The September 2012 issue of Counseling Today has a comprehensive article called ‘Should counseling practice be evidence based?’ The answer of course is Yes. I have never met a counselor who does not want to be effective and to be effective each of us uses the best evidence we can get given who we are and who our client is. However, those who use this phrase usually mean something more narrowly defined—should results from randomized clinical trials (RCT) be the gold standard for discerning information about what works and what does not in a counseling situation.
For those advocating RCT, the answer is of course No. Such trials are as inappropriate for discerning the best counseling approach as they would be for discerning which is the best pitch a pitcher can throw in a baseball game. The counseling situation is a system in which it is impossible to isolate the effect of a single variable. Models from systems theory or even chaos theory would be more appropriate than from medical research. Like the flap of the butterfly wings, a single word or look can effect a complete change in a client. As a counselor for over 40 years and a clinical statistician for over 30 years, I never seen results from any RCT that would clearly raise one counseling approach above all others. In fact some have suggested that to make a clear diagnosis is to inhibit the counseling process itself and a clear diagnosis in a critical element in any RCT.
CBT is often proposed as one clear, evidence-based approach that is being looked favorably by counseling clinics, hospitals and even HMOs because it is asserted that its effectiveness has been demonstrated in scientific research. CBT does seem to have some effectiveness with certain clients with certain personality adaptations—most likely for those whom thinking is their ‘open door’ as described by Vann Joines and Ian Stewart in their book ‘Personality Adaptations’. However, for others with different personality adaptations, thinking is their ‘trap door’ and using CBT could prevent a therapeutic alliance from forming. In fact it might even exacerbate the dysfunction of such a client! For such adaptations, a behavioral or emotional approach should be tried.
If you have read this blog this far, I can say that you are already a counselor who uses evidence-based counseling. My suggestion is that you be more intentional about what you try and how it affects your client. Each counseling situation is an ‘n of 1’ as we say in statistical jargon and it contains information that can help you improve your effectiveness. Just go for it!
Ray McKinnis is a counselor with a special interest in 'spirituality beyond religion' and veterans 'beyond PTSD'