Practice Review: Psychotherapy

This is an open invitation for authors to submit what Charlie Gelso developed and termed a Practice Review for possible publication in Psychotherapy. I want to continue this series as a step toward enhancing the value and relevance of scientific research on psychotherapy and related processes to practice.

The general aim of the Practice Review is to clarify, as much as the current state of knowledge permits, what empirically-derived findings in a given area imply for practice in that and related areas. In this type of review article, the reviewer begins the process with the intent of deriving implications for practice from the research and theory that is examined.

Much like program evaluation research, the central question for the writer of a Practice Review may be phrased as: "Despite the near inevitability of at least somewhat mixed findings on virtually any topic, what is the most likely relationship between these variables, and what does that relationship imply for the practitioner?"

The above kind of question is based on an awareness that the practitioner must do his or her practice, despite the general lack of fully consistent research findings; and it will be useful in that practice if the best available knowledge were used. This, of course, is not to say that the reviewer may take a cavalier attitude toward drawing implications for practice. The reviewer needs to derive such implications with great care.

At the same time, the Practice Review does not convey the same degree of scientific skepticism that is typical of the classical scholarly review. For example, in the traditional scholarly review, as in classical scholarly inquiry in general, one takes a very conservative attitude toward accepting results. Substantial evidence must accumulate before we may safely say a given finding is confirmed and valid. In the Practice Review, on the other hand, the investigator searches for the most likely conclusion, when all evidence is weighed, and then seeks to place that conclusion within the context of practice.

The process of relating a "most likely conclusion" or finding to practice is rarely if ever a straightforward or linear process. As but one example, the most likely conclusions about the role of duration of treatment in outcome is that, other things being equal, the longer the therapy (at least up to a certain point), the more positive the outcomes.

What implications does this have for the practitioner? For implications to be drawn, this finding needs to be placed within the context of related findings, existing theory, and other factors (e.g., pragmatic ones) that help the practitioner conceptualize duration factors in his or her practice. Placing findings within contexts such as these may well modify the findings.

With these considerations in mind, the following guidelines are offered for those who write Practice Reviews:

  • Your set from the beginning should be to find out what are the most likely conclusions about the relationships under investigation.
  • In doing so, consider how particular findings may be integrated with related findings in your area of review.
  • Once the most likely conclusions are arrived at and placed in the context of related knowledge, discuss what these findings imply for the practitioner.
  • In relating findings to practice, show an appreciation of the likelihood that the findings-to-practice links will not be direct and clear cut. Rather, given findings ("facts") may relate to practice through their connection to theories, clinical wisdom, practical and political concerns, etc.
  • Although the refrain, "more research is needed," is virtually always valid, the practice review must not hide behind scientific equivocation. Rather, the approach ought to be that, although more research is surely needed, here is our best available knowledge and what it implies for practice.

Although the length of practice reviews should be dictated by the subject matter, such reviews generally should be limited to about 25 pages of text. Reviews of relatively narrow topics should naturally be much briefer.

Authors are invited to email me if they are considering writing such a review but have questions about the process.