Think about the last time you bought a new appliance – how did you decide on it? Most of us have a shorthand for making these decisions – narrowing the choices down based on the features that you need, asking friends and family what they recommend, reading consumer reviews and product test sites (thank you The Strategist!), checking out different versions in a brick-and-mortar store, and then selecting which one fits best based on all that information. When I needed a new vacuum recently, I knew I wanted a corded model with a lot of power that could handle dog hair and random toddler crumbs on hardwood floors and was lightweight and easy to store. After some internet research and a few texts to my most organized friends, I was able to pick one out relatively easily.
When seeking out a service like therapy, however, the process is often not so easy. Many people use similar methods – asking around to trusted friends or medical professionals, clicking through therapist profiles on aggregate sites, asking for names from their insurance company, or even doing a simple internet search. But how do you know what you are looking for? Beyond wanting a warm and empathic therapist (which most therapists are – it’s kind of the defining trait of the profession), what should you consider?
If you need help navigating through a stressful period or a strained relationship, general counseling might work well. However, if you are experiencing a more defined mental health problem like depression, anxiety, or trauma, there are specific, skills-based treatments that have a lot of research behind them to show that they work in a short period of time. We typically refer to these as evidence-based treatments (EBTs) or, when applied more loosely, evidence-based practices (EBPs). Treatment models like cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), interpersonal therapy (IPT) and parent management training (PMT) have been tested in large number of clinical trials and help people feel better in a matter of months. We know there are these effective, short-term treatment options and many mental health professionals are trained in them – we just are not great at marketing these treatments to the public and making sure individuals and families know what to look for. (Side note: That’s my goal with this blog – to make the therapy process more transparent and to pass on what I have learned so that others can make informed decisions!).
Although each EBT has specific unique features, there are also some components of evidence-based care that cut across different models. This list, of course, is not inclusive of all evidence-based practices and reflects my own experience and training. Everyone does things differently and even the most disciplined therapist will also take detours from these activities from time to time to provide more personalized care.
Here are some things that would indicate your therapist is practicing evidence-based care:
Completes a thoughtful and comprehensive assessment of your or your child’s current concerns and provides feedback on their impressions.
Using a semi-structured interview like the Anxiety Disorders Interview Schedule (ADIS) or the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND) is a great way to collect information across multiple areas and makes it less likely that any relevant information is overlooked. That’s important because missing information could lead to the wrong diagnosis and, subsequently, the wrong treatment. These interviews were created for research purposes and are intended to be lengthy so most clinicians who use them create an adapted version that can completed within a session or two.
Works alongside you to set both short and long-term goals for treatment.
Even better if they use the SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) acronym to create them. Think about if you were planning to run a marathon – you would know that the end goal would be to run 26.2 miles in a certain amount of time. How would you get there? Maybe you would start with being able to run a few miles throughout the week and then build up to some longer runs on the weekend until you felt comfortable being able to run at least 20k at a time. Those short- and long-term goals let you assess how you’re doing and if you need to adjust your training plan at all. Similarly, setting goals for treatment helps you and your therapist define what progress looks like and how to adjust if things get off track.
The collaborative piece is key here too – it should be your voice and perspective on where you’d like to be over time rather than your therapist defining what success looks like for you.
Asks you to fill out validated (i.e., successful at detecting changes across large groups of people) measurements to see how you are doing and tracks these over the course of treatment.
It’s especially helpful if your therapist is able to show you the change in your scores visually (e.g., using a graph or an infographic) to highlight where things have shifted and where they have not. Sometimes we don’t recognize the progress that we’ve made until we reflect on where we started and visuals make that easier to see.
Sets an agenda that outlines the plan for the session and sticks to it.
Good evidence-based care requires some advance planning. It’s ideal if your therapist has an idea of what they would like to cover in that session and then invites you to collaborate on the plan together. You should feel comfortable to add items or give feedback on items that you don’t think will be as helpful.
Practices skills with you during session.
Just like with any new skill, the hands-on physical practice drives our learning. It would be impossible to learn to ride a bike without actually getting on one, moving the pedals for ourselves, and figuring out how to maintain balance as we move. Many therapy skills require the same real-world practice to ensure we can work out the kinks before being able to do it on our own.
Sets you up with skills to practice between sessions.
Even more important than the practice you do in session is the practice you do outside of session. The time you spend with your therapist is a small sliver of your time. It’s crucial to integrate the skills with your every day life so that it becomes something you just do naturally over time rather than something you're prompted to do occasionally.
Adapts your treatment plan based on feedback from you and your progress.
Our lives are often messy and veer from what we expect. An evidence-based therapist will often have an idea of a path they think treatment might follow but is also ready to pivot and change that plan when new stressors or concerns come up or if it is clear that the original plan is not working.
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