Bridging Psychotherapy Research and Practice: An Interview with PPRNet’s Giorgio Tasca

With the College of Registered Psychotherapists of Ontario (CRPO) being proclaimed earlier this month and the Psychotherapy Act being considered further, the act of psychotherapy is on the mind of many in health governance and clinical practice. As we move forward into regulating psychotherapeutic practice it is important to consider the broader issues of psychotherapy, including the growing research base that can be used to inform our own practice and to help understand why regulation may be in the public interest.

OAPA President, Michael Decaire, had an opportunity to recently interview Dr. Giorgio Tasca, C.Psych, on the work he has been completing as the Director of the Psychotherapy Practice Research Network (PPRNet). PPRNet began in 2012 and has already become an excellent resource at bridging research and clinical practice. PPRNet’s monthly postings have become required reading to many OAPA members and will undoubtedly help shape the clinical practice of future readers as well.

Dr. Tasca has worked for many years at bridging psychotherapeutic research and clinical practice. He holds staff positions at The Ottawa Hospital, is a Research Chair in Psychotherapy Research at the University of Ottawa, has cross appointments with Carleton University, and is the associate editor for APA’s journal Group Dynamics. OAPA would like to thank Dr. Tasca (listed below as GT/PRN) for taking the time to participate in an interview with Mr. Decaire (listed as MD/OAPA).

MD/OAPA: Can you provide us with an overview of what the PPRNet is and outline its primary goals?

GT/PRN: The Psychotherapy Practice Research Network (PPRNet) exists to bridge the gap between practice and research in psychotherapy. We are taking a ground-up approach to this by seeing psychotherapists as active participants in the research process. For example, the traditional view of psychotherapy research is that academic researchers decide what to research and how to go about that, and then they expect clinicians to change their practices according to the research findings. This model of disseminating research hasn’t worked so well primarily because clinicians have felt alienated from the research, have found the research has not always reflected their practice, and have sometimes felt coerced into practicing according to models that do not fit their experiences with clients. On the other hand, clinicians have a responsibility to their clients provide treatments based on the best possible evidence. PPRNet’s approach is to include clinicians in the research by asking them what is important and including them in the process of developing studies and disseminating the findings. By doing so we believe clinicians will feel more connected to the research and that the research will be more easily translated into clinical practice.

MD/OAPA: Can you identify some of the barriers you see to the successful implementation of up-to-date research supported psychotherapeutic practice?

GT/PRN: One of the barriers, as I mentioned is that clinicians and researchers do not often talk to each other, and so the research may not be perceived as relevant to clinicians. This lack of communication means that clinicians do not travel within social or professional circles in which they see what research has to offer, and researchers do not always appreciate clinicians’ knowledge and experience. Also, clinicians are sometimes not fully aware of relevant research that could improve their clients’ outcomes. For example, most clinicians do not know much about outcome monitoring and so many do not use this technique in their practices.

MD/OAPA: Has PPRNet thought about ways that it may help in overcoming these barriers?

GT/PRN: Our main goal has been to bring clinicians and researchers together in mutually respectful dialogues. In 2012 we had a terrific conference in which about 100 clinicians and researchers sat down together and hammered out a preliminary research agenda. That agenda became the basis of a large scale survey that asked clinicians what they wanted from psychotherapy research. We just published the survey results and the findings were instructive. Mainly clinicians are interested in research on the therapeutic relationship, therapist factors, professional development, and client factors. They are less interested in research on treatment manuals, outcome monitoring, and technology assisted therapy. The survey findings can guide researchers to produce research that is relevant to clinicians. A second main thing that PPRNet does is to make the existing research more available and relevant to clinicians. Every month I write a blog in which I summarize three reviews, meta analyses, or large scale studies and talk about their practice implications. Clinicians can see these blogs by going to our web site: www.pprnet.ca. If you join PPRNet (it’s free), we will send you blog updates every month.

MD/OAPA: The “Working Group” and Stakeholders that make up PPRNet are quite diverse. In Ontario we are transitioning to psychotherapy being a controlled/regulated act, but one that will remain accessible to many different types of professionals. Do you think the regulation of psychotherapy will support a stronger connection between the science and the practice of psychotherapy? Do you anticipate any barriers as a result of having so many Colleges having accessing to this practice?

GT/PRN: As I see it, the main role of Colleges is to protect the public. If a college of psychotherapists can establish equitable and minimum qualifications for practice, and require members to engage in continuing education, then this will be an improvement over the current state of psychotherapy practice. I hope that some of the continuing education requirements will include basic knowledge of psychotherapy research.

MD/OAPA: Regulatory Colleges essentially require a minimum acceptable standard of practice to be met and in the past have seem resistant to identifying models of “best practice”. Does PPRNet have a role to play in defining what optimal psychotherapeutic practice looks like?

GT/PRN: This is a complicated topic. Evidence based practices (EBP) is a newer broader term that the older idea of empirically supported treatments (EST). That broadening of the definition of evidence has been a good thing. Now, EBP relies on three areas of evidence: (1) best research evidence that is internally valid and clinically relevant; (2) clinical expertise to integrate research and clinical experience; and (3) patient characteristics and values that affect patient outcomes. For many disorders there is little or no difference between bona fide treatments (i.e., psychotherapies that are expertly applied by a trained professional, based on a well articulated theory, and subjected to research trials). There are also “evidence based relationships in psychotherapy” that are not specific to a therapy orientation, like: developing and maintaining a therapeutic alliance, repairing alliance ruptures, managing countertransference, therapist empathy, outcome monitoring, etc. This is based on the work of John Norcross. Fundamental to all of these (EBP and evidence based relationships) is that there is evidence to support these practices.

MD/OAPA: Psychoanalytic and psychodynamic clinicians have long complained that therapeutic models like Cognitive Behavioural Therapy (CBT) simply lend themselves better to research and thus provide inaccurate information about the efficacy of one therapeutic model over another. How do you think models that are less structured or linear can be better explored?

GT/PRN: There is now a lot of research on psychodynamic models of psychotherapy. Psychodynamic clinicians and thinkers were very late out of the gate, and some diminished and ridiculed research evidence – this was a public relations disaster. But this has changed in the last decade or so. There are now a number of meta analyses (empirical systematic reviews of the research) showing the efficacy of psychodynamic therapies for a wide range of disorders (depression, personality disorders, anxiety disorders, and others). There remains a public and professional perception that psychodynamic therapy is not evidence based – but that’s simply not true for a number of disorders.

MD/OAPA: Is there anything in currently accepted psychotherapeutic practice that you find concerning at this time?

GT/PRN: I think that the one thing that most concerns me is that psychotherapy is a house divided. Practitioners and researchers group themselves into tribes of therapy orientations and devalue the work of their colleagues. This is not good for the practice of psychotherapy or for our clients. As I mentioned, the research evidence for the efficacy of psychotherapy is good, that bona fide therapies are generally equally effective for many disorders, and that certain practices (e.g., identifying and repairing alliance ruptures, outcome monitoring, etc.) can improve client outcomes. Those are the messages that the public, policy makers, and those who fund psychotherapy should be hearing from each of us. Of course, another concern is that research evidence too often does not influence clinical practice, and that researchers too often do not rely on clinical expertise when designing their research.

MD/OAPA: On the other hand, what areas are exciting to you or do you see anything emerging that may reshape the way we think about psychotherapeutic intervention?

GT/PRN: I have been pleasantly surprised by the rise of practice research networks in psychotherapy in Canada and around the world. I truly think that both clinicians and researchers are ready to listen to each other and to learn from each other in order to improve the lives of people who need psychotherapeutic help.

OAPA would like to thank Dr. Tasca for making himself available for this interview and for the efforts he and the PPRNet team are doing to bridge the gaps between psychotherapy research and practice. We encourage members and any other readers to visit PPRNet’s website at pprnet.ca, view the PPRnet blog, and consider PPRNet’s free membership.