In Reply: The sentence quoted by Dr. Puryear should have read, "When the board … issued its directive that we provide only treatments that are proven to work."
I do not assume that ineffectiveness is synonymous with lack of evidence. Indeed, the "common factors" model suggests that a very large proportion of psychotherapy outcomes can be attributed to factors common among clinicians, not technique. The problem is that payers and the public want evidence in the form of demonstrable outcomes from treatments that can be replicated for predictable costs. The challenge to providers is to prove that their treatments are effective regardless of how they are delivered. Fully implementing evidence-based treatments is just one way to do so.
In an article in the June 2003 edition of Behavioral Healthcare Tomorrow, I argue that an alternative use for evidence-based treatments is to accept the outcomes they yield as a "gold standard." Providers would then compare their clinical outcomes with those demonstrated by evidence-based treatments without regard to how the treatment was rendered. In doing so, providers could prove that their treatments are clinically equivalent to evidence-based treatments for similar populations. A unique contribution of using evidence-based treatments is that they provide control over the process—and therefore the cost—but if clinicians monitor cost as well as outcome, they are often able to show financial equivalence as well. This alternative allows clinicians to practice however they please but still demonstrate the effectiveness and efficiency of their treatments compared with an external standard.