2008 Ohio Psychologist - Ohio Psychological Association

disorders, and later by limiting research of different treatment
modalities (Roberts & Yeager, 2004). They also point out that
the peer review process has several restrictions. For example,
research being published has high levels of internal validity
(i.e., treatment efficacy) but fails to address issues of external
validity (i.e., clinical utility). Additionally, studies that include
non-significant results or negative trials go unpublished
(Gupta, 2003). As a result, EBP is compromised by not
representing all completed studies that may have an effect
on treatment outcomes (Straus & McAlister, 2000). Further,
most studies are conducted with a homogenous population
of white males and under represent groups such as women,
children and ethnic minorities (Harris, Tulsky, & Schultheis,
2003). Finally, because the random, double-blind placebo
controlled study is expensive, funding sources ultimately
decide what gets investigated, with much of the funding
being donated by pharmaceutical companies whose agenda
may be inconsistent with the needs of the practitioners of
EBP (Williams & Garner, 2002).
Ethical Considerations with EBP
Based on the Ethical Principles of Psychologists and Code
of Conduct, the potential for ethical violations in treatment
using evidenced based practice is apparent. Several main
issues that should be considered include: manualized care,
change in the dynamics of the therapeutic relationship,
negation of non-significant findings, and lack of empirical
evidence justifying the use of EBP.
Manualized Care
Historically, psychological treatment has been a joint effort
between the psychologist and the client. Through this
relationship, an individual treatment plan is developed. EBP
focuses on treatment outcomes for populations rather than
the individual (Kirsner & Federman, 1998). This approach
has been guiding the field to a more manualized form of
care eliminating the client’s contribution to the treatment
plan. As a result, the potential for harm increases because
the psychologist may no longer be taking into account
the individual’s needs, wants, and motivations. Further,
it poses an ethical dilemma by restricting the range of
treatment options and compromising the integrity of the
treating psychologist by forcing him/her to possibly utilize a
therapeutic technique that he/she is not as competent in.
Therapeutic Relationship
There are important aspects about research that are
not addressed in the argument for EBP. First, there are
a multitude of variables that can be contibuted to the
amelioration of a client’s symptomatology. Research
discussed in Roth and Fonagy (1996) has shown that there
is a strong relationship between the effects of treatment
and other variables beyond type of treatment used. These
include therapist variables such as years of training and
years of experience. The most commonly mentioned variable
is the idea that regardless of what treatment method is
used, a person’s condition will improve when a strong
therapeutic alliance is present (Roth & Fonagy, 1996). Due
to the imprecise nature of how to measure the strength of
the alliance, the influence of that relationship may always
be a substantial point of debate. Ignoring the value of the
therapeutic relationship simply because it may be difficult to
measure violates our duty to maintain competence.
Random Assignment
Similarly, forcing the field to use the purported “gold
standard” methodology in research in itself is unethical, as it
would require psychologists to randomly assign which clients
would and would not receive treatment. Additionally, the
idea of a “gold standard” creates a hierarchy within the field
of published research, which devalues other methodologies
(e.g. qualitative research) that can still contribute important
findings (Slowther, Ford & Schofield, 2004).
Evidence for EBP
Lastly, there is debate in the literature as to the empirical
basis of EBP (Goldenberg, 2005; Thyer, 2004). Support for
the effectiveness of EBP in psychological research is lacking,
yet the movement progresses as if the statistical evidence is
in fact sufficient. Ethically, as researchers and clinicians it is
our duty to consider what is best for our clients. This means
that for the few areas where evidence is adequate, empirical
data should be taken into consideration when therapeutic
treatment plans are established. However, psychologists
should be cognizant of all facets of the debate over
empirically based practice.
About the Authors
Michelle Madore is currently a third year graduate student
in the psychology program at the University of Cincinnati.
She is working toward her doctoral
degree with an emphasis in clinical
psychology and a specialization in
neuropsychology. She received her MA
in psychology with a specialization in
clinical psychology at the California
State University, Northridge. Coming
from a military family, Ms. Madore has
already had the opportunity to live in a
variety of locations such as Tennessee,
Arizona, Guam, and Hawaii before moving to Ohio. Upon the
completion of her doctoral degree, Ms. Madore would like to
pursue an academic career that will allow her to teach as well
as continue to work on her research interests.
Yvonne Humenay Roberts is currently a third year graduate
student in the psychology program
at the University of Cincinnati. She is
working toward her doctoral degree
with an emphasis in clinical psychology
and a specialization in child health. She
received her BA in psychology from the
University of Michigan, Ann Arbor. A
native of Michigan, she worked at the
American Psychological Association, and
Children’s National Medical Center, both
in Washington, D.C., before returning
to the Midwest to pursue her doctoral degree. Upon the
completion of her doctoral degree, Ms. Roberts would like
to pursue a career in child psychology that will allow her
to advocate for youth and their communities, as well as
continue to work on her research interests.
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