Castonguay, L., Barkham, M., Lutz, W., & McAleavey, A. (2013). Practice-oriented research: Approaches and applications. In M.E. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, 6th Edition (pp. 85-133). New York: Wiley.
In this chapter of the Handbook, Castonguay and colleagues (2013) review research methods and results associated with practice research networks (PRN). There is substantial evidence to show that psychotherapists often are not influenced by research findings when they prepare their case formulations and conduct interventions. As a result, clients may not be benefiting fully from nearly 60 years of research in psychotherapy methods and processes. There may be several explanations for this divide. Clinicians may perceive psychotherapy research, especially the emphasis on empirically supported treatments, as limited in its clinical relevance. Researchers may pay limited attention to concerns of clinicians when developing research strategies and treatment manuals. The end result is that clinicians feel disenfranchised from the research field, and therefore unaffected by the findings. Clinicians may pay more attention to psychotherapy research if they were more involved and “owned” the research and findings. One solution is to develop PRN based on a partnership of practitioners and researchers in which they collaborate on all aspects of a study; i.e., generation of ideas, implementation, and publication. Castonguay and colleagues (2013) report on the research generated by several PRNs in the U.S. The American Psychiatric Institute for Research and Education’s PRN (APIRE-PRN) conducted several studies including: one study that found that compared to White patients, African Americans were less likely to be prescribed second generation antipsychotic medications, which are considered to be the treatment of choice by psychiatrists; and a second study that reported that presence of a personality disorder, low Global Assessment of Functioning scores, and seeing a psychiatrist at a discounted fee was associated with treatment non-compliance. The Pennsylvania Psychological Association PRN (PPA-PRN) conducted several studies, including one study that found that better patient outcomes were associated with: higher expectancy for change among clients, lower client interpersonal problems, greater number of therapy sessions, and lower therapist case load. A second PPA-PRN study that I reported in my August 2013 Blog found that therapist efforts to foster client awareness of their emotions, thoughts, and behaviors were perceived as particularly helpful by both clients and therapists. Finally, the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted several studies with the intent of bringing drug abuse researchers into the real world and creating opportunities for clinicians to participate in research. This network completed over 50 trials. For example, in one trial, researchers found evidence for better retention, treatment engagement, and family functioning for brief strategic family therapy compared to treatment as usual.
A qualitative study reported by Castonguay and colleagues (2010) indicated that clinician involvement in PRN research fostered new learning as well as a sense of community with other professionals with shared goals. Therapists also indicated that their clients perceived their research participation as intrinsically meaningful and an opportunity to contribute to scientific knowledge. However, participating in a PRN had its challenges as well. Clinicians had to remember detailed procedures, at times practitioners had to depart from their clinical routine, and clinicians had to find time to complete questionnaires and other procedures. Castonguay and colleagues (2010) recommended that practice based research procedures in a PRN remain simple and clear, that clinicians have to have ready access to research staff for consultations, and that incentives have to be built in for clients and clinicians to participate. Studies in which research goals and clinical goals are indistinguishable are most likely to succeed.