Many fields are feeling the pressure to use Evidence-Based Practices (EBP). One frequently gets notice of EBP trainings or treatment manuals. There are many practices and programs for individuals, families, and groups. The emphasis on EBP is to develop an easily replicated program that practitioners can use to help individuals, families or groups change. Some popular examples of these are Trauma-Based Cognitive Behavioral Therapy and Motivational Enhancement Therapy. There is a whole list of EBP’s available via National Registry of Evidence-based Programs and Practices (NREPP).
This article is not written to put downgrade these works. I want to put the work of EBP in a context; specifically in the context of the therapeutic or change process. Ask the specific question “why do evidence-based practices work?”
In the below presentation, one of the leaders in promoting EBP, Dr. Anthony Salerno, challenges conventional thinking about evidence based practices (credit to Dr. Bart Andrews on twitter for sending this to me). What if it is not about the EBP but the practitioner that drives the effectiveness? One can try to convince someone of their model; However, if an individual does not “buy-in”, all the EBP’s go out the window. At that monument it becomes about the relationship and the practitioner’s ability to respond. Dr. Salerno argues that in order for change to happen we need a strong foundation. Here are some of the highlights how to achieve this foundation and why it is important.
He challenges the notion of being a “good listener”. Dr. Salerno asks “what if fifteen minutes into the session we asked the client, what have we been talking about? What do think has happened here?…If we listened to the answer we might be in for a big surprise.” This potential disconnect between what the practitioner said and what the individual receiving services heard is important. No one likes to admit that we are “bad listener” or a bad therapist. We should always be checking in for understanding. The hard question to ask ourselves as helpers is, are we listening with true empathy and intent?
Dr. Salerno also suggests we “make list of everything that could potentially anger a client… then don’t do that!”. Interesting exercise that as a practitioner, is challenging. Please think about something that you have done to anger a client. It is hard question that requires some soul searching. It really challenges practitioners think about how it is not always about the treatment manual or the client but we bring to the table as helpers.
Dr. Salerno argues that it is listening, trust, and empathy that matter most. In the delivery of EBP’s, it is not the manual that delivers the change but it is the practitioner. There is sometimes a disconnect between the manual and what the client or targeted population needed at that time. It is this realization that hits home for me about being an “Evidence based practitioner”. It is about being able to adapt and be present in that moment.
Dr. Salerno argues that “problem solving and informed decision making” are critical skills model and impart on our clients. When it comes to an implementing an EPB, ask if it is the right one for you as a practitioner. What EPB treatment are you using and why? How does it benefit both yourself and the people you are serve?
He concludes with a story about asking a client what helped him the most. After two years of treatment, he asked a client what helped him the most. The client’s answer was the hand shake in the waiting room. The feeling of warmth and genuineness did not come from the manual, it came from the provider.
Does this mean we need to throw all our manualized treatment’s out the window? Probably not ;)There are some great treatments out there, one has to question and reflect HOW they are being delivered. This is a hard question as it requires a lot of self reflection. Please enjoy the 15 minute presentation and let me know your thoughts. Dr. Salerno gives an incredibly engaging talk on becoming an “evidence-based practitioner”…