As is true of most therapeutic interventions, standardized treatments can be helpful with many clients. But we need a health care system that recognizes that many clients are unlikely to be helped by a medical model of treatment. And that means that if the emerging system of integrated care adopts evidence-based practice as its standard, they may not be helped at all. It is our responsibility as therapists to lift our voices and to advocate on behalf of our clients and our profession. We must make sure that the integrated care system is truly integrated and that it draws from the best of the vast range of approaches that therapists currently tailor to their clients' needs, not the limited number of techniques that are most easily studied. As we are about to enter the next stage in the evolution of our health care system, we need to draw from the accumulated wisdom in our field that teaches us that not all of our clients' struggles fit within diagnostic categories and that therapy can never be reduced to a set of prescribed interventions, no matter how "empirically" supported they may seem to be.
Barry Duncan is professor of family therapy and psychology in the Graduate School of Humanities and Social Sciences at Nova Southeastern University (NSU) and coauthor of 10 books, including The Heroic Client (Jossey-Bass, with Scott Miller) and the forthcoming Heroic Client, Heroic Agencies:
Partnerships for Change (NSU Press, with Jacqueline Sparks). He can be reached at: www.nova.edu/~blduncan. HASH(0xb895f6c) Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
Batchelor, Alexandra, and Adam Horvath. "The Therapeutic Relationship. In The Heart and Soul of Change: What Works in Therapy . Edited by Mark A. Hubble, Barry L. Duncan and Scott D. Miller. Washington: APA Press, 1999.
Castonguay, Louis R., et al. "Predicting the Effect of Cognitive Therapy for Depression: A Study of Unique and Common Factors." Journal of Consulting and Clinical Psychologys 64 (1996): 497-504.
Chambless, Diane L., et al. "Update on Empirically Validated Therapies II. The Clinical Psychologist 51 (1998): 3-16.
Elkin, Irene, et al. "National Institute of Mental Health Treatment of Depression Collaborative Research Program: General Effectiveness of Treatments." Archives of General Psychiatry 46 (1989): 971-982.
Kiesler, Charles. "The Next Wave of Change for Psychology and Mental Health Services in the Health Care Revolution." American Psychologist 55 (2000): 481-487.
Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2000. APA Clinical Resources. Washington: American Psychiatric Association, 2000.
Rosenzweig, Saul. "Some Implicit Common Factors in Diverse Methods of Psychotherapy." American Journal of Orthopsychiatry 6 (1936): 412-415.
Strupp, Hans H., et al. "Effects of Training in Time-Limited Dynamic Psychotherapy: Changes in Therapist Behavior. Journal of Consulting and Clinical Psychology 61 (1993): 434-440.
Wampold, Bruce, et al. "A Meta-analysis of Outcome Studies Comparing Bona Fide Psychotherapies: Empirically, "All Must Have Prizes." Psychological Bulletin 122 (1997): 203-215.