Evidence-Based Practice and Psychological Treatments: The Imperatives of Informed Consent.

Abstract

A decade after physicians (including psychiatrists) endorsed the shift toward evidence-based medicine, the world's largest association of psychologists, the American Psychological Association (APA), belatedly but officially embraced the tenets of evidence-based practice (EBP) [American Psychological Association (APA), 2006]. Other clinical psychology associations, including the Canadian Psychological Association, soon followed suit (Canadian Psychological Association, 2012). The interpretation of medical evidence is deeply entwined with ethics; although mainstream medicine has until recently paid relatively little attention to the ethical repercussions of evidence-based practice, the neglect in the field of psychological treatments is even more glaring. Why does EBP matter for the ethical practice of psychological treatments? Evidence carries ethical imperatives. Both the decision about what is considered to be beneficial in psychotherapy, and the current paucity of research regarding the potential negative effects of psychological treatments, carry ethical implications. We argue that the failure to pay attention to psychotherapy research effectively risks undermining key requisites included in professional codes of practice for clinical psychology, psychiatry, social work, and allied fields. First, EBP bears repercussions for the clinician's duty of professional competence, or what O'Donohue and Henderson (1999) have collectively termed “epistemic duties”—the responsibility to acquire and apply accurate knowledge. Second, EBP is relevant to the duty to respect patient autonomy—namely, the patient's right to make informed decisions concerning his or her treatment plans. Evidence shows that there are divergent views about the importance, and feasibility, of informed consent among practicing psychotherapists (e.g., Croarkin et al., 2003; Barnett et al., 2007; Goddard et al., 2008). Some of this variation, we argue, probably owes to differences in opinion about what is materially relevant to patients in deciding to undergo psychotherapy; other omissions of informed consent may persist because of continued debate and confusion about what constitutes “evidence” in psychotherapy research and practice. We argue that—despite these challenges—the profession of psychotherapy must find ways to meet the moral obligation of providing adequate informed consent to patients.