Evidence-based assessment/Step 9: Learn and use client preferences

=Learn and Use Client Preferences=

Overview
Patient beliefs about the causes of problems, their attitudes towards biological or spiritual explanations, the past experiences of relatives and friends with treatment, and other cultural and idiographic factors all shape perceptions of treatment. Better to start the dialog early and give their opinions weight at the beginning, or they will vote with their feet later in the form of low motivation and engagement, and early drop out. There are some findings that can guide conversations about options: Families often put higher value on spiritual perspectives than the therapist does; and some cultures are less likely to conceptualize things in biological terms than the research community does at present. Cognitive behavioral therapy may be less effective with people from Asian cultures, who may be less likely to focus on cognitive symptoms of depression than Europeans and European Americans, and interpersonal psychotherapy (IPT) may be more attractive and effective than other ESTs for Hispanic families due to the greater emphasis on family relationships. A core portion of the values discussion needs to be idiographic, though. What is important to the outcome for the individual is their own constellation of beliefs and attitudes, not stereotypes and averages that may or may not match them. The growing emphasis on collaborative models of care as a core feature of evidence based practice recognizes this.

As we move towards collaborative care models and shared decision-making, we need to also attend to what information our clients have, how they interpret it, and how we can help them navigate the information effectively. Researchers can give more thought to packaging results in a way that is digestible by a lay audience, and we can do more to teach the public critical thinking skills to separate hype from evidence. Effective communication will involve a blend of attention to details such as graphical formats and concrete ways of describing probabilities as well as a greater willingness to engage with popular and online media. We need to understand where the client is coming from and how things look to them before we can engage in a conversation about change.

Rationale
No matter how convinced we are by our own arguments, they do not help anyone if the client does not agree. One of the biggest obstacles is failure to connect on the emotional or value-driven levels. Evidence-based clinicians are masters of facts. Successful engagement depends on understanding the client's values and beliefs, and responding to questions and concerns at an emotional level, as well as clearly presenting the facts.