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It Isn't All About Evidence-Based Practice

Posted Apr 30 2009 10:39pm
This article from Counselor does a good job pointing out some of the limitations of the push for evidence based practices.

The whole issue is a double-edged sword. Measuring your own outcomes is a good thing, but it's no small burden for a treatment provider. (Imagine if every doctor had to measure their outcomes.) The adoption of and evidence-based practice (with some measures to assure fidelity) could relieve providers of this burden, but it comes at the cost of autonomy--which no one likes. Providers also hate that the process for identifying evidence-based practices is so political. (Consider the case of MRT.)

Note the straw man hit job by the journalist in the comments:
Yeah, I'm skeptical of this resistance as well: the reason there's such a push for evidence-based practice is because the non-evidence-based practices in addiction-- like harsh confrontation, humiliation, one-true-wayism (particularly insistence that the alternative to AA is jailsinstitutionsdeath: way to give hope, guys!)-- are not only ineffective but harmful.

These practices are antithetical to therapeutic alliance and to most of the other things you say are important for treatment.

All evidence-based practices incorporate "best practices" like emphasizing therapeutic alliance and empathy and opposing one-true-way stuff-- so it's really rather absurd to argue against EBT's by saying that those things matter.

If the non-evidence-based stuff did that, this wouldn't be a huge issue, but it doesn't and harmful and ineffective practices continue to be widely utilized.
How did this turn into a sarcastic 12 step bashing moment? (By the way, 12 Step Facilitation is an evidence-based practice.) Why does she insist on painting treatment providers with such a broad brush?

Besides, a quick google search of the author of the article finds that that the guy wrote a book on controlled drinking--hardly a 12 step nazi. Another important point is that one of the biggest critics of the push for the adoption of evidence-based practices is Scott Miller --not a 12 stepper in ANY way. In fact, he's the biggest advocate of the notion that the therapeutic alliance is for more important than the treatment model and he uses lots of evidence to support his arguments--not just anecdotes and slurs against people who think differently.

So much for the false notion that questioning the push for adoption of evidence based practices means your a mindless, abusive treatment provider who can't bring yourself to give up "harsh confrontation, humiliation, one-true-wayism"!

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