PSY 2311st Edition Lecture 20Outline of Last Lecture I. Practical SignificanceOutline of Current Lecture II. How Research Informs Clinical EthicsIII. Traditional PsychotherapyIV. New Accountability for Treatment EffectivenessV. Evidence Based Practice MovementVI. Does Count as EvidenceVII. Why Therapist Should Care About Bad “Evidence Reputation”Current LectureHow Research Informs Clinical Ethics● Clinical ethics-- treating clients fairly and safely● Research shows that some treatments actually work● If they don’t work and cause active harm(actually make things worse)○ dare program● If they do not work and cause passive harm (Opportunity cost)○ longer discomfort (lost quality of life)○ lost chance to get better● Things that do not work always cause harmTraditional PsychotherapyIndividual chooses therapist therapist chooses treatment therapist bills health insurance● Competence-- clinical insight, the longer you work the better you getNew Accountability for Treatment Effectiveness● Special education laws-- started in the 1970’s, required clear goals and documented progress● De-institutionalization of the mentally ill (1970’s)-- family’s became more responsible for the care of their mentally ill family member● Media age-- better informed consumers● Insurance industry-- managed care, some decisions making shifts from therapist to payer●Insurance Company chooses therapistInsurance Company approves specific treatmentsTherapist bills Insurance Company● Insurance company determines amount paid to the therapist, quality of therapy, and duration of therapyEvidence Based Practice Movement● Emphasis on what works● Empirical-- research determines what works● Testimonials do not count as evidence, nor do…○ case studies○ correlational research○ flawed experimentsDoes Count as Evidence● Good clinical treatments : randomized controlled trials○ IV= treatment○ DV= treatment outcome● Prime evidence= the randomized controlled trial○ subject selection○ subject assignment○ internal validity○ reliable and valid measurement● Experimental design○ presence vs. absence■ no treatment (wait list) control group○ type manipulation■ active treatment (treatment as usual) control group○ amount manipulation■ compare different doses of one treatmentWhy Therapists Should Care About Bad “Evidence Reputation”● It is depressing to be ineffective○ less than 10% of treatment is evidence based● Bad for business● What makes a good therapist○ old days-- clinical experience, intuition○ the evidence based approach-- evidence from clinical research guides choice of therapies○ therapist skills include searching through the literature, and applying the formal rules of
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