The Unevaluated Framework of APA's Policy on Evidence-Based Practice in Psychology (EBPP)

Abstract

Responding to the recent debate concerning evidence-based practice (Norcross, Beutler, & Levant, 2005, pp. 3-9), APA president Ronald F. Levant commissioned a Presidential Task Force with the mandate to establish a consensus that "acknowledge[s] the valid points from all sides of the debate" ("A presidential," 2005, p. 59). As a result, the Task Force (APA, 2006) produced a statement concerning evidence-based practice in psychology (EBPP) that was approved as APA policy by APA's Council of Representatives in 2005. The policy defines EBPP as the "integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (p. 280). In a more extensive report explaining the process and rationale for the policy (APA, 2006), the Task Force explains that "best available research" includes, but is not limited to, randomized clinical (or controlled) trial (RCT) methodology and empirically supported treatments (ESTs) for specific DSM disorders (p. 273). In comparison to narrower systems of evidence-based practice (e.g., an EST monopoly; see Slife, Wiggins, & Graham, 2005), EBPP's inclusion of a diversity of methods and practices better reflects the complexity of psychological treatment. As the Task Force has emphasized, real-world practice is too complex to be informed by the robotic institutionalization of a single type of research, such as the RCT (APA, 2006). Instead, it requires "a decision-making process for integrating multiple streams of research evidence-including but not limited to RCTs-into the intervention process" (p. 273). This process "requires that psychologists recognize the strengths and limitations of evidence obtained from different types of research" (p. 275). I agree wholeheartedly with the need to handle "multiple streams" of evidence, but I wish to take a more critical look at the "decision-making process" the Task Force has in mind. Such an ambitious endeavor would require, it seems, an underlying framework to inform how a diversity of evidence-based methods and practices might be used and evaluated. In this article I demonstrate that the APA policy and report imply such a framework but, curiously, it is neither explicated nor evaluated. This unevaluated framework is committed to a narrow epistemology, and this commitment, I argue, is inconsistent with EBPP's values of justification and inclusiveness.