Psychology

In many professions like medicine, psychology, education and psychiatry, outcome-focused practice and evidence-based practice are frequently used among other approaches. Due to lack of evidence-based information, the knowledge that many practitioners have been using is the knowledge that has build up from experience and it has not been researched on, to prove the validity of the same. Nevertheless, this does not mean that the information is always wrong, the information may be right but the evidence of the same may be lacking. Psychology has been affected by this as well as other professionals. Consequently, this essay seeks to analyze both outcome-focused and evidence-based practice and explain how counselors can contribute to the development of evidence-based practice. In addition, it shall also explain some shortcomings of outcome-focused practice and client directed practice.

Since evidence based practice is the practice that has been recommended by many associations, it would be of much importance to look at it more comprehensively. According to American Psychological Association (2005), evidence-based practice can refer to combination of the best research available with the clinical knowledge in the context of patient characteristics, culture and preferences. The same studies record that the Institute of Medicine defines the same as the integration of best research evidence with clinical expertise and patient values. In psychology, this is very important as it helps to promote effective psychological practice which eventually enhances public health by the application of empirically supported principles of psychological assessment, therapeutic relationship and intervention.

To be in a position to understand comprehensively what is meant by evidence-based practice, it would be necessary to understand the different components of the same. There must be best research evidence which refers to a body of evidence on intervention strategies, assessment procedures and clinical problems among others, drawn from various research designs and methodologies attesting the effectiveness of psychological practices.  The evidence should also be based on reasonable sizes, systematic reviews, statistical and clinical significance, and a body of supporting evidence.  In order for the research to be valid, the same should be based on progression from clinical observation by systematic reviews from of random clinical trials while at the same time recognizing gaps and limitations in the literature which is already inexistence and its applicability to a specific case (American Psychological Association, 2002).

Clinical expertise in psychology refers to all the competencies that promote and lead to positive therapeutic outcome which are inclusive but not limited to conducting assessments and coming up with diagnostic judgments, systematic case formulation, monitoring patient progress, among others. It is actually used to integrate best research evidence with clinical data which can refer to information about the patient and which is usually obtained in course of treatment by the counselor or psychologist. In psychology, treatment is most effective when the services address patients specific problems, personality, and socio cultural context. The therapeutic outcome largely depends on some of the patients characteristics like readiness to change, level of social support, functional status, chronological age, developmental history and religion.  Environmental context like health care disparities, stressors like unemployment, personal preferences and values like world views and goals, are all very important and usually have much to do with the outcome of any psychological intervention.  Although the main goal of evidence based practice is to maximize the choice of the patient among other alternative and effective interventions, clinical implications of the same are considered to a very great extent.

Having discussed what is meant by evidence-based practice and its components, it would be necessary to discuss the role of a counselor in the development of the evidence based practice. The first role of the counselors should be to join efforts with other researchers and professionals so as to make sure that the all the research data available on psychological practice is both clinically relevant and internally valid. Therefore, they should join the rest in conducting psychological research in order to validate the already available information.  The research should also address the widely used psychological principles due to the fact that though there is no evidence to support the same, this does not mean that they are all wrong.

For a long time there have been barriers and challenges that face the use of research-based evidence. Since counselors are the people who face these challenges daily in the course of their practice, it would of great significance if they helped in identifying these challenges. After identifying the challenges, they should be addressed if any positive outcome should be expected. However, addressing these challenges may be a very complicated process for any counselor especially without the support of others in the same and in other related professions. Therefore, it if counselors can combine and form organizations that can address this issue much can be realized from the same. For instance, if the problem facing the research happens to be lack of funds, an organization can raise the same easily or even be in a better position to influence some funding organizations to provide funding for the same. The American Psychological Association has been in the front line in ensuring that psychologists deliver the best services to the patients.

In order to enhance development of evidence-based practice, counselors should strive to see to it that the psychological principles they use while addressing the problems of the patient are supported by sound evidence. This can only be achieved if they are well informed. It is therefore important for all counselors to be updated on various research findings in their area of profession. This can be achieved through attending various workshops and seminars. It would be very vital for all counselors to disregard all other information that does not originate from the credible sources. Counselors are the key people who can make sure that evidence-based practice is in operational because they deal with the patients directly.

On the other hand, outcome-focused practice is a different approach from evidence-based practice, although the goal may actually be the same.  Outcome focused generally refers to any approach that is more aimed at  attaining the outcome of any method used .It is an approach that also focuses on building an alliance with the client and getting of the feedback from the client. This approach is most of the times client directed and that is the reason as to why the key person in this approach is basically the client. The first step in this approach is to listen and identify what the client want. The psychologist then plans the intervention strategies in such a way that the goals of the client can be easily achieved. To achieve this, the practitioner keeps on getting feedback from the client concerning the whole process to determine whether the goals of the client are being addressed. The reason as to why it is mostly client directed is because it aims at attaining the goals set by the client and the method of doing the same is by using strategies which are also designed by the client (Abraham  Michie 2004).

Client driven and outcome focused practice is more often than not very successful although this does not mean that it is the best form of practice. Research has shown that it enhances the outcome of those cases that face the risk of the poor outcome more so because the clients contribution is encouraged. Moreover, it reduces the drop out rates since the client is unlikely to drop, out of the strategy that has been devised to favor him.  This practice is widely used especially while dealing with mental health patients as well as other emotional disturbances. Failure to use such a practice while dealing with such sensitive issues can easily interfere with the outcome.

However, although outcome focused and client directed practice are widely used especially in psychology, the same has got some shortcomings. Some scholars have urgued that in outcome-focused practice, sometimes the outcome becomes the opposite of what is already expected. This is due to the fact that most of the times the practitioner lays a lot of emphasis on the outcome and forgets all about the process. The process is very important since the outcome largely depends on the process that has been used. For instance, while counseling a bereaved person, the process of doing that is very important as it dictates the outcome of the same. Failure to use the right process may not only interfere with the outcome but it can also easily worsen the condition of the patient or the client.
Despite the fact that client directed practice reduces the drop out rates in any intervention procedure as highlighted earlier, there are still some shortcomings of the same.  In client directed practice, the use of research based-evidence is sometimes compromised. This is because in this practice, the client is allowed to come up with goals and the means of achieving those goals. The truth is that the counselor may not get the opportunity of using the already available knowledge in solving the problem. Since the client is not actually a professional of the same the required outcome may be achieved but without the use of the best practice method. The counselor also strains a lot while trying to devise ways and means that will best address the clients problem in a manner that will favor the client (Abraham  Michie 2004).

In psychology the mode of practice is very important because it does not only affect the outcome, but the future of the subject as well. Since psychology is a science, all strategies and the methods of practice should be adequately researched on before they are applied in solving human problems. This is the main reason that makes a lot of organizations and associations to propose the use of evidence-based practice. This allows the use of strategies that have been verified by use of sound research procedures which is not only effective but also minimizes the chances of having a lot of quacks in the profession. However, there is also outcome-focused practice and client directed practice. The study of the same shows that it is largely used in psychology as it is used in other relevant areas. Although it is highly successful for it improves the outcome of very sensitive issues, it is at the same time not the best. This is because at times it disregards the use of the already researched methods and knowledge which is a draw back, for it prevents change and development in the field of psychology. Moreover, patients interpretation of a certain situation may change in the course of the intervention which may complicate the whole procedure or interfere with it altogether (Wilson,  Taylor, 2005).

Although more emphasis has been laid on the evidence-based practice, outcome and client directed practice cannot and should not be done away with altogether. They are all important, but the counselor should be empowered and be in a position to make the right decision while dealing with the client. Moreover, incorporating evidence based practice should not be rushed because change may actually take some time, especially when a whole system is concerned. Nonetheless, evidence-based and outcome-focused practices are all modes of practice in the field of psychology and contribute differently towards the same.