Challenges and Solutions in Evidence-Based Practice for Person-Centered Care

On this episode I sat down with Cameron Faller, physical therapist and educator to discuss some of the shortcomings of the current approach to evidence-based practice and how a move to process based therapy may be the answer. 

We went through the following topics:

Q 1: To begin with, do you mind if we dive into some of the issues or shortcomings of evidence based practice as we know it?

Shortcomings of the current approach to therapy (biomedical model)

• Focussed on biology 

• Has saved lives 

• Struggles to capture the interplay between biological, social and psychological 

• Reductionist problem solving 

Mechanistic world view 

• View body like a machine 

• The focus is on fixing isolated parts 

The idea that we can understand individual trajectories by understanding normal and the

 deviation from normal. They thought that between subject variability was a good estimate of within subject variability. 

• Falsely homogenized group and situationally decontextualised individual units 

• The Bell Curve of the collective only to decontextualized individuals (which is no one) 

• Normative concepts may not be applicable to specific individuals (as they are non-ergodic) 

• It's a kind of individualism but not related to a real individual 

Question 2: Issues with the application of the biopsychosocial approach to clinical practice

Question 3: What is process-based therapy?

What core biopsychosocial processes should be targeted with this client given this goal in this situation, and how can they most efficiently and effectively be changed? 

Process based therapy approach: 

• What creates the problem for the individual 

• What historical factors may have contributed 

• What are the factors that maintain the problem 

• Create a network of nodes of possible factors [network functional analysis] 

• What strategies can we use to perturbate this complex system? How can we introduce healthy variation or retention?” What treatment kernels do we have available to us to do this in the particular context?

• We are aiming to perturbate the system to turn it from maladatpive to adaptive.

• This has to be done in the right context. 

• What is the network in the process that you are targeting?

• Use data to track progress and to test hypotheses. 

• Adjust as needed.

ACT - incorporates functional contextualism - what works (functions) in a given situation or context. 

• Unique to the individual 

• Does this work in this moment? Is this moving us towards the type of life we want to have? To reduce suffering and engage in our values

Q: How does it address some of the issues with the current approach to therapy? 

Q: Does a systems based approach bastardize Evidence-Based Practice? Does it come down more to clinicians appreciating the evidence then being able to skillfully apply it to the person in front of them and their individual context? 

Q: To help me and any of the listeners understand how it is actually applied, do you have any examples we could run through? 

Q: Example of a network analysis? Eg thought of keeping back in neutral when bending. 

Q: What can we do with this information from a network analysis to create positive change of an individual ? 

Q: For listeners who want to learn more about process based therapy - what can they do / where can they go to learn more?

You can find out more about Cameron here: https://www.instagram.com/camfallerdpt/?hl=en

You can find out more about the Human Rehabilitation Framework here: https://hrfhome.com/