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Evidence based practice refers to the use of best available research in clinical practice and decision making while considering the characteristics, preferences, and culture of patient (APA, n.d.). Therefore, it is considered as the integration of best available research evidence, clinical expertise, and the patient values (Buysse, Winton, Rous, Epstein, & Lim, 2012). Some researchers suggest that the information from local context is also an important element of evidence (Oliver, Innvar, Lorenc, Woodman, & Thomas, 2014). In the evidence based practice, best research evidence refers to the clinically relevant published studies showing the positive impact of an intervention with the help of sound methodology. Clinical expertise is the combination of clinician’s education, total professional experience, and clinical skills. Patient values refer to the personal preferences, expectations, and unique concerns of patients. These values are also related to the culture of the patient (Duke University Medical Centre, 2016). In this essay, I will be discussing the historical development of evidence-based practice, analysis of shift towards this practice, and analysis of client-counsellor relationship in the practice and counselling outcomes.
Evidence based practice is a client-direct and outcome-focused practice. In an outcome focused practice, health care experts try to fulfil the hopes of client and to improve the self-image. With the help of this thinking, clinicians genuinely try to make things better by solving real problems and making other issues of the client less problematic. Client-direct and outcome-focused practice also helps in improving the relationships of the client and counsellor (Mayer, 2012).
Evidence based practice consists of the following steps (Duke University Medical Centre, 2016):
Development of a well designed clinical question,
Acquisition of the evidence by selecting the appropriate resources and conducting a research,
Appraisal of the evidence for its applicability and validity,
Application of the evidence to the practice while considering the clinical expertise and patient values, and
Evaluation of the performance of evidence based practice by considering the outcomes.
In order to work on the acquisition, appraisal, and application of the evidence, it is also important to consider the nature of evidence, context of the research, and the method in which the process or research is facilitated (Rycroft-Malone et al., 2013).
Historical development of evidence-based, outcome-focused counselling
Evidence-based treatment approach is a part of applied psychology from the very start of its development. In the year 1947, American Psychological Association (APA) developed a policy of training doctoral psychologists both as scientists as well as psychologists, which can be considered as the basis for the evidence-based, outcome-focused counselling. In the same year, Frederick C. Thorne, who was one of the earliest psychological practitioners, developed the method of integrating science into practice of psychology. In order to use the science based evidence into practice, he increased the application of experimental approach to the individual cases while considering the clinician’s personal experience. In the 1970s, several meta-analytic reviews showed the general benefits of psychotherapy. These things are also showing that psychologists are among the first experts, who have started using the evidence-based practice (Anderson, 2006).
During the initial part of the evidence-based practice movement, APA found the importance of an evidence-based comprehensive approach in the design of guidelines for appropriate practice. In the year 1992, APA formed a task force of the Committee for the Advancement of Professional Practice, the Board of Professional Affairs, and the Board of Scientific Affairs, for the development of evidences that can be used in designing guidelines. In 1995, the document produced by the task force was approved by the APA Council of Representatives. According to the document, it became necessary to consider systematic weighing of research data as well as clinical expertise for the emerging clinical practice guidelines (Anderson, 2006).
The initial document developed and approved by the APA and the subsequent revised policy documents showed that bases of evidence for any psychological intervention must be on two important dimensions, i.e. clinical utility and efficacy. Efficacy is related to the strength of evidence for establishing causal relationships between disorders and interventions. On the other hand, clinical utility is related to the use of available research evidence as well as clinical consensus while considering the patient acceptability and feasibility, generalizability, and benefits and costs of the interventions (Anderson, 2006).
In 1999, several divisions of APA worked on the identification and dissemination of the information on empirical research based therapy showing the strong relationship between several aspects of therapy and its outcomes. They also showed the effectiveness of empirical research in counselling psychology. Meanwhile, The Society of Behavioural Medicine also started considering the evidence based research for behavioural medicine interventions (Anderson, 2006).
Now, evidence-based practice is one of the most essential parts of health care policies and health care systems . Health care organizations such as the American Nurses Association, the American Occupational Therapy Association, and the American Physical Therapy Association, and health care agencies both at the state level and federal level have started evaluating, implementing, and promoting evidence-based health practices within the health care systems. At all levels, the purpose of the evidence-based practice is to improve the quality as well as cost-effectiveness of the health care. This is also helpful in increasing accountability of health care experts, thereby helping in enhancing their responsibilities. However, experts are of opinion that evidence-based practices have not to be used inappropriately. Experts have to consider the evidence-based health practices, but they have not to inappropriately limit the care and choice of treatments (Anderson, 2006).
Analysis of the shift towards evidence-based, outcome-focused counselling practice
A successful treatment is based on many factors such as the therapist’s personality as well as therapeutic style, the therapy relationship, the environmental factors, and most importantly the client. Among the important factors in a successful treatment, evidence-based counselling practice is based on the best available research evidence. This evidence helps in knowing the most efficient and effective treatments that can be used in a clinical practice (Corey, 2016).
Actually, the evidence of the research itself is not able to help in reaching an optimal decision for a care. Even if the completion of the health care process is not achieved, helping and counselling with appropriate evidence could move the process forward (Sanders, 2011). Evidence-based practice is a combination of best available research evidence, clinical expertise, and patient values that are helpful in reaching the best possible clinical care and outcome. These three components also help in improving the quality-of-life of a patient. Usually, meetings with patients or clients help in starting the evidence-based practice as the meetings generate more questions about the outcomes of the therapy, the prognosis of the disease, the use of diagnostic tests, and/or the causes of the disease (Duke University Medical Centre, 2016).
In the past, chances were high that people from different fields of practice including psychology, medicine, and psychiatry, might start working without any authentic and valid foundations of knowledge. Sometimes the knowledge for practice came from either personal experiences or from experiences of others. Most of the knowledge was without any valid scientific evidence. That kind of practice also increased the chances of quackery in which people, who had no training in a specific domain started giving the impression that they are helping others, when in fact they were playing with the lives of others. With the advancement of the scientific knowledge, the authority of quack practitioners has declined as they are unable to provide scientific background of their work. This decline of false or quack practitioners had also helped in improving the integrity of the profession.
In many health care settings, health care experts are often pressurized to use therapeutic strategies that are brief and standardized. In those institutions, standard method of treatment is to use the treatment manual that shows the method of treatment and the number of sessions required for that treatment. Many health care experts are of opinion that this method of treatment is mechanistic and does not consider the association of the psychotherapy process with individual variability. Moreover, relying heavily on standardized treatments for certain problems could raise many ethical problems (Corey, 2016).
Human beings are complicated. It is often difficult to determine the problems and deal with those problems with the help of some simplistic and standardized methods. Moreover, not all the clients have clear idea of their psychological problem before coming to a health care expert. Evidence-based practice provides health care professionals with more knowledge about the issues of clients, who may have some cognitive, emotional, and behavioural disorders, thereby helping those clients according to the latest knowledge obtained through empirical research. For example, recent researches show that behaviour therapy, cognitive therapy, cognitive behaviour therapy, short-term psychodynamic therapy, and mindfulness-based cognitive therapy can successfully help in the treatment of depression (Corey, 2016). Overall, it can be said that ethical health care practice requires the utilization of efficacious procedures in dealing with the problems of clients and providing a therapeutic rationale for the treatment options, and this can be done only through evidence-based practice.
Influence of the client-counsellor relationship on counselling outcomes
Counselling session can be successful and give encouraging outcomes, if there is a satisfactory relationship and positive connection between the client and counsellor. With the help of a good connection, a patient may start giving quick responses to the treatment. Research shows that a good connection between a therapist and his or her client can develop within 10 minutes of meeting (Littauer, Sexton, & Wynn, 2005). Therefore, the clients also start responding to the treatment without wastage of much time.
Study shows that clients reported that their therapists have to be patient, understanding, and accepting in nature. They also noted the importance of the therapist’s ability to attentively listen to the client while questioning and commenting in a friendly manner (Littauer et al., 2005). Moreover, empathy is also an important element in the healing process, and it develops easily with better relationship. Empathy of the counsellor is helpful in developing a good relationship that would help in better communication not only orally, but also with body posture, eye contact, listening skills, and tone of voice (Raina, Alam, & Siddiqui, 2010). Experts have reported that the facial features of a therapist can remind the patient of his or her parent, and this association can also lead to the positive or negative outcomes. For example, if the patient has positive feelings towards parent, he or she may start attaching those feelings with the therapist, thereby leading to several outcomes; the client-counsellor relationship could be more than a “professional” relationship, which is not ethical, but can help the client in talking more openly with the counsellor. On the other hand, if the patient has negative feelings towards parent, he or she may start attaching those negative feelings with the therapist, thereby resulting in disturbed relationship that could lead to negative outcomes (Levy & Scala, 2012).
Actually therapy is a kind of commitment to make adjustments in the behaviour and patterns of thinking. In order to get better counselling outcomes, counsellors have to use the best of their knowledge and expertise, and the client has to make a commitment in time, finances, and energy, so that both the client and counsellor would be compatible with each other and can develop the best ways of dealing with problematic feelings, thoughts, and behaviours.
Concluding Remarks
Evidence-based practice is an interdisciplinary method of utilizing the best possible information for the betterment of clients or patients. It has three main components; best available research evidence, clinical expertise, and client values. In the last few decades, health care organizations and experts have started giving much weight to the evidence-based practice. Several organizations such as American Psychological Association, the American Nurses Association, the American Occupational Therapy Association, and the American Physical Therapy Association, strongly recommend gathering evidence about an intervention through empirical research and review of literature.
Evidence based practice can be found in various fields of life such as psychology, nursing, medicine, education, and information science. This practice has helped in not only improving the quality of care but also enhancing the image of organizations and experts working in those organizations. With the help of evidence-based practice, clients feel safer and know that their therapists are working according to the recent and most appropriate knowledge. It has also helped in eliminating quackery in the field of health care by removing traditional method of sharing knowledge with others with more appropriate empirical research.
References
Anderson, N. B. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285.
APA. (n.d.). Evidence-Based Practice in Psychology. Retrieved from http://www.apa.org/practice/resources/evidence/
Buysse, V., Winton, P. J., Rous, B., Epstein, D. J., & Lim, C. (2012). Evidence-based practice. Zero Three, 32, 25-29.
Cooper, M. (2014). Clinical Social Work Practice: An Integrative Approach: PEARSON EDUC.
Corey, G. (2016). Theory and Practice of Counseling and Psychotherapy: Cengage Learning.
Duke University Medical Center. (2016). Introduction to Evidence-Based Practice. Retrieved from http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
Levy, K. N., & Scala, J. (2012). Transference, transference interpretations, and transference-focused psychotherapies. Psychotherapy, 49(3), 391.
Littauer, H., Sexton, H., & Wynn, R. (2005). Qualities clients wish for in their therapists. Scandinavian Journal of Caring Sciences, 19(1), 28-31.
Mayer, B. (2012). The Dynamics of Conflict: A Guide to Engagement and Intervention: Wiley.
Oliver, K., Innvar, S., Lorenc, T., Woodman, J., & Thomas, J. (2014). A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC health services research, 14(1), 1.
Raina, R. L., Alam, I., & Siddiqui, F. (2010). Communication for Management: Sanbun Publishers.
Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C. A., Crichton, N., Allen, C., . . . Strunin, L. (2013). The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci, 8(1), 28.
Sanders, P. (2011). First Steps in Counselling: A Students' Companion for Introductory Courses: PCCS Books.
