Wednesday, August 20, 2008

The Practical Realities of Evidence Based Practice

I wanted to write a quick post demonstrating how often the concept of evidence based practice is explored in the literature . . . even when it is not referred to as evidence based practice. The reality is, any time you see an article that refers to the effectiveness of a certain intervention, program, or agency, you are reading about evidence based practice. Simply put, evidence based practice is applying research to intervention, program, agency, etc in an attempt to examine whether or not what is being done is actually working.

Think about it, how many of you have worked at an agency, or even a store in the mall, when you were told what to do without any explanation as to why you are doing it, or how what you are doing is benefitting the desired end result. . . probably not very often. However, with the advent of the concept of evidence based practice, research is providing the practitioner the ability to examine the hows, whens, wheres, and whys of what they are doing. Check out the following links to read some examples.

Evaluating Therapeuting Effectiveness in Counseling and Psychotherapy

The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up.

Behavior Modification in the Treatment of Obesity

51 comments:

jefN said...

Indeed, some research has even suggested that counsellors in training and newly-qualified counsellors are more effective than their more experienced peers!
--I wonder if that is because the older one gets the more settled and set in their ways they become, as opposed to the fresh therapist who is not convinced that he/she knows everything.
--And as for the anorexia and CBT, how much is some? (with some sustained benefit over a one year period)
---I suspect that we will see more people presenting because of obesity due to the state imposing a $25 a month increase to those employees who are obese. How is that defined, I wonder?

ojwashington said...

Re: Behavior Modification in the Treatment of Obesity

I found the research of the effectiveness of behavior modification and conventional group psychotherapy interventions pertaining to obesity and weight loss interesting. I have always been amazed by all the weight loss programs, diets, herbs, and surgeries that people often use to lose weight. I have often wondered how people actually know if they are going get the desired results when they participate in particular programs because not all diets and weight loss programs are going to work for everyone since people are unique and have different lifestyles. I would be interested to see what research has been done to show the effectiveness of the Nutra System Diet, and if we are sold the image through the middle aged woman who lost fifty pounds and now is the trophy house wife. This article really allowed me to see research outside of the parameters of being in our Social Work Evaluation class because it allows for research of the effectiveness of interventions affecting numerous people in our society. This article also allowed me to draw a parallel between the numerous weight loss programs which are not effective to the interventions we commonly use in practice that are not effective for our clients. We must always use research to determine whether the interventions that we not only use for ourselves, but provide to our clients, are the most effective interventions that are available.

Sara said...

Since I am interested in working with youth and adolescents with eating disorders I found these studies on anorexia and other eating disorders to be interesting. As I was reading I started to think to myself “why aren’t there more long term studies done on patients with eating disorders”? I don’t have the answer, but it is an interesting thing to think about. I would like to see more qualitative research done on patients with eating disorders. Most of the articles and studies I have read are quantitative studies done to evaluate the best treatment. If researchers did qualitative studies on the participant’s maybe they could observe different behaviors and come up with new answers. Some of the research articles I read on the blog focused on the level of depression the patients were experiencing. This made me think about CBT and the effect it could have on patients with eating disorders. Most people who have eating disorders are type A personality, strive to be perfect in everything, and feel like they have lost control in their lives, therefore they control what they eat. Many people with eating disorders also suffer from obsessive compulsive disorder and a distorted body image. CBT has been researched on patients with OCD and has been proven to work, and now CBT techniques are being evaluated as a means of treatment for patients with eating disorders. I believe that more research will prove that it is a very effective treatment for patients with anorexia and other eating disorders.

Sara S. (Tuscaloosa)

drcraft said...

I share the same with Jeff regarding the research that had suggested that counselors that are in training or newly qualified are more effective than the more experienced-Jefn questioned,as I also wondered was it partly due to the older ones maybe settling in to the same treatment/routine each time and remaining there while the more newly qualified counselors remain more open to different approaches and willing to try whichever will fit the client yet even while lacking in experience. In regards to Behavior modification and conventional group psychotherapy interventions and the research effectiveness of these pertaining to obesity and weight loss were very informative and interesting.I found the primary objective of developing self control from eating and weight loss was a consequence with reinforcements provided for self control an enlightenment. Now I know to monitor when I eat and particularly to try the pound of suet-cut placed in a bag to add or remove some fat from the bag depending on the fluctuation of adding or shedding weight.I feel praise is key following a target reached-even more motivation than prizes. Effectively evaluating the programs we are own whether they are the most effective and researching the most effective plans and treatments for our clients will be ongoing. Great to know Behavior Modification is effective in the treatment of Obesity.

drcraft said...

I share the same concern with jefn regarding the research suggesting that the counselors newly qualified are more effective than their more experienced peers; could it partly be because of the more experienced -maybe they are in a routine of using certain treatment methods and plans whereas the counselors in trainging are still eagerly searching for the most effective approach and are willing to try the ones to eventually utilize the most available and effective. In addressing Behavior Modification in the Tx of Obesity, the effectiveness of the research that it was more effective in treating obesity was very enlightning. I particularly was interested that the primary objective was developing self control from eating and then wt. loss was a consequence. Reinforcements were provided for control which I find praise to be the key to reinforcement rather than prizes. The pound of suet-cut and placed in a bag in fridge was a great way to visualize weight shed or gained by removing an ounce or adding it. When the goal is reached and the bag would be empty would be all of the encouragement I would need. To actually visualize the amount of weight lost in comparison to the empty bag would in itself be rewarding.This was informative that Behavior modification was more effective in Tx of Obesity.These different articles will allow me to see Research "outside the box"and the
times it is being used but had not been termed that.

Anonymous said...

I was not surprised that the individuals that were part of the behavior modification group lost more weight than the control group. Reason being is the fact that the behavior modification group as stated in the article had activities of exercise period, preparation and eating of a low calorie diet and group therapy. While the control group received supportive psychotherapy, instruction about dieting and nutrition.
I feel that the behavior modification group was lead through the program with hands on treatment and the control group was provided with ok here is what you need to do to lose weight, now do it.
We all know what we need to do to lose weight, but if we are to be held accountable by others we will usually do better with the weight loss.
From a personal stand point, I have kept a daily journal before of my food intake. Once I started writing it down, I became more aware of my food choices and I started to work on my eating habits (that was awhile back - I need to get back to daily journal).
This was a great article and I was able to follow it and comprehend what the study was about.
S. Luck

Anonymous said...

In response to jefn, I am currently employed with the health dept and we have already started the program if you smoke you pay extra money each month for your insurance. With the new program they are looking at for obesity they will use the Body Mass Index (BMI) as a guide. If I am not mistaken the BMI has been set at 35. If your BMI is over the 35, you will have to pay the extra per month for insurance. I understand why most of the states are going to the extra fee on insurance for obesity, due to obesity has been linked to other health problems such as diabetes, high blood pressure, etc. I am personally just barely under the BMI that has been set, so I will have to make the decision to exercise more and eat better vs. paying more per month for insurance. Is the new guidelines enough to cause me to change my lifestyle, we shall see. S. Luck

Kristie said...

Overall effectiveness vs. individual effectiveness of counseling was ver interesting. The article states that individual counselors play a vital role in the quality of counseling. It would be interesting to see some research regarding therapeutic interventions and their individual and overall effectiveness as well. I am wondering if the difference in individual councelors can be attributed to a difference in interventions.
Kristie R

scarlett holt said...

In response to jefn...
Yes, research has suggested that new counselors are more effective than their experienced peers, and this could be due to seasoned therapist being set in their ways, or perhaps burn-out is an issue,or even a combination of the two. I agree that the new therapist is likely to be more open to suggestion/observation of others with more experience in order to gain confidence and information from those who have been in practice.
Regarding the anorexia nervousa clients/CBT,I asked the same question aloud... will someone define "some?"
I am not familiar with the imposed increase to employees who are obese...
Scarlett H.

Stacy said...

I don't know where in the world this information regarding the effectiveness of counseling and psychotherapy comes from using an evidenced based perspective. I only say that because, while what is stated makes perfect sense to me, I don't understand how the exact information was gathered. Also, this reading is a good example of how certain research questions can be very hard to answer. Since every individual is different and reacts to therapy differently, not to mention that everyone has different issues in the first place, how can effectiveness really be measured. I mean what works well for one person may not work at all for another, which is why I liked the bit about the importance of the patient/counselor relationship. I just scrolled down and read some input from my fellow classmates and noticed that you all were responding to obesity and weight loss and I did not read about that; however, forgive me for not knowing the system enough yet (Josh:) because I am entering my statements here for now.

Sara said...

In response to ojwashington's blog

Like ojwashington, I also found these articles to be interesting and was amazed by all the products and programs available for overweight individuals. As I was reading ojwashington’s blog I also began thinking about what kind of research has been done on the particular programs like weight watchers and nutria-system. I also thought about all the medications advertised that are supposed to “help you lose weight”. None of these drugs are FDA approved and can be dangerous. Maybe there should be a research study done on non-FDA approved research drugs so that people who are taking them can see how effective they are and if they are even safe to use.

Sara S.

S.Ray said...

According to Dr. Greg Mulhauser research evidence about the effectiveness of counseling is that “counseling does work.” The article gives several examples of findings that were a result of subjective and objective conclusions. The article stated that no specific therapy was found to be more effective however individual counselors were found to be effective. This effectiveness was defined by client relationships. I found the information regarding relationships between individual clients and counselors to be remarkable. The article mentioned that 40% of therapeutic change was a result of clients’ commitment to a particular therapy. In turn this commitment was directly linked to the connection between the client and therapist. The evidence indicated that the most important influences of therapeutic outcomes is the relationship between the client and therapist; not necessarily the qualifications of the therapist. As social workers, we have learned that client satisfaction is not an indication of program effectiveness. It appears that client satisfaction with the therapeutic relationship is something the research takes into account. There are numerous variables that could account for the conclusions of this research. Is the therapeutic relationship the most influential factor in client success in every outcome? This is certainly a very subjective analysis. What particular data was analyzed and how was the data analyzed to indicate the conclusion regarding client/therapist relationship? How were the client “subjects” comparable and what constituted a successful outcome? This article left me asking more questions than it answered. Suzanne R.

Anonymous said...

I agree with a lot of what my fellow students have already said. I too was not surprised that patients with behavior modification. I have always heard that you have to learn to react differently to food, emotions, exercise to loose weight if you are significantly overweight. I know this may only apply to some people. I also wondered about the length of the study-3mos. I would like to see a longer study like the 1 year one by Stuart. I was also not surprised by the results because the behavioral modification group included exercise and group support. Group support with almost all addictions has shown to have some improvement.
The difference between the therapists experience was interesting. I have seen in my work experience (Addictions) newer therapists be able to help people others could not. But I think records and other exercises helped too. The fact that a woman related her anger to her desire to eat for the first time in her life is huge. I have had clients with serious eating disorders so this article was very interesting to me. Donna A

Anonymous said...

In response to JefN and several others about the effectiveness or ineffectiveness of counselors, I have to say that I have seen both aspects from personal experience. I have seen career counselors be extremely effective with their clients as well as being ineffective. Do I think that burnout can affect therapists, YES; burnout can have a huge effect. I have seen therapists who need to step back and take a break so that they do not harm their patients. I have also seen seasoned therapists, who have in my opinion, created an adverse environment for their clients. Some have not had the necessary training to provide for their clients. Do some clients respond to certain therapists and not others, yes that happens. Any good therapist will acknowledge this and will step aside to find a therapist for their client that they can form the appropriate therapist/client bond. For therapy to be effective, I truly believe that the individual needs to be comfortable with their therapist and be able to address the issues that they have in their lives. While most of my experiences have involved children and adolescents, as a result their parents/caregivers have been a factor. Sometimes these parents may not agree with what is going on with their child, but as one mother that I worked with said, I am willing to deal with certain things, if it benefits my child. Therapy is not going to be effective no matter what kind of intervention, therapist, medication, etc., is put in place unless the client is willing to work toward their problems.
S.Williams

Anonymous said...

In response to JefN and several others about the effectiveness or ineffectiveness of counselors, I have to say that I have seen both aspects from personal experience. I have seen career counselors be extremely effective with their clients as well as being ineffective. Do I think that burnout can affect therapists, YES; burnout can have a huge effect. I have seen therapists who need to step back and take a break so that they do not harm their patients. I have also seen seasoned therapists, who have in my opinion, created an adverse environment for their clients. Some have not had the necessary training to provide for their clients. Do some clients respond to certain therapists and not others, yes that happens. Any good therapist will acknowledge this and will step aside to find a therapist for their client that they can form the appropriate therapist/client bond. For therapy to be effective, I truly believe that the individual needs to be comfortable with their therapist and be able to address the issues that they have in their lives. While most of my experiences have involved children and adolescents, as a result their parents/caregivers have been a factor. Sometimes these parents may not agree with what is going on with their child, but as one mother that I worked with said, I am willing to deal with certain things, if it benefits my child. Therapy is not going to be effective no matter what kind of intervention, therapist, medication, etc., is put in place unless the client is willing to work toward their problems.
S.Williams

R.A.Montgomery said...

Evaluating Therapeutic Effectiveness in Counselling And Psychotherapy

I found this article interesting but It appeared to contradict itself on some points, or state a fairly valid point of interest and then preceed to tell whey that point may or may not be valid. However, I found some of the information valuable. On occasion I would reminisce about my past counseling sessions and I could see what I did wrong and what I did right for my consumers.

The “What Effectiveness Research Might Mean for Clients” paragraph stated that,
“Virtually all relevant empirical studies agree that clients benefit more when they are committed to working within the therapeutic approach offered in their particular counselling environment.” I also feel that a client or consumer must at some point believe that the treatment modality or type of counseling can be successful. However, the conselor must believe that the treatment modality or type of counseling can help their client or consumer. How can you convince someone else if you are not convinced yourself. However, I did get the point the auther was attempting to make. Therapy should be based in qualitative and quantitative data and Counselors should based their counseling techniques on reasearch and skills learned.

R.A. Montgomery

R.A.Montgomery said...

Evaluating Therapeutic Effectiveness in Counselling And Psychotherapy

I found this article interesting but It appeared to contradict itself on some points, or state a fairly valid point of interest and then preceed to tell whey that point may or may not be valid. However, I found some of the information valuable. On occasion I would reminisce about my past counseling sessions and I could see what I did wrong and what I did right for my consumers.

The “What Effectiveness Research Might Mean for Clients” paragraph stated that,
“Virtually all relevant empirical studies agree that clients benefit more when they are committed to working within the therapeutic approach offered in their particular counselling environment.” I also feel that a client or consumer must at some point believe that the treatment modality or type of counseling can be successful. However, the conselor must believe that the treatment modality or type of counseling can help their client or consumer. How can you convince someone else if you are not convinced yourself. However, I did get the point the auther was attempting to make. Therapy should be based in qualitative and quantitative data and Counselors should based their counseling techniques on reasearch and skills learned.

R.A. Montgomery


Hi! I'm glad to be in this class although I don't ...
Wednesday, August 27, 2008, 3:33:00 PM | noreply@blogger.com (bekkah_s)
Rebekkah S. I fell the same way but this is difficult for me since I have never used a blog before. I feel limited at this point.
RA Montgomery.

Indeed, some research has even suggested that coun...
Tuesday, August 26, 2008, 11:55:00 AM | noreply@blogger.com (jefN)

Indeed, some research has even suggested that counsellors in training and newly qualified counsellors are more effective than their more experienced peers!
--I wonder if that is because the older one gets the more settled and set in their ways they become, as opposed to the fresh therapist who is not convinced that he/she knows everything.

I was thinking the same thing. I feel that maybe someone new may more in willing to research a subject for new ideas because their knowledge base is limited. Whereas a more experienced counselor may be more prone to go with what they know has worked in the past.
R.A. Montgomery

Anonymous said...

I found the article concerning Behavioral Modification and Obesity interesting. I have always known that for someone to be successful in their weight loss you needed to be aware of what and how you consume food along with exercise. Every day we are bombarded with ads proclaiming the success of the “newest” diet fad and the “research” proclaiming success. We have also seen the Weight Watcher’s ads that say that diets do not work but their program does. The more in-depth that I got in the article the more that I begin to think that the authors had a good idea in Behavioral Modification concerning weight loss. If you think about it, people associate food with a behavior, going out to eat as socialization, throwing a party to watch the ballgame, etc. For some food has become an outlet for different things including anger, frustration or other issues. I have attempted to loose weight several times but honestly, my motivation has not been in it. I wonder if I had been involved in this study would I have had lost weight, I do not know but reading the actual process and ideas that was used would have helped me and I just might use them in the future.
S. Williams

T M Morgan said...

I thought it was very interesting to read a researcher state that it was not so much the theoretical perspective a counselor followed, but the counselor's skills and their repoire with the client that made the most difference. A counselor friend of mine once told me that if you don't see an improvement after the first few sessions, you need to find a new counselor. I believe she was right. I think it is also important as the researcher mentioned that the client be on board with whatever framework they are using.

Anonymous said...

-original post-
Evaluating Therapeutic Effectiveness in Counseling and Psychotherapy:
I think many times our intuition and instincts are accurate and in a therapeutic relationship we can help someone if we use common sense. Many related disciplines to Social Work i.e. Counseling and Psychology, hold the view that the therapist is the most important tool in the counseling relationship. Hopefully the therapist is not actually a tool themselves. Instrument would be a more appropriate term. Often times a novice counselor might be successful on accident or by instinct. This is good in a way because there are some innate abilities that cannot be taught. The flip side is they are probably not going to know how to repeat the success they have blindly achieved. I agree with the author of the article that quality of the relationship established with therapist is the number one aspect in Tx.

“Perhaps the most defeatist approach is that there is just no point learning about various therapeutic approaches, given that none has ever demonstrated a clear overall advantage over others.”
In reference to the above statement, classically trained artists must first learn the basics before moving into the abstract realm. In other words, in the era of postmodernism one could paint realism like nobody’s business before they had success in non-representational work.
I feel the same applies when discussing counseling techniques. For example, I think it would serve the therapist well to learn and have a respect for psychoanalysis regardless whether we seek to adopt any of that method in practice or agree with it; if nothing else, because of it's historical importance.

The article makes an analogy between religion and one’s therapeutic approach and convincing someone another way might be just as or more effective. It is very much like a person growing up a member of a particular religious denomination. When that person is a child they are born into that school of thought; they grow and began to think for themselves. For some, truth is where they are. For others, they find what works down the road at a different church. Some choose not to think at all.
If we look at the some of the great theorists of our time, many started their careers adopting the method that was taught to them by their mentor. It was not until later they either revamped or adopted a new theory all together. Even as adults we are highly influenced by others. I like the fact that in the school of Social Work there is great diversity in personality, style, and theoretical orientation to learn from; with a focus on finding the evidence for ourselves.
-Matt G (Gadsden)

T M Morgan said...

I agree with Stacy about the health insurance reasoning. I get charged extra for being a smoker and have nothing to complain about because that is my choice. Why not charge obese people more if it truly is their choice? (In other words, exempt those who have an actual medical reason for being overweight.) We all make choices...if some of us have to pay, why not all?

Stu J. said...

Two comments in regards to the effectiveness of counseling and psychotherapy. I perceive the article highlights some of the difficulties of measuring counseling effectiveness across clients, between different therapists, and in different environments. Separately, last year working in a residential setting with adolescents, I experienced the difficulty of many in maintaining client records in the agency's database. I came across information about the State of Utah using Blackberry-like devices to update client records real-time and the system's ability to evaluate effectiveness of interchanges real-time. While I am certain there were many challenges with the system, it sounds like a helpful idea.

Stu J. said...

In reply to Kristie's posting, I felt the article made some useful points, but could have been more informative. Difficult topic to prove in my opinion.

Amy H. said...

After reading the article, Behavior Modification in the Treatment of Obesity, I realized as the rates of obesity in children and adults increase there is a need for continued research in this area. This article discussed some behavior modification techniques and their results. Those techniques asked of them included daily journaling of their food intake, surrounding environmental factors, exercises of counting mouthfuls of food and sitting the utensils down, and a reinforcement plan was devised. All these techniques appeared to have a positive outcome on weight loss efforts. I do think society continues to look for faster and more convenient ways in many aspects of their lives due to limited time. I think it is good that fast food resturants are allowing healthier food choices on their menus. This study was just one that indicated the need for more studies and the importance of behavior modification in the treatment of obesity. -Amy H.(Gadsden)

Amy H. said...

In response to S.Luck...I think that the higher insurance premiums in regard to BMI would be beneficial for some but for others unless it is a very large increase they would just pay the additional fees. At some places of employment they offer incentives for being within a healthy weight range. I think this would be a good step as you stated due to obesity being related to high blood pressure, diabetes, etc. These other health problems can lead to missed days at work and could eventually effect your overall performance. Also, I was not surprised that the individuals that were part of the behavior modification group lost more weight than the control group. I do think journaling your food intake helps a person see how much they are consuming and when. This exercise also makes a person slow down and think before they eat.

Karen P said...

Topic: Evaluating Therapeutic Effectiveness in Counseling and Psychotherapy
(Original Post)

I am not at all surprised by the ambiguity that results from evaluating the effectiveness of therapeutic practices. If we purposefully commit ourselves to becoming well-informed, competent social work practitioners, we will continuously seek to expand our knowledge base and expertise, which should in turn, produce practitioners that are not just competent, but creative and innovative towards obtaining positive therapeutic outcomes for the clients. We, as practitioners, have to be skilled at strategically evaluating the needs of our clients and determining an effective therapeutic intervention. I support the rationale denoted in the article that “doing what works” is not enough. We must research evidence-based practices (or empirical evidence) regarding our selected mode of intervention to ensure we are providing our clients with the best options for treatment that will yield the most beneficial outcome. Moreover, it is obvious that alternative approaches to a specific therapeutic strategy are sometimes necessary when a client no longer is benefiting from the therapeutic relationship or when the practitioner’s competence level is limited or impaired. Doing what is best for the client in this regard could involve making an appropriate referral to another practitioner with expertise is the specified area of concern.

Our primary responsibility is focusing on our client’s welfare and doing them no harm. In my opinion, being a responsible, competent, and ethical practitioner implies that one seeks to become a “master of his/her craft”. Practice standards, strategies, interventions, etc. should be researched, learned, applied, evaluated, challenged (if needed), and re-evaluated again to determine what works best for a given client’s situation. Each client has different values systems and identities and will respond either positively or negatively for a certain therapeutic intervention. Therefore, we must continuously explore empirical evidence and evidence-based practices that work, but also effectively determine what is working within the parameters of the therapeutic relationship between the client and practitioner (looking at both the subjective and objective evidence of effectiveness).

Karen P said...

Topic: Evaluating Therapeutic Effectiveness in Counseling and Psychotherapy
(Original Post)

I am not at all surprised by the ambiguity that results from evaluating the effectiveness of therapeutic practices. If we purposefully commit ourselves to becoming well-informed, competent social work practitioners, we will continuously seek to expand our knowledge base and expertise, which should in turn, produce practitioners that are not just competent, but creative and innovative towards obtaining positive therapeutic outcomes for the clients. We, as practitioners, have to be skilled at strategically evaluating the needs of our clients and determining an effective therapeutic intervention. I support the rationale denoted in the article that “doing what works” is not enough. We must research evidence-based practices (or empirical evidence) regarding our selected mode of intervention to ensure we are providing our clients with the best options for treatment that will yield the most beneficial outcome. Moreover, it is obvious that alternative approaches to a specific therapeutic strategy are sometimes necessary when a client no longer is benefiting from the therapeutic relationship or when the practitioner’s competence level is limited or impaired. Doing what is best for the client in this regard could involve making an appropriate referral to another practitioner with expertise is the specified area of concern.

Our primary responsibility is focusing on our client’s welfare and doing them no harm. In my opinion, being a responsible, competent, and ethical practitioner implies that one seeks to become a “master of his/her craft”. Practice standards, strategies, interventions, etc. should be researched, learned, applied, evaluated, challenged (if needed), and re-evaluated again to determine what works best for a given client’s situation. Each client has different values systems and identities and will respond either positively or negatively for a certain therapeutic intervention. Therefore, we must continuously explore empirical evidence and evidence-based practices that work, but also effectively determine what is working within the parameters of the therapeutic relationship between the client and practitioner (looking at both the subjective and objective evidence of effectiveness).

Karen P said...

Response Posting to Sara S. Comment:

Sara, I also feel that a more qualitative research design will provide a more enhanced perspective of the causes and/or recurrent patterns of behavior in patients with eating disorders. A qualitative design would allow the researcher more insight and clarity into the personal struggles one has and other underlying factors that contribute to eating disorders. CBT seems like a logical and potentially effective approach to address eating disorders, with its emphasis on awareness to certain adverse behavioral patterns, thought distortions, and corrective behaviors and strategies. I, as well, would like to see more research on this particular treatment modality for eating disorders. I really appreciated and enjoyed reading your comments.

Karen P. (Gadsden)

Anonymous said...

I found the "Effectiveness of Counseling" article to be very interesting, I partially agreed with some of the statements in the article or at least have an understanding of why they were stated. The article pointed out that the combination of medication and counseling at times can be a better treatment mode than counseling alone. I agreed with this statement and truly feel that there are circumstances that do require medication and behavior modification, diagnoses such as OCD or certain stages of depression. I also strongly agree with the statements referring to counseling effectiveness related to the client practitioner relationship. I think if the client doesn’t feel comfortable with the counselor very little progress can be made, as most likely the client will not open up to the them. I think that no matter what type of intervention is used, if you do not have confidence in your counselor, you will most likely not fully engage yourself in the intervention that they are recommending.
Heather M

Anonymous said...

I found the "Effectiveness of Counseling" article to be very interesting, I partially agreed with some of the statements in the article or at least have an understanding of why they were stated. The article pointed out that the combination of medication and counseling at times can be a better treatment mode than counseling alone. I agreed with this statement and truly feel that there are circumstances that do require medication and behavior modification, diagnoses such as OCD or certain stages of depression. I also strongly agree with the statements referring to counseling effectiveness related to the client practitioner relationship. I think if the client doesn’t feel comfortable with the counselor very little progress can be made, as most likely the client will not open up to the them. I think that no matter what type of intervention is used, if you do not have confidence in your counselor, you will most likely not fully engage yourself in the intervention that they are recommending.
Heather M

Anonymous said...

In response to Stacy L:
I think the BMI thing is interesting, but could we get into an area of discrimination? Some people are very successful at gaining weight, depending on several factors. Others have a higher metabolism etc… Could we see an employee come into the HR dept. with a disability letter from their GP stating the need for accommodations or to be excused?

I personally support the overall theory behind this movement. I happen to love exercise in the order of swim-bike-run. However, if my employer were to adopt a program such as this I would expect they provide: cardio equipment, weights, nautilus machines and a shower, or a voucher to a local fitness center. I would love to work-out on my lunch break, before or after work. When people exercise on a regular basis I think they are more productive in all areas of their life. This can be a win- win for everyone.

I agree with some of the other posts in that we are soon going to see other behaviors that come with a price in the workplace. An example of this is recreational hobbies that people enjoy that may be considered dangerous by insurance companies.
Matt G (gadsden)

Anonymous said...

In response to tm morgan:
Your comments provoke some thought. Out of curiosity, how does the company know an employee is a smoker? Where is the empirical evidence? Do they observe this habit or do they use a drug test to detect nicotine? Maybe it is on the honor system. Do you smoke…yes or no?
Are you allowed to wear a nicotine patch without penalty?
Matt G. (gadsden)

Anonymous said...

Re: Behavior Modification in the Treatment of Obesity

I look forward to future studies that address behavior modification in the treatment of obesity and reading the comments posted regarding this topic. It is remarkable of the amount of individuals that battle with some type of weight issue. Alabama state employees were notified of an increase with their health insurance, if considered obese. A $25 monthly charge will begin in 2010, if employees fall into a certain criteria. I was aware of this as a state employee, but it was within the past month that I have heard the media and others speak about it. I feel a monthly “fat tax” is not a solution, however, behavior modification might be.
joann

Anonymous said...

I really agreed with comments made by Jeff and Destin concerning the effectiveness of the newer therapist. I know at my last job a new therapist would hire in and be all excited and want to help everyone, and the older therapists would just laugh and say give her a year or two. It always made me think that maybe the older ones had forgotten what they were there for. Donna A

Anonymous said...

Conteria Williams, comment to Jeff post

I agree that the older or more seasoned counselors are sort of set in their ways and are not open minded to doing things different, as well as keeping updated on the new techniques that arise. But most certainly, the best way to be sure that one is doing their best when providing counseling is strictly through workshops and research, that will keep you updated with the current time.

In reference to obesity, I don't care how much the government may or may not be paying for individuals who are over weight. It is certainly not worth the gaining of the extra pounds nor the health issues that will eventually come along with it.

Anonymous said...

Conteria Williams original post

According to the article on disorders, I agree that an individual would show better results when combinding CBT and weight restoration. Through the use of both process, the individual will have somone not only telling them what they should do, but also working with them on a diet plan that will be suitable for their health, along with being logic enough that they can obtain their goal. It has been proven through research that Cognitive Behavior Therapy along with outpatient treatment has been affective.

Anonymous said...

I appreciate people, such as Sara S., who show interest regarding eating disorders with youth and adolescents. Eating disorders are a growing problem that needs more attention. It is affecting the youth and adolescent population in alarming numbers. It is important to find people who are dedicated to the prevention and treatment of eating disorders because it can affect any individual, regardless of age. joann

nikkig said...

In response to Joann and her thoughts on the "Fat Tax"

I was doing my internship when I got the email regarding the increase in premiums for overweight employees, and I remember thinking how serious the problem must be in order for the state to have concluded that it is necessary to raise premiums for overweight employees, and I was also amazed that they are being allowed to do so. I can't help but wonder about the discussion surrounding the issue and what must have been said with regard to ensuring that this change will not be considered discrminatory and the repurcussions that might follow. It's all very interesting to me.

nikkig said...

In repsonse to Jeff's inquiry about how obesity is defined by the State,

Since I'm finished with my internship I don't readily have access to my DHR email, but I do recall that it was specifically outlined in the memo that was sent out to State employees. I also recall chuckling at what constituted obesity I can tell you that much. Perhaps you could find more info about it if you look at the State DHR website, www.dhr.state.al.us. Just a thought.

nikkig said...

Evaluating Therapeutic Effectiveness in Counseling and Psychotherapy

I'm glad I checked out this site because it made me think about some of my past experiences with both effective and ineffective therapeutic interventions.
As I read the information, I found that two points stuck out for me:
*Counseling AND medication TOGETHER sometimes offer better results than when one is not paired with the other.
I could not agree more! This is not to say that they must always be paired, but I find so often that the families I work with allow their children to take medication with no regard for appropriate med management or other therapeutic intervention such as regular appointments with psychiatrists or psychologists.

*Clients feelings about the therapeutic process: Studies show that clients benefit more when they are committed to working within the therapeutic approach offered.
As I read this, I found myself thinking about how many times I've seen client who were only a month into service, and I knew that they were not going to benefit or show progress because they were not committed to improving their family system. The agency I work with uses a systems approach to therapy, and when it works it's wonderful. However, it never ceases to amaze me how easy it is for one system to blame another instead of examining their role in the dysfunction. It is so true that people have to want to work within the approach being offered to them.

ojwashington said...

Re: Amy H

I agree with you that there needs to be more research concerning the treatment of obesity. With the increased percentage of obesity in our nation I think it would be to our benefit to research new treatment methods and techniques to combat this issue.

chaunp said...

This was a very interesting article because I am that middle aged woman struggling with weight gain and control. Im not surprised by the behavior modification program being more effective. Many people who want to lose weight want to see results right away and sometimes get impatient with the process. The approach of using visual aids such as with the pound of suet-cut in the bag was a creative tool. It immediately allows you to see what you're actually carrying around on your body, and although a pound may not appear to be much loss at the time to actually see it being removed from the visual aid can be quite encouraging. I think the fact that people who participate in a group setting whether it is a control group or not will lose weight because of the fact that they are held accountable to the program and most people who volunteer for such an endeavor want to be successful especially when you are required to participate in a weigh in process with others observing. The fact that the less experienced researchers used more innovative techniques involving behavior modification in my opinion made the difference. Having to journal and take notice of stress factors, schedules, along with each individuals daily routine can affect how a person views dieting. I thought the assigned place to eat with the particular place setting also was a great idea. In my opinion this helps a person consciously observe their eating patterns and practices. The more traditional methods that the older therapist used may have some success but in the long run may not have lasting success. Anyone wanting to lose weight has to change their pattern of thinking and how they relate to food and identify those triggers that cause them to stress eat and to overeat. Very enlightening article.
chaunp

chaunp said...

I am in agreement with Stacey's comments. To be provided with hands on support, innovative techniques and acccountability in a group supportive setting is the key to being successful in weight control. I do agree that behavioral therapy is effective and another motivating factor which Jeff mentioned is the $25 dollars a month increase to state employees who are obese. It has definitely motivated me. :)

chaunp said...

Evaluating therapeutic effectiveness in counseling and Psychotherapy. The primary point that stood out in my mind concerning this article suggested that the client therapist relationship was contingent upon the effectiveness of how successful the therapeutic process will be. I do feel that if the relationship is good and there is full disclosure about the methods to be used there will be an increase in the success of the therapeutic process. The article was a little confusing to follow and I do feel that each individual should be assessed according to their unique personalities and situations. This appears to be the best way to choose a therapeutic model to utilize and more than one method may be necessary to reach the desired goals.

chaunp said...

In response to tm morgan's comment on Therapeutic effectivness. I do agree that the client/therapist relationship is the most important factor in the success of the therapeutic process.Regardless of the best possible model to use if the client does not have a well established rapport with the therapist it will be of little benefit in reaching the desired goals established and I agree that person should find a new therapist.

jefN gadsden said...

In response to TM Morgan: I agree that the client should be on board with you, when possible, but the client doesn't always know how to get where they want to go. I have never been asked what theoretical perspective I practice under, but I have had them say, "please, I need help, get me in anywhere."

Gina Smith said...

Comments to several classmates posts:

As a state employee that is looking at paying the extra money to BCBS for meeting their definition of obese, I have thought about ways to lose weight. And, honestly, that is about all that I have done...thought about it. I have been overweight since I was a child, possible around 5-6 years old. However, I have always been active in that I played sports and was a cheerleader in high school. I have worked several manual labor jobs since I was 13 or 14 years old. I have tried pills, programs, herbs, home remedies and still today I am overweight. I even thought one time about forcing myself to throw up after eating, but that seemed really stupid to me, so I never did. I have identified that I am a stress eater so it is surprising that I can walk around. I want to be healthier, but it appears that after 40 years of trying, I am not sure that I am going to get there.

Gina Smith/Gadsden

stacy c said...

i just wanted to respond to drcraft's statement about the newly trained staff being more effective. I also wonder why it is they are stating this and whay makes them more effective - how do they know this. I like how you pointed out that mabey they are searching for the more evidenced based practices.

Taylor said...

Honestly, I think behavior modification is the most obvious intervention for obesity. I mean every diet magazine I have every read has always said the only way to lose weight is to commit to changing. Nevertheless, I thought this research was interesting. Personally, I am a big fan of Evidence Based Practice. I think it is neat when a program can prove that its interventions are effective based on past research and theories. In this article case, they show how behavior modification is effective through statistics and past research.

Taylor said...

In response to Gina Smith-
I am gald that you did not resort to purging! Thank you for sharing your personal information regarding this taboo topic. I think weight is such a difficult subject to discuss, especially for women, and honestly I wish more women would embrace and love the bodies God gave them. Where I work, all of my female co-workers always discuss calories and diets at lunch and it makes me feel so self conscious. I think if people would just make life-sytle adjustments rather than obessing over their weight they would see faster results.

Debbie Walker said...

Dr. Mulhauser’s article indicated that there is evidence that the abilities of individual therapists is more of a contributing factor regarding outcome than therapeutic orientation. Also, I thought that it was interesting that newly trained therapists were found to be more effective than experienced therapists.