[AVAPL Members] Re: Some Thoughts on Evidence Based Practice

  • From: "Freeman, Marianne" <Marianne.Freeman@xxxxxx>
  • To: <members1@xxxxxxxxx>
  • Date: Thu, 20 May 2010 16:25:15 -0400

Having just come from an intern case presentation this issue was fresh on my
mind.  The intern used elements of MI, DBT, and CBT with a veteran with a
complex set of problems including an abusive childhood, MST, and substance
dependence, to name a few.  His outcome?  Over the last eight months he has
demonstrated improved affect regulation, increased self-esteem and
self-confidence, getting and  holding a job, and sobriety, to name only the
major changes.  To what did he attribute this success?  The quality of their
relationship and the therapist's ability to provide a good therapeutic
environment (e.g., common factors).  His words "I liked all the tools you
gave me, they all helped, but without you I wouldn't have bothered to stick
with it". 

 

 

Marianne R. Freeman, Ph.D.

Director of  Psychology Training

North Florida/South Georgia Veterans Health System

X.6308

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Smith, Tracey L. -
Madison,WI
Sent: Thursday, May 20, 2010 11:20 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

I completely agree with Dr. Goldberg and am often mystified as to why some
people see these as orthogonal, as though we have declare allegiance to one
camp or another - evidence-based psychotherapies and a focus on therapeutic
alliance and alliance repair coexist and are complementary - I think we
would be wise as a system to honor, train, and focus on both!

 

Tracey L. Smith, Ph. D.

Psychology Executive

Wm. S. Middleton Memorial Veterans Hospital

2500 Overlook Terrace

Madison, WI 53705-2286

 

Messages: (608) 280-7084

Fax: (608) 280-7204

 

Assistant Professor of Psychiatry

Univ. of Wisconsin, Madison

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Goldberg, Robert W.
(VHACLE)
Sent: Thursday, May 20, 2010 10:12 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

Apart from the way the VA is approaching evidence-based practices, with
which I am generally supportive, there are more traditional evidence-based
practices that are not being rolled out systematically.   There are many
relationship, therapeutic alliance, and technique variables which have been
empirically supported in dozens of studies:  Rogers, Kiesler, Strupp, et al.
There are protocols for training people in these techniques.  However,
they've been shunted aside as mere preconditions or 'nonspecific' factors
when, indeed, they are the vehicles for powerful change.   

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Besyner, James K
Sent: Thursday, May 20, 2010 10:45 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

I agree with Martha and Chad.  All that we do should have 1) evidence to
decide to offer it, and 2) evidence that it did/did not do some good.  

 

I also like the idea of standardization of training and practice but do not
believe that given all the important variables impacting outcomes, such as
the quality of the therapeutic alliance,  that training in a set of
techniques itself guarantees positive outcomes.  Perhaps the forthcoming
templated progress notes will go a long way for VA Psychology/MH to tease
out a whole host of issues/problems/factors associated with our therapies -
including the clinical reasons for going "off manual."

 

Jim

 

James K Besyner, Ph.D., ABPP

Board Certified in Clinical Psychology

Chief of Psychology

Mental Health Service

VA North Texas Health Care System

Dallas, TX

 

Clinical Professor of Psychiatry

University of Texas Southwestern Medical Center

 

Voice:  214-857-0534

Fax:  214-857-0531

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Brownlee-Duffeck,
Martha CMOVAMC
Sent: Thursday, May 20, 2010 9:31 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Some Thoughts on Evidence Based Practice

 

Dear All,

 

I too was very inspired by Dr Goodheart's talk and discussed with our
psychologists the idea of "piloting" her model at our VA to the extent
practicable.  I am looking forward to the workshops she will be doing at APA
this year. 

 

In the end, treatment efficacy (with or without a manual) becomes an
empirical question.  It is only by making clinical outcomes research part of
clinical care that we move the science and practice of psychology forward. 

 

Perhaps, if there is a group of us that want to try this we could approach
her via e-mail  and form an "electronic workgroup" to problem solve
implementation issues as the arise.

 

Let's talk more "back channel" to avoid overloading mailboxes.

 

Martha

 

 

Martha Brownlee-Duffeck

Martha Brownlee-Duffeck, Ph.D., ABPP

Psychology Leader & Director of Training, 

Post-doctoral Program

Behavioral Health Service Line, 

Harry S Truman Veteran's Hospital

800 Hospital Drive, BHSL

Columbia, Missouri 65201

 

Adjunct  Professor, 

Department of Physical Medicine & Rehabilitation

University of Missouri School of Medicine

 

Adjunct Professor, Department of Health Psychology

University of Missouri School of Health Professions

 

E-mail: Martha.Brownlee-Duffeck@xxxxxx
<mailto:Martha.Brownlee-Duffeck@xxxxxxxxxx> 

 

Tel.  573-814-6486

FAX: 573-814-6493

 

From: avaplmembers-bounce@xxxxxxxxxxxxx
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Feld, Daniel
Sent: Thursday, May 20, 2010 9:11 AM
To: AVAPL Membership
Subject: [AVAPL Members] Some Thoughts on Evidence Based Practice

 

Dear Friends and Colleagues,

It was great to see and talk with many of you at the AVAPL conference.  I
was left with some thoughts about evidence based practice after hearing Dr.
Goodheart's address that I wanted to put out there. 

It occurred to me that the way VA is responding to the call to offer
evidence-based treatments to all veterans who want them is to train
clinicians in specific therapies that have been supported by the research
literature--and that have been shown to be effective for many.  I think this
approach is admirable and we've seen first-hand at our facility how these
treatments have helped several veterans reclaim their lives. 

But what I found particularly inspiring about Dr. Goodheart's talk was the
idea that we can develop an evidence base for the treatments we already do
by incorporating outcome measures into our clinical work with veterans. I'm
sure that many of us who haven't been trained in any of the evidence-based
therapies being rolled out do feel that we are effective with many of the
veterans we work with, and that the folks we see make significant changes in
their lives.

So.what I'm wondering is if we can consider including the use of outcome
measures to look at how effective we are in working with our veterans. This
could only add to the constructive efforts that we're already making in VA
to provide our veterans with treatments that work. It also has the potential
of expanding how we define evidence based practice. 

What do you all think?

Best,

Danny

Daniel Feld, Psy.D.

Assistant Chief of Psychology

VA New York Harbor Healthcare System

Brooklyn and St Albans Campuses

(718) 836-6600 x6806

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