Friday, January 13, 2012

Not everyone who practices psychology is in agreement that Evidence-Based Practices are always the best options. Step 1: Find at least two articles that talk about the pros and cons of using evidence-based practices. Present a summary of your findings in the research in your discussion post that addresses the pros (at least one) and the cons (at least one) on this matter. Step 2: What are your opinions on this topic? Do you think all clinicians should be limited to evidence-based practices? Why or why not?

The debate concerning the use of evidence-based practices in psychology hinges on three key questions, two of which pertain to divisions of professional labor and responsibility and one of which pertains to a "meta" issue regarding the relation of research to practice.
First, who gets to decide what constitutes generalizable "evidence": researchers, practitioners, or both? Secondly, should practitioners be bound to the use of evidence as defined by non-practitioners, even when practice demands going beyond existing practice via innovation? Thirdly, given that practice is invariably inflected by multiple and various modes of cultural difference (whether it be ethnic, religious, or gendered), how can research (which needs to keep its topics limited for reasons of feasibility) account for the complexity of practice and its need to go beyond what has already been demonstrated to address the changing contingencies of patient care in particular situations?
More pointedly and polemically, if the existing evidence does not include evidence relevant to a particular situation in practice (perhaps because the research in question was inattentive to issues of cultural difference), should the evidence be treated as being of secondary importance? Conversely, if practitioners fail to weigh evidence accordingly, and to make adjustments as needed to their practice in light in concerns about cultural competence, are they being remiss?
Both Whaley and Davis (2007) and Kazdin (2008) weigh the debate concerning the use of evidence-based practice. Whaley and Davis (2007) cite one influential argument against the use of evidence-based practices. They quote Bernal and Scharrón-del-Río (2001) in order to raise the question:

Are empirically supported treatments valid for minorities?

By asking this question, they hoped to engage the argument that empirically supported treatments are not the best choice for practitioners in situations limited by cultural incompetence. Empirically supported treatments may be employed, but only in conjunction with a so-called discovery-oriented approach, which is attentive to difference.
Both Whaley and Davis (2007) and Kazdin (2008), present the primary "pro" case for using evidence-based practices, namely that the efficacy of treatment is enhanced when practice is informed by researchers' construction of "evidence." Notably, however, both argue that evidence-based practice is not sufficient in and of itself. Whaley and Davis (2007) attempt to show how evidence-based practice can and should be reconciled with standards of cultural competence. Kazdin (2008) on the other hand argues that practice need not attend only to the findings of "evidence" derived from research but from findings acquired through practice as well, with the aim of reducing the gap between practice (which occurs in real time) and research (which, necessarily, studies practice "after" it has already begun to be practiced).
Arguably, any claim that clinicians should be limited to the use of evidence-based practices is on shaky ground due to the historically-constructed nature of evidence (standards which evolve over time) as well as the potential, partial irrelevance of "neutral" evidence in situations shaped by cultural particularities. Having said that, evidence is certainly part of the picture; but it is only a part and not necessarily a good guide to clinical judgment on the whole. Thus, it should be considered as one factor among others.
http://play.psych.mun.ca/~jcarter/6602/Psych%206602%20Winter%202014/Week%201/Kazdin,%202008.pdf

https://www.ncbi.nlm.nih.gov/pubmed/11759270

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