Empirical Evaluation of the Utility and Effectiveness of Clinically Flexible Application in Evidence-Based Treatments

Abstract

A common criticism of the adoption and use of empirically supported treatments is their perceived lack of applicability to complex individual cases. For example, some individual clients present with multiple problems, comorbid conditions, or respond poorly to the best available psychological treatment. An ongoing dilemma for scientifically-minded clinicians in such situations is whether and how best to proceed with deviations from manualized treatments. Conscientious clinical scientists may be reluctant to deviate from protocol without some means of assessing whether outcome will be better or worse than proceeding with the protocol. Some clinicians may abandon the protocol and the principles on which it is based, and proceed as guided by clinical judgments based on recollections of similar cases and roadblocks. How does the conscientious clinical scientist evaluate whether deviations from treatment protocol enhance or degrade outcome? I will discuss the relative merits and possibilities of the Polaris-MH-data-informed approach provided by Grissom and Lyons (2006), with attention to (a) its potential for providing evidence-based feedback to clinician and client, and (b) how it might be particularly useful in the context of empirically-supported treatments. I will also propose principles for how clinicians can use evidence from relevant literature to inform and evaluate the utility of deviations from protocol.