In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician)

Persons (2013) has commented on my article (Eells, 2013) about revisiting the case formulation approach to psychotherapy research. I elaborate on her ideas by advocating for an evidence-based case formulation (EBCF) model of psychotherapy practice. The latter encourages clinician freedom of choice to select a case conceptualization and treatment plan, as long as those choices are empirically defensible. While the EBCF approach is intellectually challenging for clinicians, it has the advantage of being flexible in accommodating evidence, including but not limited to that derived from randomized clinical trials. The EBCF approach is preferable to the untenable position of relying primarily on one’s personal experience as a therapist or primarily on intuition. The EBCF approach is an empirically defensible alternative to the empirically supported treatment (EST) movement. Clinical judgment is emphasized more in the EBCF approach than in ESTs. Conditions are described under which intuition in context can be trusted as one of a number of components of evidence-based practice. Finally, since therapists practicing ESTs tailor treatment to meet patient needs as they arise, a false dichotomy may exist between the EST and EBCF approaches when considering psychotherapy as it is actually practiced. A mixed-methods research agenda that examines the case formulation hypothesis can help determine whether such a false dichotomy exists, while advancing knowledge of psychotherapy as it unfolds in practice