"If a patient calls me and asks
how effective my treatment is, it's nice to be able to
say something," says psychiatrist and researcher Dr Allan
Abbass. It's a not-so-subtle barb aimed at those who pooh-pooh
evidence-based psychotherapy research. He says that the
today's savvy patients want to know about success rates
before they pony up for treatment.
He readily concedes that everyone
responds to treatments differently, but it's nice to
have voluminous tomes of studies to give patients some
idea of what to expect. "Of course, you can never really
predict anything," he says, "but I can tell them how
a treatment works and how long it usually goes, tell
them the odds on how well they'll do, and we'll see
how it goes between you and me."
Dr Abbass founded Dalhousie University's
Centre for Short-Term Dynamic Psychotherapy, and there
he helped establish the Canadian Psychiatric Association's
clinical practice guidelines for psychotherapy. He says
that while there's already a pile of empirical-based
research in areas like anxiety and depression, we know
precious little about types of mental illness like personality
disorders and eating disorders.
CASE
THE JOINT
A good way to address this is case-based research, which
lets you examine the nuts and bolts of a particular
case, sometimes with videotaped treatment sessions.
Dr Abbass says practitioners can find elements in these
individual cases that have wider meaning.
With outcome-based research, therapists
can measure how frequently the client visited the emergency
room and how much medication they took before and after
treatment. And there's plenty to learn from a client's
self-assessment of their own progress.
"You can look at all that data
and evaluate it without infracting on the patient at
all. It just means examining what works and what doesn't,"
he says. By drawing on a cumulative database of their
findings, he notes, therapists can figure out which
type of treatment might work best, and also if a client
needs hundreds or even thousands of sessions or merely
dozens. (Dr Abbass says he conducts an average of 15
sessions with each client).
To those who fear that empirical-based
studies lead to one-size-fits-all care, Dr Abbass counters
that all professional practitioners of psychotherapy,
clinical or not, have to focus on the individual for
the treatment to work.
"When the rubber hits the road,
that's exactly what a clinician does and wants to do.
You can't make a patient fit into a model," he says.
"You get your wisdom from literature, experience, from
different places, and you bring all of that to the treatment."
DEFENDING
THE COUCH
Failure to fully research and document benefits of psychotherapy
could lead one to think drugs are the 'be all, end all.'
"If all we have is tons of pharmaceutical data, we're
missing the critical other side of treatment," warns
Dr Abbass. "Some psychotherapy treatments do at least
as well � if not better � than meds. Over time it has
no toxic side effects and costs the person less."
It also costs society less, says
Dr Abbass, citing studies which show that, when done
well, psychotherapy can save the system money because
it lessens hospital and ER visits. "They're just not
putting all this information together and presenting
it," he says. "If we don't keep studying and presenting,
people are never going to know."
� by Sharon Aschaiek
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