Practice-based evidence: Findings from routine clinical settings

The goal of this chapter is to survey practice-based evidence (PBE) in the psychological therapies that has accumulated over the last decade. PBE, or practice-oriented research (POR), is complementary to studies that are conducted in controlled settings and are predominantly guided by researchers’ agenda. In contrast to the more traditional paradigm of evidence-based practice, PBE is conducted as part of clinical routine practice and some studies involve clinicians’ participation in the design, implementation and/or dissemination of empirical studies. The chapter provides examples of PBE studies conducted in different clinical settings, with various clinical populations, and by researchers and clinicians from diverse parts of the world and with different theoretical orientations. The studies address several aspects of the impact (therapist effects, effectiveness of single and multiple clinics) and process (alliance, therapist interventions, therapist and client experience) of psychological therapies, as well as participants’ characteristics (e.g., expectations, interpersonal/attachment issues) and contextual factors (center and neighborhood effects, training and supervision) that contribute to therapeutic change. Other initiatives that are also aimed at closing the gap between science-practice are briefly discussed, along with new developments in POR. The chapter ends with a description of features that cut across PBE studies as well as some of the challenges and limitations of these investigations, the identification of various clinical, scientific, and policy contributions of past and current investigations of routine practice, the delineation of characteristics of high quality PBE studies, and some recommendations to foster researcher and clinician collaboration and facilitate the conduct and impact of future PBE studies.