Evidence-Based Practice and Practice-Based Evidence

If what you are doing is working, then don't change it.

If what you are doing is not working, then try something different.

Simple and easy?  Then try these questions:

• How do you know if what you are doing is working?  What does that look like? feel like? How do you measure it?
• Are clients improving?  Are clients accomplishing their treatment goals?  How do you keep track of this?
• Do you feel competent and hopeful as a clinician?  A study showed that there is a difference in the rate of professional burn-out between clinicians who spend years of seeing clients improve (lower) vs. not improve (higher).
• A study showed that clients can be happy with their therapist and still not show any improvement in the problems that brought them into therapy in the first place.  Good relationship, but no progress - is this success?

• If you conclude somehow that it is not working, then what do you try instead?  Do you take stabs in the dark?  Reinvent the wheel? Or do you consult others who have done it or are doing it and find out what worked for them?
• Clinical supervision and consultation, way past the required 3,200 hours, is always helpful. 
• What about research?  Does going to the research literature to see what has been tried sound appealing?  If not, why not?  When I read the literature, I am amazed at how much is known (has been known for years!) about what works.  And yet, it is not being done - it is not yet the standard practice.  Approaches and interventions that could help our clients improve tremendously - sooner rather than later - lie dormant and unused.  Clients who are low-income and ethnic/racial minorities are least likely to receive evidence-based treatment.  That just sucks.  It's not always about working harder, longer hours or doing more.  Sometimes it's just about doing things differently.  Risking a ride on the learning curve - trying a new approach.  It's more work (especially emotionally) at first when learning something new.  But then, if you have chosen the right intervention for the problem at hand, it is less work with greater rewards.  Because the pay-off has already been proven effective (in clinical trials or quasi-experimental designs).

• If, in your practice, you discover something that works then do you have a responsibility to share it with others and add to the knowledge base in our field?