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为何许多临床心理学家抵制循证实践:根本原因和建设性的补救措施。

Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies.

机构信息

Department of Psychology, Emory University, Atlanta, GA 30322, United States.

出版信息

Clin Psychol Rev. 2013 Nov;33(7):883-900. doi: 10.1016/j.cpr.2012.09.008. Epub 2013 Apr 8.

Abstract

Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist-practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP.

摘要

心理治疗师们被教导,当客户反复表达抵触情绪时,他们必须理解并解决其潜在的根源。然而,循证实践(EBP)的支持者却经常忽略了许多临床心理学家对将科学证据用于指导临床实践的保留意见的根本原因。因此,许多人对 EBP 的抵制仍然存在,这可能会进一步扩大科学家与实践者之间已经存在的巨大差距。在对心理学家对 EBP 的态度的调查数据进行审查之后,我们研究了临床心理学和相关领域中抵制 EBP 的六个根源:(a)天真现实主义,它可能导致临床医生错误地认为客户的变化是由于干预本身,而不是由于众多相互竞争的解释;(b)对人性的根深蒂固的误解(例如,对早期经验因果优先性的错误信念),这可能会阻碍基于证据的治疗方法的采用;(c)对个体应用群体概率的统计误解;(d)错误地将举证责任归咎于怀疑论者而不是未经检验的治疗方法的支持者;(e)对 EBP 所包含的内容的广泛误解;以及(f)实际的、教育方面的和态度方面的障碍,例如许多从业者对评估日益复杂的心理治疗结果文献感到不适。我们提出了一些教育建议,以向即将到来的临床从业者和研究人员阐明 EBP 的重要性,并提出了一些建设性的补救措施,以解决临床心理学家对 EBP 的反对意见。

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