...undergirds the practice of counseling. In addition, the section is pertinent for the profession in that a broad public discourse increasingly calls for accountability for providers across many domains as diverse as business (Best Practices, LLC, 2004), education (Jones, Voorhees, & Paulson, 2002), and medicine (Buffum, Hutt, Chang, Craine, & Snow, 2007). Counselors have been a part of that larger public conversation as well (Sexton & Whiston, 1996; Whiston & Coker, 2000). Ultimately, it is the consumer who benefits most when counselors practice using their skills responsibly and intentionally.

In discourse as in other human phenomena, where there is action there also will be reaction. In the face of this trend toward identifying practice guidelines for counseling and other helping professions, there is a concurrent professional discourse that questions the assumptions underlying the best practices trend. One of these assumptions is that the best practices movement equates to a reduction of counseling to a medical model (Wampold, Ahn, & Coleman, 2001). Another discourse arises from humanistic and postmodern perspectives, wherein the argument assumes that the change process in counseling is recursive and coconstructed between counselor and client and therefore cannot easily be described empirically (Lieb & Kanofsky, 2003). A final relevant assumption is that if best practices are grounded in positivist research models, ethnic minority groups will be marginalized because controlled studies usually have a plethora of White participants and a dearth of people of color (Sue, 2003). All of these assumptions are critical and warrant further exploration.

To introduce the section, we begin with a set of definitions to clarify the kinds of offerings we hope to solicit for the Best Practices section. For the second part of this inaugural statement, we invited authors who represent some of the perspectives we just outlined to respond to questions exploring the intersection of science and art that is the foundation of counseling.

Of what does a best practice consist? Practice guidelines, for example, are meant to provide counselors with goals to which they can aspire. Guidelines are distinguishable from standards in that the latter are enforceable whereas the former are motivational. Guidelines and standards are not interchangeable, and best practices can be more closely aligned with the guidelines rubric. Thus, if a group of counselors with expertise in narrative therapy were to derive a consensus from their respective experiences with technologies they have used in deconstructing client histories, that consensus statement would represent a best practice. If the same group of narrative therapy experts were to design a series of N = 1 case studies using deconstructive strategies, systematically analyze the most effective strategies, and derive a statement based on their research, the resulting best practice would come from an evidence-based perspective and not from an expert consensus alone. Empirical validation of deconstructive strategy guidelines would only be possible when enough evidence-based studies had accumulated to allow systematic analysis of their combined effects. Replication and a preponderance of evidence are required for empirical validation. Empirical validation rests on the scientific method, whereas expert consensus relies on the artistry that is clinical intuition shaped by the crucible of experience.

Seven authors, whose views are representative of some of the arguments just outlined, were invited to respond to nine questions regarding the topic of best practices:

1. What is your understanding of best practices? Can the idea of best practices include both modern and postmodern perspectives?

2. What purpose is served by identifying what is best about any of the counseling profession's theories or technologies?

3. How do you integrate, if at all, any part of the medical model in your practice?

4. How may counselors demonstrate accountability when they work from a humanistic perspective?

5. What is your view of the tension between the "common factors" research perspective and the evidence-based, or empirically validated, therapy perspective? Can there be rapprochement between the two perspectives?

6. What is the balance that counselors should look for between their role as scientist/practitioner and their role as facilitator of human growth?

7. What, if any, role is there for manualized practices from your theoretical perspective?

8. From your theoretical perspective, can cultural competency be measured?

9. How do you respond to the idea that counseling based on best practices may be oppressive to marginalized client populations?

Four authors, representing three distinct theoretical perspectives, responded affirmatively to our invitation. Thomas Sexton, from Indiana University, responds from the perspective of evidence-based interventions. John West and Don Bubenzer, from Kent State University, respond from a social constructionist perspective. Jorge G. Garcia, from George Washington University, responds from a multicultural and ethical perspective. Their responses were edited only for consistency of format.

Thomas Sexton

A comment on the questions. These are interesting and useful. The form of the questions, however, is based on a number of inherent assumptions that pit evidence-based treatment and best practices against other perspectives. Unfortunately, the form of the question may serve to continue the either--or divide between these perspectives and inflame the strong emotional responses rather than generate useful and thoughtful debate. in my perspective, there is no need for an either--or approach. Traditional models of counseling are just that, traditional models. They do not reflect the significant advances in knowledge and theory that emerged over the last decades. As a result, they are flawed. The movement toward evidence-based practices (EBPs) is a bold and helpful move to improve the services received by clients of all types. Untbrtunately, the emotional, political, and closed nature of the current debate does not move the field forward to our common goal of helping clients in the most efficient, effective, and responsive way possible. This goal has been lost in the use of polarized words like modern versus postmodern, theory versus manual, culturally competent versus effective. In each case, I find these opposing words to be representative of straw man arguments that divide the field rather than move it forward. My comments below are intended to represent this perspective.

Response to Question 1. The term best practices has come to have a variety of meanings. In some professions, it means the best the profession has to offer based on a consensus opinion of professionals at any given time. For example, evidence-based medicine, a movement established in Canada and Great Britain to address the need to move research into practice, provides a model for the use of systematic research reviews for clinical decision making with the aim of improving clinical effectiveness. Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) defined evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of Evidence-based Medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research" (p. 71).

In counseling, best practices has come to mean an evidence-based or evidence-informed approach. This approach is based on the emergence of important clinical research. The evolution of psychological EBPs has been influenced further by the significant rise in the depth, breadth, and clinical relevance of clinical research into the outcomes and change mechanisms of both prevention and treatment programs (Sexton, Gilman, & Johnson, in press). In the broader clinical field, initial questions regarding the effectiveness of psychotherapy (Eysenck, 1952) have been replaced by a consistent stream of research evidence that demonstrates the positive effects of a wide range of psychological treatments (Kazdin & Weisz, 2003; Lambert & Bergin, 1994; Lambert & Ogles, 2004; Luborsky, Singer, & Luborsky, 1975; Shadish, Montgomery, Wilson, & Wilson, 1993; Shadish et al., 1997; Smith & Glass, 1977; Wampold, 2001). In the area of family psychology, both outcome and process studies have clearly identified successful treatments (Pinsof & Wynne, 2000; Sexton, Robbins, Hollimon, Mease, & Mayorga, 2003) and the mechanisms of change (Alexander, Holtzworth-Monroe, & Jameson, 1994).

Despite the debate and controversy within professional organizations like the American Counseling Association (ACA), the impact of EBPs is dramatic in that they are fundamentally changing the way practitioners work, the criteria from which communities choose programs to help families and youth, the methods of clinical training, the accountability of program developers and interventions, and the outcomes that can be expected from such programs (Sexton et al., in press). It is interesting that these changes are coming from community applications and not from either professional organizations or training programs. It is community providers and funders that are demanding accountability, not professional organizations.

Despite the strong research support made and the widespread development and dissemination of evidence-based programs, many controversies remain. For some, evidence-based programs are viewed as a challenge to well-entrenched traditional means of treatment. EBPs are viewed as simple curricular approaches with paint-by-numbers guidelines that are unresponsive to the needs of individuals, families, and communities. Although others may agree that such programs are necessary, the definition of what constitutes evidence based remains unclear.

Oppositional conversations are, in my mind, myths that have been used to polarize and divide the profession, making it more difficult to pursue the best practices for the diverse clients we see. At the most basic level, EBPs are no different from any other practices. The core philosophical principles of EBPs are not unique. In fact, the central guiding principle is likely to be shared by anyone who works with any client: Every individual has the right to the most effective services available at the time (Schoenwald, Sheidow, & Letourneau, 2004; Sexton et al., in press). Through the use &models based in scientific evidence, these approaches attempt to provide clinicians, communities, and families with the opportunity to choose intervention and prevention programs in which they can have confidence that positive outcomes will occur. It is the method that EBPs use to achieve this goal that is unique. The basis of the best care is quality through accountability. Accountability is the establishment of programs that, when implemented well, will result in positive outcomes for clients. Accountability is based on scientific evidence to create a standard of quality and reliability that allows the best care possible.

There are two important implications of this definition of accountability. First, it suggests that one can demonstrate that the programs used produce positive outcomes with a wide range of clients, in different communities, and in a way that ensures that the positive outcomes are maintained over time. In addition, this definition assumes that intervention and prevention programs must maintain a level of quality...

NOTE: All illustrations and photos have been removed from this article.



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