How might we go about assessing and, where needed, improving the quality of psychotherapy practice delivered in usual care? Given the numbers of mental health specialists practicing in the U.S. (recently estimated at one-half million), the diversity of professional training and licensure that establish credentials to practice therapy, a broad range of practice settings, and variations in the types of individuals treated, the task of answering this question seems daunting (Institute of Medicine 2006a). This special issue includes a range of studies that have made first steps toward tackling this challenging task. Not surprisingly, given the groundbreaking nature of this research, these papers overwhelmingly raise more questions than they answer. A large part of the value of these studies is lessons learned that inform next steps to assess and improve the quality of psychotherapy in usual care.
2) How broadly should assessment cover the range of practice in psychotherapy? Approaches in this issue have ranged from a broad scope that attempts to cover most of what is observed in mental health care for children (Garland et al. 2009; Hurlburt et al. 2009; Kelley et al. 2009) to a more narrow focus on identifying elements of prominent therapeutic approaches in the treatment of depression (Hepner et al. 2009a; Miranda et al. 2009). Differences in breadth of the assessment approach reflects differences in study aims: a broad assessment was suited to the goal of describing natural variation in psychotherapy practice and the associations between that natural variation and outcomes; the narrow focus on specific psychotherapy techniques for depression treatment aimed to understand the extent to which evidence-based practices were delivered in usual care. Both approaches appear to be fruitful ways of generating knowledge about usual care psychotherapy practice.
lesson 3 homework practice measures of variation answer key
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