The case for evidence-based psychotherapy treatment guidelines.

Abstract

WILLIAM C. SANDERSON, Ph.D.* One contemporary issue in area of psychotherapy which has received increasing attention concerns advantages and disadvantages of treatmentguideline development.1-3 The discussion of treatment-guideline development appears to be fueled, for most part, by changes in healthcare delivery system in United States. It seems safe to say that in past, practitioners of many forms of psychotherapy were less concerned than now about scientific evaluation and accountability. Accountability was desirable, but not necessary. However, need for accountability has sharply increased, as treatments without supporting efficacy data are unlikely to survive. Indeed, as noted by Trabin,4 the development of an accountable, science-based model of behavioral healthcare may be catalyzed on a broad scale by competitive from marketplace and from (p. 8). Recognizing importance of establishing a body to identify and promote empirically supported psychotherapeutic treatments, Division of Clinical Psychology (Division 12) of American Psychological Association assembled a Task Force to accomplish goal.5 Based upon a specific review process, a list of empirically supported treatments was identified.5 The Task Force report acknowledged that list is never final, and must be maintained and updated on a regular basis to include new data as they emerge (in fact, recent list represents third update). During a time of sweeping healthcare changes, list represents a crucial step in identification and promotion of proven-effective psychotherapies, with overall mission of making these treatments more widely available.6 Several authors have raised important concerns and criticisms7-9 regarding identification of empirically supported therapies. fact, I agree that there are difficulties and risks in establishing psychotherapy guidelines-or any treatment guidelines for that matter.lo However, I strongly disagree with premise that development of evidence-based psychotherapy guidelines is . . self-destructive behavior, consequences of which will degrade our calling far worse than anything government or managed costs corporations will ever conceive8 (p. 136). To contrary, it is my opinion that failure to develop treatment guidelines will result in psychotherapists being our own worst enemy.3 Unfortunately, to date, psychotherapists have not taken an active role in promulgating guidelines. Recognizing importance of treatment guidelines, organizations, such as American Psychiatric Association, have accelerated development process. Indeed, Dr. Harold Pincus,lo who has been a member of a committee overseeing development of American Psychiatric Associations Guidelines has noted: In absence of standards, what is cheapest is best.... Evidence-based guidelines developed by professional organizations assist clinicians in asserting professional values in face of economic pressures (p. 45). From my vantage point, question is not whether or not we should develop treatment guidelines whenever possible, but instead, have we already missed boat? The danger in not creating our own guidelines is obvious from Persons, Thase, and Crits-Christoph's11 analysis of AHCPR12 and American Psychiatric Association report.13 Essentially, they conclude that both guidelines understate value of psychotherapy and, in particular, American Psychiatric Association's Guidelines does not reflect a balanced assessment of available empirical evidence supporting cognitive, behavioral, brief psychodynamic, and group psychotherapy. Clearly, having other groups (i.e., those not primarily involved in providing and evaluating psychotherapy) construct guidelines is not in psychotherapists' best interest. Of course, there are risks and drawbacks in developing guidelines. …