I sometimes wonder what best practice is. Is best practice the over riding need to follow evidence based practice, which is practice based on what has been researched and published. Or is it best to practice what feels right, what makes sense to you the therapist. I know that Art Therapy is used for people that are striving to explore their emotionality, therapeutic community, or in relationship therapy. Also I know that the 12 step AA and NA program is all around the world and many people swear by it, but this program did not start with evidence based implementations. I also know that some therapists are using Maslow's Hierarchy of Needs as a therapeutic tool and form of measuring client's advancement in a program, even when there are reported flaws in the theory of Maslow's Hierarchy. Now the confusion that I have is that Psychology and therapies are based on Art, not Science. Psychology at University is part of the Faculty of Arts. The problem all started with how psychology started and in the era that it started, Psychology was in competition with pharmacology (Chemistry), and the other sciences like metallurgy, physics and alike. So the issue is, Human behaviour is an art because human behaviour does not act like any other contemporary science. Human behaviour follows a bell curve which is a curve of probability. Where as other sciences, apart from quantum physics, does not work with a probability bell curve, they know the outcomes when mixing chemicals with 100% certainty. Whereas a therapeutic treatment does not have certainty when treating a group of people with a therapeutic technique that it will work 100% of the time. With psychological testing tools, they usually are self reporting questionnaires, observations with a reliability test. All of which are governed by statistics that measure people on a probability bell curve comparing them with a larger group of individuals. Thus in order to have a treatment passed as being best practice with evidence that it works a hole host of things need to be done that follows the psychological science procedure. Firstly a target group is used for the therapy is needed, so if we use addiction as a target group, the experiment must discriminate between all the types of addictions that people have. Thus people that inject cocaine will be discriminated from those that snort cocaine. Now we need to measure the level of success which will make a probability bell curve, thus some will benefit from the treatment and others will not. The next stem is to measure the level of success with other therapeutic treatments, and the two probability bell curve from the treatments are compared with each other to compare the value of the treatment against other established treatments. So you can imagine for a service that uses only evidence based practice, that their practice would be 10 to 20 years or more behind the latest treatments and even if new treatments are very successful, it would need to be researched, reviewed, and then published, then adopted by therapists'. Also many self reporting questionaries and tests are designed people of a particular socioeconomically and cultural group with others discriminated against, although experimenters in human behaviour now try to safe guard against this unintentional discrimination. I know of a psychologist in Australia that has researched the correlation between the spiritual connection with their deceased relatives and the land with the level of their grief and loss. This psychologist is not recognised within Australia and the work he has done, but is recognised overseas. Although evidence based practice is the bases of our hospital system and research in keeping people in physical health and should be because it is designed as such. But when it comes to human behaviour which is not as cut and dry as health, human behaviour is subject to many more variables than health. There are a few people that look at this subject with out much care because they are not impacted as much as some. Thus when it comes to health always look for evidence based practice, but when it come to therapy, go with what feels right with a person that you trust. We through around key phrases such as, CBT, DBT, NLP, Psycho-theatrics, Psychodrama, AA 12 step, Rogerairen Counselling, and Hypnosis. If evidence based practice would be the cornerstone of treating people in the science of psychology, we should only have one type of therapy that works with every one. I am not picking on Psychology or therapists, I recognise their good work, What I am criticising here is the use of "evidence based practice" with in the art of psychology. Psychologists should be open to new treatments and keep their own records and listen to client feedback to see if the treatment is beneficial. And as always, ant treatment is better than none unlike Health Treatment. If the wrong treatment is given for the Health the patient will die, this is not so in psychology. OR Is best practice evidence informed practice. There are treatments out there that are sold as psychology and treatment for problems, but can cause more harm than good. One or two of these treatments have come to the light in the media and do cause a great deal of psychological damage to consumers, such as "emotional-expressive therapy" for crisis debriefing or "Scared Straight" programs for delinquency (Stuart & Lilienfeld, 2007). To find the evidence that fits your therapeutic style can be impossible to find, so we try to find a best fit so practice can "be informed by evidence but not necessarily driven by it (Stuart & Lilienfeld, 2007). One source of evidence that a treatment is working is with client feedback, and evaluate cases on an ongoing basis (Stuart & Lilienfeld, 2007). Furthermore try to find all the research you can on a therapy that has been used in the past by others. Granted this is difficult to do when the therapy is new or you have linked information from other disciplines to make a hybrid type of therapy. At the core of all medical and therapeutic professions is the understanding of "first , do no harm" (Primum non nocere). Also with the American Psychological Association (APA) is the ethical dictate that we must "take reasonable steps to avoid harming their clients/patients (APA, 2002, p.1065). Thus it is clear that the therapist needs to undertake research to satisfy them-selves that a therapeutic method is safe for the client. With all the differences in the styles of therapists and there clients some therapeutic method may hinder or slow the recovery of clients (Lilienfeld, 2007). To think that any treatment is better than no treatment is a naïve understanding (Lilienfeld, 2007) of the treatment process and the cognition of clients. It is suggested that between 3 to 10% of clients do get worse after treatment, and for people suffering addiction to substance the result is higher from 10 to 15% getting worse after treatment (Lilienfeld, 2007). Though we must not forget that in some cases that these figures may have a level of error in them, with some clients getting worse with or without treatment (Lilienfeld, 2007). Furthermore, there are a number of clients that have been through the mental health system numerous times with social workers intervening in employment agencies and social welfare agencies. It is in these cases that people may have had many counsellors, psychologists, psychiatrists, and social workers all telling the client different things using different methods to get different outcomes. Where does that leave the client? Confused, and bewildered with no real direction. Lilienfeld (2007) suggests the following criteria in order not to use a treatment method:
- They have demonstrated harmful psychological or physical effects in clients or others (eg, relatives).
- The harmful effect are enduring and do not merely reflect a short-term exacerbation of symptoms during treatment.
- The harmful effects have been replicated by independent investigative teams.
Thus as a result not all treatments are treatments, just as not all oils are oils. The client must be monitored and give their feedback with every session, and the therapist be flexible enough to change their approach. Bibliography
- Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Association for psychological science , 2 (1), 53-70.
- Stuart, R. B., & Lilienfeld, S. O. (2007). The evidence missing from evidence-based practice. American Psychologist , 615-616.
I sometimes wonder what best practice is. Is best practice the over riding need to follow evidence based practice, which is practice based on what has been researched and published. Or is it best to practice what feels right, what makes sense to you the therapist. I know that Art Therapy is used for people that are striving to explore their emotionality, therapeutic community, or in relationship therapy. Also I know that the 12 step AA and NA program is all around the world and many people swear by it, but this program did not start with evidence based implementations. I also know that some therapists are using Maslow's Hierarchy of Needs as a therapeutic tool and form of measuring client's advancement in a program, even when there are reported flaws in the theory of Maslow's Hierarchy. Now the confusion that I have is that Psychology and therapies are based on Art, not Science. Psychology at University is part of the Faculty of Arts. The problem all started with how psychology started and in the era that it started, Psychology was in competition with pharmacology (Chemistry), and the other sciences like metallurgy, physics and alike. So the issue is, Human behaviour is an art because human behaviour does not act like any other contemporary science. Human behaviour follows a bell curve which is a curve of probability. Where as other sciences, apart from quantum physics, does not work with a probability bell curve, they know the outcomes when mixing chemicals with 100% certainty. Whereas a therapeutic treatment does not have certainty when treating a group of people with a therapeutic technique that it will work 100% of the time. With psychological testing tools, they usually are self reporting questionnaires, observations with a reliability test. All of which are governed by statistics that measure people on a probability bell curve comparing them with a larger group of individuals. Thus in order to have a treatment passed as being best practice with evidence that it works a hole host of things need to be done that follows the psychological science procedure. Firstly a target group is used for the therapy is needed, so if we use addiction as a target group, the experiment must discriminate between all the types of addictions that people have. Thus people that inject cocaine will be discriminated from those that snort cocaine. Now we need to measure the level of success which will make a probability bell curve, thus some will benefit from the treatment and others will not. The next stem is to measure the level of success with other therapeutic treatments, and the two probability bell curve from the treatments are compared with each other to compare the value of the treatment against other established treatments. So you can imagine for a service that uses only evidence based practice, that their practice would be 10 to 20 years or more behind the latest treatments and even if new treatments are very successful, it would need to be researched, reviewed, and then published, then adopted by therapists'. Also many self reporting questionaries and tests are designed people of a particular socioeconomically and cultural group with others discriminated against, although experimenters in human behaviour now try to safe guard against this unintentional discrimination. I know of a psychologist in Australia that has researched the correlation between the spiritual connection with their deceased relatives and the land with the level of their grief and loss. This psychologist is not recognised within Australia and the work he has done, but is recognised overseas. Although evidence based practice is the bases of our hospital system and research in keeping people in physical health and should be because it is designed as such. But when it comes to human behaviour which is not as cut and dry as health, human behaviour is subject to many more variables than health. There are a few people that look at this subject with out much care because they are not impacted as much as some. Thus when it comes to health always look for evidence based practice, but when it come to therapy, go with what feels right with a person that you trust. We through around key phrases such as, CBT, DBT, NLP, Psycho-theatrics, Psychodrama, AA 12 step, Rogerairen Counselling, and Hypnosis. If evidence based practice would be the cornerstone of treating people in the science of psychology, we should only have one type of therapy that works with every one. I am not picking on Psychology or therapists, I recognise their good work, What I am criticising here is the use of "evidence based practice" with in the art of psychology. Psychologists should be open to new treatments and keep their own records and listen to client feedback to see if the treatment is beneficial. And as always, ant treatment is better than none unlike Health Treatment. If the wrong treatment is given for the Health the patient will die, this is not so in psychology. OR Is best practice evidence informed practice. There are treatments out there that are sold as psychology and treatment for problems, but can cause more harm than good. One or two of these treatments have come to the light in the media and do cause a great deal of psychological damage to consumers, such as "emotional-expressive therapy" for crisis debriefing or "Scared Straight" programs for delinquency (Stuart & Lilienfeld, 2007). To find the evidence that fits your therapeutic style can be impossible to find, so we try to find a best fit so practice can "be informed by evidence but not necessarily driven by it (Stuart & Lilienfeld, 2007). One source of evidence that a treatment is working is with client feedback, and evaluate cases on an ongoing basis (Stuart & Lilienfeld, 2007). Furthermore try to find all the research you can on a therapy that has been used in the past by others. Granted this is difficult to do when the therapy is new or you have linked information from other disciplines to make a hybrid type of therapy. At the core of all medical and therapeutic professions is the understanding of "first , do no harm" (Primum non nocere). Also with the American Psychological Association (APA) is the ethical dictate that we must "take reasonable steps to avoid harming their clients/patients (APA, 2002, p.1065). Thus it is clear that the therapist needs to undertake research to satisfy them-selves that a therapeutic method is safe for the client. With all the differences in the styles of therapists and there clients some therapeutic method may hinder or slow the recovery of clients (Lilienfeld, 2007). To think that any treatment is better than no treatment is a naïve understanding (Lilienfeld, 2007) of the treatment process and the cognition of clients. It is suggested that between 3 to 10% of clients do get worse after treatment, and for people suffering addiction to substance the result is higher from 10 to 15% getting worse after treatment (Lilienfeld, 2007). Though we must not forget that in some cases that these figures may have a level of error in them, with some clients getting worse with or without treatment (Lilienfeld, 2007). Furthermore, there are a number of clients that have been through the mental health system numerous times with social workers intervening in employment agencies and social welfare agencies. It is in these cases that people may have had many counsellors, psychologists, psychiatrists, and social workers all telling the client different things using different methods to get different outcomes. Where does that leave the client? Confused, and bewildered with no real direction. Lilienfeld (2007) suggests the following criteria in order not to use a treatment method: 
