Substance Abuse and Mental Health Services Administration (SAMHSA), regulates what’s considered evidenced based, which means there is substantial evidence behind the treatment program or practices (EBPP). In 2018 the Trump administration forced SAMHSA to take down the registry which is where people could get information about treatment options. I think there is some pros and cons to this that we will go over in a few lines. To become an evidenced based practice, a treatment model or practice has to have a lot of research behind it. Now, many clinician see progress being made when manualized models are not used; narrative therapy is a huge model in the post modern theories, that has a lot of change behind it, but it is not considered an EBPP. This is why many clinicians do not take insurance, models can be used with what works best for the client regardless of the evidence.
On the other hand, having some evidence behind a model “assures” the likelihood that treatment will be effective. The truth is, there are numerous factors that go into making therapy effective, not just the model. I air on the side of using evidence based models; but I am more outcome based than anything else. Insurance companies and state agencies still require EBPPs, even though the federal government has placed a barrier of an updated list, thus possibly preventing new models from becoming an EBPP. The benefit of this, it allows clinicians to have more clinical judgments and the utilization of models. One benefit of having an EBPP registry is informing the public on treatments that may not be effective, safe, or flat out unethical. Taking this information away is one more way the undereducated are oppressed. Knowledge is power, it gives individuals control over treatment choices and this can limit their awareness of options.
Being a family therapist, many models we use are not considered “evidenced based” although there’s tons of research behind interventions. Studying family interactions are very difficult for a researcher. However interpersonal and relational neuroscience is flourishing right now. Relationally based treatment is growing in evidence, for example, Dr. Sue Johnson has made tremendous changes in the adult attachment area, Dan Siegel and Bruce Perry. But that research has to translate to a “model.” To be on the list of EBPP, there has to be so many outcome studies and meta-analysis studies….not to bore you with research but it is a lot.
So what’s the point in all of this? One, to educate readers, and two, understand how I practice and why. I am an integrative therapist, meaning I draw from many models, interventions, and theories to treatment my clients and help project them forward. I primarily work from attachment and family systems theories, using models that are rooted in either or both, with interventions that are play based, expressive arts, movement, or interactional. I may use cognitive restructuring but do so in a play based way with cognitive reframing, restructuring, challenging… I may use reflecting and tracking to help a client process trauma through a narrative with hands on activity like a puppet show. There are many layers to treatment. So regardless of the language you may be using as a clinician (or if you’re a parent a clinician may be using) there is likely multidimensional change going on within the brain and within the relationship- well if you are using effective strategies…
One of the biggest issues I see with new referrals is the compliant that the therapist just spends a few minutes with the child, asks how their day is going, and change is something in the far distance. That is not effective therapy. Many clinicians that are either new or not trained in childhood and adolescent treatment struggle to provide effective treatment services for their child clients. This is a systemic issue, not just a therapist one. Graduate school teaches just enough to be legal to practice as an associate, supervision lasts for 2+ years, then a therapists may be able to access some training. Rural clinicians are at a disadvantage as well.
**If you are a new therapist, here are few things to focus on- Play. Parent. Connect.
- Play and connect with the child- honoring the child’s experience
- Connecting with the parent- understanding the parent’s position but also providing education for more effective parenting
- Connecting parent and child to create lasting change
- ….. Acknowledging we as therapist do not know everything, humans are complicated and we’re trying to figure this out together
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