Evidence based assessment/Step 9: Learn and use client preferences
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|Steps 1-2: Preparation phase|
|Steps 3-5: Prediction phase|
|Steps 6-9: Prescription phase|
|Steps 10-12: Process/progress/outcome phase|
Learn and Use Client Preferences
Patient beliefs about the causes of problems, their attitudes towards biological or spiritual explanations, the past experiences of relatives and friends with treatment, and other cultural and idiographic factors all shape perceptions of treatment. Better to start the dialog early and give their opinions weight at the beginning, or they will vote with their feet later in the form of low motivation and engagement, and early drop out. There are some findings that can guide conversations about options: Families often put higher value on spiritual perspectives than the therapist does; and some cultures are less likely to conceptualize things in biological terms than the research community does at present. Cognitive behavioral therapy may be less effective with people from Asian cultures, who may be less likely to focus on cognitive symptoms of depression than Europeans and European Americans, and interpersonal psychotherapy (IPT) may be more attractive and effective than other ESTs for Hispanic families due to the greater emphasis on family relationships. A core portion of the values discussion needs to be idiographic, though. What is important to the outcome for the individual is their own constellation of beliefs and attitudes, not stereotypes and averages that may or may not match them. The growing emphasis on collaborative models of care as a core feature of evidence based practice recognizes this.
As we move towards collaborative care models and shared decision-making, we need to also attend to what information our clients have, how they interpret it, and how we can help them navigate the information effectively. Researchers can give more thought to packaging results in a way that is digestible by a lay audience, and we can do more to teach the public critical thinking skills to separate hype from evidence. Effective communication will involve a blend of attention to details such as graphical formats and concrete ways of describing probabilities as well as a greater willingness to engage with popular and online media. We need to understand where the client is coming from and how things look to them before we can engage in a conversation about change.
No matter how convinced we are by our own arguments, they do not help anyone if the client does not agree. One of the biggest obstacles is failure to connect on the emotional or value-driven levels. Evidence-based clinicians are masters of facts. Successful engagement depends on understanding the client's values and beliefs, and responding to questions and concerns at an emotional level, as well as clearly presenting the facts.
Steps to put into practice
Tables and figures
- Yeh, M., Hough, R. L., Fakhry, F., McCabe, K. M., Lau, A. S., & Garland, A. F. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Journal Consulting and Clinical Psychology, 73(5), 800-807. doi: 10.1037/0022-006X.73.5.800
- Yeh, M., Hough, R. L., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 605-612. doi: 10.1097/00004583-200405000-00014
- McKay, M. M., McCadam, K., & Gonzales, J. J. (1996). Addressing the barriers to mental health services for inner city children and their caretakers. Community Mental Health Journal, 32(4), 353-361.
- Carpenter-Song, E. (2009). Caught in the psychiatric net: meanings and experiences of ADHD, pediatric bipolar disorder and mental health treatment among a diverse group of families in the United States. Cult Med Psychiatry, 33(1), 61-85. doi: 10.1007/s11013-008-9120-4 Gigerenzer, G. (2002). Calculated risks: How to know when numbers deceive you. New York, NY: Simon and Schuster.
- Kalibatseva, Z., & Leong, F. T. (2011). Depression among Asian Americans: Review and Recommendations. Depress Res Treat, 2011, 320902. doi: 10.1155/2011/320902
- Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300-313. doi: 10.1037/0021-843X.117.2.300
- Mufson, L. H., Dorta, K. P., Olfson, M., Weissman, M. M., & Hoagwood, K. (2004). Effectiveness research: transporting interpersonal psychotherapy for depressed adolescents (IPT-A) from the lab to school-based health clinics. Clinical Child and Family Psychology Review, 7(4), 251-261.
- Norcross, J. C., Beutler, Larry E., & Levant, Ronald F. (Ed.). (2006). Evidence-based practices in mental health. Washington, DC: American Psychological Association.
- Kraemer, H. C., Lowe, K. K., & Kupfer, D. J. (2005). To Your Health: How to Understand What Research Tells Us about Risk. New York: Oxford University Press.
- Gigerenzer, G., & Muir Gray, J. A. (Eds.). (2011). Better doctors, better patients, better decisions. Cambridge, MA: MIT Press.
- Kosslyn, S. M. (2006). Graph design for the eye and mind. New York, NY: Oxford University Press.
- Blastland, M., & Spiegelhalter, D. (2013). The Norm Chronicles: Stories and Numbers About Danger London, UK: Profile Books.
- Becker, S. J., Spirito, A., & Vanmali, R. (2015). Perceptions of 'Evidence-Based Practice' among the consumers of adolescent substance use treatment. Health Education Journal. doi: 10.1177/0017896915581061