ERIC Identifier: ED435948
Publication Date: 1999-00-00
Author: Sexton, Thomas L.
Source: ERIC Clearinghouse on
Counseling and Student Services Greensboro NC.
Evidence-Based Counseling: Implications for Counseling
Practice, Preparation, and Professionalism. ERIC Digest.
The practice of professional counseling, like that of psychology and social
work has its roots in the early humanistic, behavioral, and cognitive
theoretical traditions. Lessons from the outcome and process research were only
distant voices in the background. This early bifurcation between practice and
research evolved into a fairly wide "research-practice gap" that has plagued the
practice of professional counseling for the last two decades.
Two major issues make the artificial dichotomy between research and practice
not only irrelevant but also potentially harmful to the current and future
status of counseling practice and preparation. First, most practitioners know
that today's landscape of counseling practice is one dominated by
accountability. In fact, many have claimed that accountability is now a primary
principle of professional practice--a principle more important than theory
congruence or philosophical allegiance (Sexton, Schofield, & Whiston, 1997).
In this "era" of accountability, concerns for service costs, intervention
effectiveness, and research supported "best practice" are the primary factor in
much clinical and administrative decision making. Thus, research, because of its
focus on outcome, is now a major factor in the real world "practice" of
Furthermore, the counseling process and outcome research has grown into an
undeniably reliable, valid, and necessary source of clinical practice knowledge.
There is no question that much of the early research was irrelevant to practice.
It was conducted on isolated issues in settings with little connection to the
complex world of the practitioner (e. g. with Psychology 101 students). This
research produced contradictory evidence, the presentation of which was most
often followed by the caveat, "...our results show that more research needs to
be done in this area." However, as one would expect, the methods of clinical
research have evolved to the point such that many of the early problems of
clinical relevance are no longer of concern. Today there is a large and ever
increasing body of applicable and relevant research that is now an invaluable
source of guidance for both the general practice of counseling and the
application of counseling to specific problems and populations (Sexton, 1997).
In fact, the research evidence has become so reliable that the term "best
practices" is now defined as approaches to counseling practice that have
empirical evidence to support their effectiveness.
Regardless of one's position in regard to the "art vs. science" or "research
vs. practice" debate, it seems clear that evidence-based counseling practice is
the future of both the preparation of counselors and the practice of
professional counseling. The integration of research into practice through an
evidence-based approach to counseling actually brings the best elements of
practice, clinical experience, and reliable treatment protocols together to
serve the task of helping clients with the complex problems they bring to
counseling. What follows are a number of the broad implications for both the
preparation of counselors and the practice of counseling.
IMPLICATIONS OF EVIDENCE-BASED COUNSELING PRACTICE
specific implications of the accumulated body of research on counseling
practices are well beyond the scope of this article (see references for further
sources). Research has clearly established the efficacy of individual, group,
and family counseling for a variety of presenting client concerns (Sexton,
Whiston, Bleuer, & Walz, 1997). More important for practice, research now
points to a number of very stable trends that support the efficacy of some
practices of counseling over others, the differential value of some aspects of
counseling over others, and effectiveness of matching certain client problems
with specific counseling models (Sexton et. al, 1997). These trends inform
counseling practice and preparation and form the basis of an evidence-based
model of counseling.
These broad trends can be categorized in two domains each with significant
implications for the general practice of counseling: findings about clinical
models and findings about the counselor. There has been considerable attention
to determining the most valuable clinical models. While counseling is, in most
cases, effective, there is no "best" theoretical approach. The outcome research
evidence has repeatedly found that theoretical orientation is not a major factor
in the outcome of counseling. Instead, the research points to a set of "common
factors" that seem to be part of effective counseling regardless of counselor,
client, or theoretical orientation. According to Lambert (1991) approximately
30% of outcome is attributable to common factors evident in all therapies
regardless of theory. Of the remaining variance, 40% is attributable to factors
outside of counseling, another 15% to client expectation, and the final 15% to
specific psychological techniques. Most of the current theoretical descriptions
of these common factors point to broad areas of: (1) the supportive value of a
collaborative counseling relationship (Sexton & Whiston, 1994); (2) the
value of learning (through affective experiencing, corrective emotional
experiences, and skills acquisition); and (3) action (through behavior change,
successful experiences, behavioral regulation, and mastery).
While specific theoretical models do not seem important to positive outcomes,
evidence-based counseling intervention protocols are differentially effective
with the client problems they were developed to help. These protocols are
systematic intervention models, usually manual-based, with an extensive
collection of efficacy and effectiveness research in multiple settings, with
diverse client groups, across various counselors, that produce clinically
significant results both in controlled labs and community settings that last for
long periods of time (Sexton, et al., 1997). Called Empirically Supported
Treatments (EST), such protocols are available for many individual problems
(anxiety disorders, depression, etc.) and family problems (see discussion of
Functional Family Therapy in Alexander, Sexton, & Robbins, in press). While
the professional and conceptual issues surrounding empirically supported
treatments are considerable and the criteria likely to evolve, they are a
valuable resource for practicing counselors when faced with certain client
problems. EST's also point the way for the future of counseling providing a
glimpse into evidence-based counseling practice. As a result, these protocols
will need to become a central component of the clinical portion of future
counselor education curricula.
A second major domain of counseling research that informs evidence-based
counseling practice, focuses on the counselor. The counselor is probably the
most studied "object" in our research history. Much of that effort has been
guided by a desire to understand how to train successful and effective
counselors. From all these efforts we have, however, yet to discover the
prototypic effective counselor. In fact, much of what we have discovered is that
many of our historic beliefs about the importance of counselor characteristics
do not seem to have research support. For example, the current evidence suggests
that, all other things being equal, demographic factors (race, gender, age,
cultural background), professional identity (counseling vs. psychology vs.
social work), and even professional experience (defined as years of practice)
are unrelated to counseling outcome. Matching of clients and counselors on these
dimensions (e. g. like race counselor and client working together) does not
result in increased efficacy. Furthermore, the old adage, "counselor know thy
self" does not seem to hold true. There is currently no systematic research that
would suggest that counselors improve their work by receiving personal therapy,
becoming more self aware, or learning about themselves (Sexton et al., 1997).
What do seem to be important counselor contributions to effective counseling
are a level of skillfulness (defined as competence rather than experience),
cognitive complexity (ability to think diversely and complexly about cases), and
ability to relate and relationally match with the clients with whom they are
working (see Whiston & Coker, in press). In addition, it is essential that
counselors have the knowledge and ability to assess the presenting "problems" of
the client so they can identify the appropriate evidence-based protocols and
competently apply those protocols in order to increase the likelihood of
successful intervention. The implications of these research trends are dramatic
in regard to counselor education. For example, they suggest redirecting efforts
from personal awareness to building cognitive complexity and increasing the
knowledge of and ability to apply evidence-based counseling protocols.
EVIDENCE-BASED COUNSELING AS THE FUTURE OF PROFESSIONAL
Evidence-based practice has the opportunity to move the
profession of counseling out of its theoretical boxes and historical beliefs
into an era of integrated practice in which counselors use the best of available
science combined with clinical experience to successfully help a wide variety of
clients. Evidence-based practices can provide a source of clinical knowledge
that can increase a counselor's effectiveness with clients, become a basis of
professional education and counselor development, and serve as a unifying force
for the profession that will set the agenda for the next evolution of
Alexander, J. F., Sexton, T. L., & Robbins,
M. A. (in press). The developmental status of family therapy in family
psychology intervention science. In H. A. Liddle, Family Psychology Intervention
Science. American Psychological Association Press: Washington, D. C. Lambert, M.
J. (1991). Introduction to psychotherapy research. In L. E. Beutler, & M.
Crago (Eds.), Psychotherapy Research: An international review of programmatic
studies (pp. 1-23). Washington DC: American Psychological Association.
Sexton, T. L. (1996). The relevance of counseling outcome research: Current
trends and practical implications. Journal of Counseling and Development, 74,
Sexton, T. L., & Whiston, S. C. (1994). The status of the counseling
relationship: An empirical review, theoretical implications, and research
directions. The Counseling Psychologist, 22(1), 6-78.
Sexton, T. L., Schofield, T. L., & Whiston, S. C. (1997). Evidence-based
practice: A pragmatic model to unify counseling. Counseling and Human
Development, 30(3). Love Publishing: Denver CO.
Sexton, T. L., Whiston, S. C., Bleuer, J. C., & Walz, G. R., (1997).
Integrating outcome research into counseling practice and training. American
Counseling Association: Alexandria. VA.
Whiston, S. C., & Coker, J. K. (in press). Reconstructing clinical
training: Implications from research. Counselor Education and Supervision.