Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track.

Waller, G., & Turner, H. (2015).

Behaviour Research and Therapy, 77, 129–137.

https://doi.org/10.1016/j.brat.2015.12.005

Abstract

Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.

Highlights

• We consider the recent evidence that therapist drift is a common phenomenon in psychological therapies.

• We consider the reasons that therapist drift takes place.

• A cognitive-behavioural approach to overcoming therapist drift is outlined.

Here are some thoughts:

Therapist drift is when clinicians fail to deliver evidence-based treatments effectively, despite having the training and resources to do so.  This drift can occur consciously or unconsciously and results in patients receiving suboptimal care, reducing their chances of recovery.  Factors contributing to therapist drift include the therapist's knowledge, beliefs, emotions, personality, behaviors, and social environment.  Research indicates that therapist drift is a significant issue in delivering cognitive-behavioral therapy (CBT).  To address therapist drift, strategies incorporating a cognitive-behavioral approach may be beneficial, targeting the beliefs, emotions, and behaviors that lead therapists away from evidence-based practices. 

Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track

Glenn Waller and Hannah Turner
Behaviour Research and Therapy
Available online 15 December 2015

Abstract

Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviors and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioral approach for therapists that addresses the cognitions, emotions and behaviors that drive and maintain our avoidance of evidence-based treatments.

The research is here.

Looking for Evidence That Therapy Works

By Harriet Brown
The New York Times
Originally posted on March 25, 2013

Mental-health care has come a long way since the remedy of choice was trepanation — drilling holes into the skull to release “evil spirits.” Over the last 30 years, treatments like cognitive-behavioral therapy, dialectical behavior therapy and family-based treatment have been shown effective for ailments ranging from anxiety and depression to post-traumatic stress disorder and eating disorders.

The trouble is, surprisingly few patients actually get these kinds of evidence-based treatments once they land on the couch — especially not cognitive behavioral therapy. In 2009, a meta-analysis conducted by leading mental-health researchers found that psychiatric patients in the United States and Britain rarely receive C.B.T., despite numerous trials demonstrating its effectiveness in treating common disorders. One survey of nearly 2,300 psychologists in the United States found that 69 percent used C.B.T. only part time or in combination with other therapies to treat depression and anxiety.

C.B.T. refers to a number of structured, directive types of psychotherapy that focus on the thoughts behind a patient’s feelings and that often include exposure therapy and other activities.
Instead, many patients are subjected to a kind of dim-sum approach — a little of this, a little of that, much of it derived more from the therapist’s biases and training than from the latest research findings. And even professionals who claim to use evidence-based treatments rarely do. The problem is called “therapist drift.”

The entire story is here.