Thursday, June 12, 2008

Evidence Based Practice

"Evidence-Based Medicine" is a popular term these days. But it has a dark side, doesn't it? If this is a new idea, what on earth were doctors basing their decisions on before? It reminds me of a Chris Rock routine (which I have only had related to me, I have never seen it) where a father responds to criticism about his drug use and petty crimes with "Well, I take care of my children!". To which Rock says: "Aren't you supposed to take care of your children?"

Finally, it seems the evidence-based approach is wending its way through psychological circles. Not to be too snarky about it, but why now and not 10 years ago?

I hope the answer is that the high water mark of "the chemical hypothesis" has passed. The idea that behavior and emotion is determined by linear chemical processes is silly. Yet a lot of people went to the bank on that one. I think that soon it will be quite clear that a straight line from flawed gene to screwy neurochemical to maladjusted thought to an unwanted behavior does not exist. It was at best simple-minded and at worst profoundly cynical and self-serving.

But people suffer, and suffer greatly. And there is a role for medication. But psychological problems are primarily social problems and require social solutions.

Here is very interesting, modest, and clear step in that direction: a manual for evidence-based practices in children's psychology.

Page nine has the criteria. Page 11 begins with "anxious and avoidant behaviors". Take a few minutes to read through it. It is a good place to start. This has some seeds of thought for adult treatment as well.

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