In medicine, adding the words “evidence” and “valid” to an instrument, treatment, or concept lends them a sense of gravity and certainty—almost as if the words themselves are some kind of effectiveness insurance policy.
An Evidence Based Treatment is a method of care developed by experimental design and in-depth analysis of statistical data. The goal: to derive the most reliable, vetted practice guidelines for a particular diagnosis. Typical names for it are Evidence-Based Medicine, Empirically Supported Therapy, and others. In psychiatry, evidence- based treatments are usually culled from psychotherapy or psychopharmacology research. For the sake of simplicity I will refer to them in my article as Evidence Validated Treatments (EVT).
For a client seeking treatment, these phrases could provide a sense of security and reassurance, and dare I say, hope. Ideally, they reinforce the very reasonable idea that their provider is versed in the latest successful treatments, and by extension, able and trustworthy, an instrument for positive change. Unfortunately, they’re also capable of producing a different effect, one that is subtle, but meaningful. Sometimes, a client’s expectations of what a particular EVT can do for him are out of pace with what can realistically be delivered. Most patients are not trained to interpret study data, so the latest treatment to filter down from academia may appear to work in a one-size-fits-all manner. In day to day practice, this is rarely the case, and perceiving it as such only increases the potential for disappointment. If left unexplored in treatment, this kind of disappointment can lead to demoralization and hopelessness.
One of my primary jobs is to figure out how to balance the practicalities of EVT with the artfulness of individual exploration.
The truth is that on many occasions, EVTs can and do fail to deliver their desired therapeutic benefit. This is not a problem—it’s merely an expected part of the complicated process involved in transitioning a treatment from the academy into the real world. The tension between honoring the individual and respecting evidence validated data is a challenge faced by all clinicians. If handled skillfully, it can facilitate a healthy dialogue between client and provider and lead to positive, individualized treatment outcomes.
As a career-long student of psychoanalytic psychotherapy, my method of practice embraces individual exploration. A quick blog definition: psychoanalysis, psychoanalytic and psychodynamic therapy are all part of the same school of talk therapy. By nature, psychoanalytic process looks towards individualized treatment and strains away from one-size-fits all approaches. It is a process facilitated by healing a client’s psyche via the exploration of his unique life experiences. These individualized treatment relationships can foster dramatic and positive change. Psychoanalytic therapy itself is an EVT but more importantly, it serves as a sturdy foundation for treatment. It allows for a flexible framework in which the clinician can artfully layer other EVTs and psychopharmacologic treatments.
As the medical director of a small outpatient mental health clinic, I’m frequently questioning and evaluating how best to use data to inform implementing care standardization, quality improvement measures, and EVT. One of my primary jobs is to figure out how to balance the practicalities of EVT with the artfulness of individual exploration. To be sure, EVT is necessary and valuable, particularly when viewed in context. To do so, one must extract the treatment out of the academic paper and shepherd it into the office. The complexities of performing this integration and performing it well are vastly underrated and challenging to explain. In addition, the engineers equipped to lead this conversation are few and far between.
Venturing into the world of blogging may offer a productive way to engage in this conversation. Publishing field journal posts allows writer/provider to explore topics through multiple bite-sized, reader-friendly entries. Over time, the entire body of work takes form and shape in describing complex subjects. Reducing the size and scale of information to a “field journal bite” allows the writer/provider and reader to explore subjects from individualized angles. Thankfully, it is also ideal for absorbing, recognizing, and mitigating the unintended gaffes and missteps inherent in any conversational learning process.
It’s my hope that our field journal entries on EVT and other topics will help demystify the outpatient mental health process and start a productive conversation about balancing the needs of the individual with the need for pragmatic, EVT-informed mental health delivery.