reotypes based on race or ethnicity, contribute to the ineq- Conclusions

uitable care that patients of color receive across health care

services. Clinicians must carefully consider the impact of EBPP is the integration of the best available research with
race, ethnicity, and culture on the treatment process, rela- clinical expertise in the context of patient characteristics,
tionship, and outcome. culture, and preferences. The purpose of EBPP is to pro-
The patient’s social and environmental context, in- mote effective psychological practice and enhance public
cluding recent and chronic stressors, is also important in health by applying empirically supported principles of psy-
case formulation and treatment planning. Sociocultural and chological assessment, case formulation, therapeutic rela-
familial factors, social class, and broader social, economic, tionship, and intervention. Much has been learned over the
and situational factors (e.g., unemployment, family disrup- past century from basic and applied psychological research
tion, lack of insurance, recent losses, prejudice, immigra- as well as from observations and hypotheses developed in
tion status) can have an enormous influence on mental clinical practice. Many strategies for working with patients
health, adaptive functioning, treatment seeking, and patient have emerged and been refined through the kinds of trial
resources (psychological, social, and financial). and error and clinical hypothesis generation and testing that
Psychotherapy is a collaborative enterprise in which constitute the most scientific aspect of clinical practice. Yet
patients and clinicians negotiate ways of working together clinical hypothesis testing has its limits, hence the need to
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that are mutually agreeable and likely to lead to positive integrate clinical expertise with the best available research.
outcomes. Thus, patient values and preferences (e.g., goals, Perhaps the central message of this task force report—
beliefs, preferred modes of treatment) are a central com- and one of the most heartening aspects of the process that
ponent of EBPP. Patients can have strong preferences for led to it—is the consensus achieved among a diverse group
types of treatment and desired outcomes, and these prefer- of scientists, clinicians, and scientist– clinicians from mul-
ences are influenced by both their cultural context and tiple perspectives that EBPP requires an appreciation of the
individual factors. One role of the psychologist is to ensure value of multiple sources of scientific evidence. In a given
that patients understand the costs and benefits of different clinical circumstance, psychologists of good faith and good
practices and choices (Haynes, Devereaux, & Guyatt, judgment may disagree about how best to weigh different
2002). EBPP seeks to maximize patient choice among forms of evidence; over time, we presume that systematic
effective alternative interventions. Effective practice re- and broad empirical inquiry—in the laboratory and in the
quires balancing patient preferences and the psychologist’s clinic—will point the way toward best practice in integrat-
judgment— based on available evidence and clinical exper- ing best evidence. What this document reflects, however, is
tise—to determine the most appropriate treatment. a reassertion of what psychologists have known for a
century: The scientific method is a way of thinking and
Future Directions observing systematically, and it is the best tool we have for
Much additional research is needed regarding the influence learning about what works for whom.
of patient characteristics on treatment selection, therapeutic Clinical decisions should be made in collaboration
processes, and outcomes. Research on cross-diagnostic with the patient on the basis of the best clinically relevant
characteristics, polysymptomatic presentations, and the ef- evidence and with consideration for the probable costs,
fectiveness of psychological interventions with culturally benefits, and available resources and options. It is the
diverse groups is particularly important. We suggest the treating psychologist who makes the ultimate judgment
following research priorities: regarding a particular intervention or treatment plan. The
involvement of an active, informed patient is generally
● patient characteristics as moderators of treatment crucial to the success of psychological services. Treatment
response in naturalistic settings; decisions should never be made by untrained persons un-
● prospective outcome studies on treatments and re- familiar with the specifics of a case.
lationships tailored to patients’ cross-diagnostic The treating psychologist determines the applicability
characteristics, including Aptitude ! Treatment in- of research conclusions to a particular patient. Individual
teraction designs; patients may require decisions and interventions not di-
● effectiveness of interventions that have been widely rectly addressed by the available research. The application
studied in the majority population with other of research evidence to a given patient always involves
populations; probabilistic inferences. Therefore, ongoing monitoring of
● examination of the nature of implicit stereotypes patient progress and adjustment of treatment as needed are
held by both psychologists and patients and success- essential to EBPP.
ful interventions for minimizing their activation or Moreover, psychologists must attend to a range of
impact; outcomes that may sometimes suggest one strategy and
● ways to make information about culture and psy- sometimes another, and they must attend to the strengths
chotherapy more accessible to practitioners; and limitations of available research vis-à-vis these differ-
● maximizing psychologists’ cognitive, emotional, ent ways of measuring success. Psychological outcomes
and role competence with diverse patients; and may include not only symptom relief and prevention of
● identifying successful models of treatment decision future symptomatic episodes but also quality of life, adap-
making in light of patient preferences. tive functioning in work and relationships, ability to make

280 May–June 2006 ● American Psychologist