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At the same time, it's important to scrutinize empirical results with a critical and discerning eye, as sometimes the certainties we look for from research fade over time, especially when short-term findings are compared with long-term results. For example, it has long been believed, both by researchers and within the popular media, that stimulant medications have proven themselves beyond a doubt to be extremely effective in treating ADD and AD/HD in children. However, prominent AD/HD researcher William Pelham, after reviewing the most recent findings from the best long-term outcome studies of ADD and AD/HD, concluded that a decade after treatment began, the only difference between those treated with stimulants and those who weren't was a two-inch difference in average height stemming from the side effects of stimulant medication. Despite positive short-term effects, drugs such as Concerta had no demonstrated impact on improving long-term functioning in academic performance, behavior, or symptoms when measured over a decade.
As therapists, we live in a world of evidence and accountability, a world in which a persuasive statement of theory, a case study, or a videotape demonstrating that a dramatic one-session "cure" occurred is no longer enough. Given the trend toward closer and closer scrutiny of what we do, we all need to become more attuned to recognizing the difference between what's known and what's claimed to be known. Although science can and should inform practice, psychotherapy remains a complex interpersonal activity, mediated by a vast array of variables, so that clinical acumen will always be essential in navigating the process. In 2005, an American Psychological Association task force on evidence-based practice was convened by former APA president Ronald Levant. It consisted of eminent scholars identified with research-supported therapies, such as David Barlow and Steven Hollon, those opposed to those therapies, such as Bruce Wampold and Drew Westen, and practicing clinicians. The task force produced a consensus statement (albeit one that parties on all sides found less than their own ideal vision) that research evidence needs to be incorporated into treatment, but with clinical judgment and a deep respect for the client's values and preferences. Ultimately, psychotherapy is a moral activity, filled with value-laden decisions about how to live life, not just how to feel better in the short term or how to be less symptomatic.
Despite the polemics among assorted camps of researchers, there seems to be ample room for a view that emphasizes attention to the common factors within therapy practice while employing specific treatment methods with some specific clinical problems. At the most practical level, session-by-session tracking of progress within therapy is not only becoming well established as clinically useful, but is likely soon to become part of standard practice. Accountability to clients and to third-party payers is a reality of our lives, and it seems clear that the days in which therapists could ignore research findings and continue to do therapy as they were originally trained to, indifferent to the emergence of new evidence, have passed forever.
Jay Lebow, Ph.D., is a contributing editor to the Psychotherapy Networker, senior therapist and research consultant at the Family Institute at Northwestern University, and clinical professor of Psychology at Northwestern University. Contact: firstname.lastname@example.org. Tell us what you think about this article by e-mail at email@example.com, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.
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