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The problem with treatment lists

Through the 1990s the dominant answer to the question “what works?” was a list. The American Psychological Association’s Chambless task force set criteria for empirically supported treatments, and a treatment either met them or did not. The list was useful. It was also incomplete, because the same treatment protocol produces different outcomes in different hands, and the list said nothing about the hands.

In 2006 the APA’s Presidential Task Force on Evidence-Based Practice in Psychology corrected the emphasis. It defined evidence-based practice as the integration of the best available research with clinical expertise, in the context of the client’s characteristics, culture and preferences. Research evidence became one of three legs.

What the APA means by clinical expertise

The 2006 report is specific. Clinical expertise is not a synonym for experience or intuition. It is a set of competences, and the task force listed eight:

1. Assessment, diagnostic judgement, systematic case formulation and treatment planning.
2. Clinical decision making, treatment implementation and monitoring of the client’s progress.
3. Interpersonal expertise.
4. Continual self-reflection and acquisition of skills.
5. Evaluation and use of research evidence.
6. Understanding the influence of individual, cultural and contextual differences on treatment.
7. Seeking available resources as needed, such as consultation, adjunctive or alternative services.
8. A cogent rationale for clinical strategies.

Two things follow. Expertise can be trained, supervised and assessed, because each item on the list is observable. And the fifth item folds research back into expertise: the ability to read and weigh evidence is itself a clinical skill, not a separate academic activity.

Content and process

Writing in the International Journal of Clinical and Experimental Hypnosis in 2007, Alladin, Sabatini and Amundson applied the task force position to hypnosis. Their distinction is worth keeping. Content research asks whether a particular intervention works for a particular problem, and its instrument is the controlled trial. Process research asks what therapists do, across all approaches, that is associated with better outcomes: the quality of the working alliance, the clarity of the formulation, the handling of ruptures, the fit between method and client. Both bodies of research bear on practice, and a therapist who attends only to the first is working with half the evidence.

Hypnosis makes the point sharply. A hypnotic technique is delivered through a relationship, inside a formulation, to a person with their own expectations about what hypnosis is. Trial evidence for the technique does not travel intact into a session where those conditions are neglected.

Two ways to get it wrong

Alladin and his colleagues name the failure modes. Romanticism treats therapy as an art beyond measurement, so that outcome research is an irrelevance and personal conviction stands in for evidence. Scientism treats the trial protocol as the whole of practice, so that the therapist’s judgement, the client’s preferences and the relationship are noise to be controlled out. Each is a way of not doing the work the other requires.

RICBTC’s position sits between them, and not as a compromise. The register expects members to use interventions with a research rationale, and to deliver them with the assessment, formulation, monitoring and interpersonal skill that the APA list describes. Neither half is optional.

What this asks of a registered therapist

• Formulate before treating. A treatment plan should be traceable to an assessment, and the rationale for each intervention should be one the therapist can state.
• Treat each case as a single-subject study. Monitor progress against the client’s own goals, and change course when the measures say so.
• Read both literatures. Outcome trials for the methods used, and the process research on what makes therapy work generally.
• Use supervision and CPD as the mechanism for the fourth competence on the list, continual self-reflection and acquisition of skills, rather than as a requirement to be logged.
• Refer on. Recognising the limit of one’s competence and knowing where else the client can go is part of expertise, not a departure from it.

These expectations are given effect through the register’s evidence-based practice requirements and Code of Practice.

References

• American Psychological Association Presidential Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271 to 285.
• Alladin, A., Sabatini, L. and Amundson, J. K. (2007). What we ought to mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis. International Journal of Clinical and Experimental Hypnosis, 55(2), 115 to 130.
• Chambless, D. L. and Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7 to 18.

Last reviewed: September 2026.