions” course that would teach each of the effective elements and how and when to use them. Faculty trained in each of the psychotherapies would have to be retrained in the elements approach, with new or harmonized terminology and an “un-silo-ing” of their approach to assessment, treatment, and formulation. This could be difficult, as loyal practitioners of different psychotherapies often mix as well as oil and water. Even if psychotherapies continued to be delivered and taught in their extant forms, beginning to think about the effective elements of these interventions could prompt new and innovative ways to teach these common elements, much as we teach factors such as therapeutic alliance, empathic listening, and maintaining frame/boundaries as being common to all forms of therapy. The elements approach would also require new directions for psychotherapy research training, with requisite reframing for established psychotherapy research mentors. Beyond the discussion of the elements approach, the major thrust of the report is the importance of delivering psychosocial interventions that maintain fidelity to the effective form for which evidence exists. Sadly, much is often lost in translation, leading to less than ideal health care delivery. Changing this for psychosocial interventions will require increased attention to quality measures, as well as altering training in the following domains.