How to Utilize Clinical Research in Practice

Clinical research competencies and techniques are interwoven into initial case conceptualization, treatment planning, and ongoing psychotherapy. 

The below is an example of a patient case we will utilize to demonstrate these techniques. The patient’s name and identifying characteristics have been changed to protect privacy.

Case Conceptualization

John, a mid-30’s, cis-gender, bisexual, white male came for treatment at Kimberly Keiser and Associates after being convicted of a sex offense soliciting a minor for sex and receiving a court mandate. He was allowed to choose his treatment provider for sex therapy and did not attended a sex offender treatment program as typically required by the courts. 

John was married, had children and had a successful career.. He reported a long history of depressive symptoms and multiple, ongoing affairs with both males and females, but had no other prior legal issues. 

The initial stages of psychotherapy require a clinician to utilize clinical research skills in the form of clinical assessments conducted quantitatively or qualitatively. Given John had already gone through the legal process of court-mandated psychological testing, a copy of his full psychosexual evaluation and psychological assessments conducted by a licensed clinical psychologist were available for treatment.  

The psychological assessments provided an evidenced-based scientific approach and reviewing these assessments allowed more information about John’s mental health history and current diagnostic picture. Psychological testing is one of several means of obtaining quantitative data during the intake and case conceptualization process. 

Clinical psychologists are the only licensed mental health professionals that can administer psychological testing. If a client is working with a licensed counselor, social worker, or marriage and family therapist, psychological testing can be obtained through collaboration between mental health professionals if these types of assessments are needed to inform treatment planning or clarify a diagnostic picture. 

Collecting quantitative data at the beginning of treatment allows a psychotherapist to collect specific information on the issues the client reports.

Qualitative information about their thoughts, feelings and behaviors simultaneously provide the clinician and the patient information about possible psychological mechanisms causing the issues. 

Given John’s extensive history of sexual behaviors that resulted in negative consequences, assessments from the Out-of-Control Sexual Behavior model were used. Qualitative assessments are usually based on a patient’s self-report and are used to understand various aspects of the quality and scope of a client’s experience along any domain that is being investigated. 

Psychotherapists that are conducting an assessment on a patient at any time during the psychotherapeutic process use assessments that have been developed through scientific research so that the psychometric measures are both valid and reliable. In other words, the measure will accurately measure what they claim to measure and that they measure it consistently across patients and time. 

Treatment Planning

Treatment planning requires clinical research competence to use information collected and develop a plan towards symptom reduction. 

During the intake and case conceptualization phase, information obtained about the psychological mechanisms  that are causing distress can be viewed as the dependent variable, while symptoms can be viewed as the independent variable. This is one means of using a scientific approach in clinical application. 

From the beginning of treatment, a clinical research informed, and scientist-practitioner psychotherapist will be thinking about potential relationships between variables within a clinical presentation and how treatment interventions can lead to the desired change of decreased symptomatology. 

For example, in John’s case, a symptom that initially presented was depression, the independent variable, and the hypothesized one psychological mechanism creating that was leading a double life, the dependent variable. In working with John — like with many clients who have problematic sexual behavior, or OCSB — when they integrate their sexual behavior into one life rather than two where one is hidden in the shadows, their mood symptoms improve. 

Psychotherapy Process

When a psychotherapist has completed an initial assessment and has a good working case conceptualization based on the types of scientific tools previously outlined, the psychotherapy process becomes the primary focus in treatment. During the psychotherapy process clinical research and scientific thinking are continually utilized in additional to many types of psychotherapeutic interventions.

For example, John was given the Hypersexual Behavior Consequences Scale, a qualitative measure of behavior, throughout treatment as a means for him to understand his own behavior more objectively on a week-by-week basis. The insights obtained through John and his therapist reading his responses over time informed treatment interventions. John’s treatment also used evidence-based cognitive-behavioral therapy for both treatment of his anxiety and cognitive distortions that maintained his cycle of sexual acting out to cope with unresolved childhood trauma. 

As treatment interventions are continually given and progress is made in psychotherapy, new hypotheses are formed about what is creating the current symptom picture. New dependent and independent variables are identified and corresponding treatment interventions appropriate to those are implemented. 

It is fairly typical for clients with OCSB to have problematic behaviors stabilize after several years of treatment, after which time the client is well  positioned to work on the underlying causes of the behaviors. Such as the case with John, who learned that his own history of childhood sexual abuse was causing a lot of shame and fear about him expressing himself and the true nature of his sexual identity and preferences.

It is often during this phase of treatment that clients will own who they are sexually and be able to express it without triggering from their own abuse histories or leading a double life to get needs filled. 

Learn More About the Importance of Science in Sexual Health »

Providing Effective Clinical Care

The case conceptualization requires obtaining quantitative and qualitative data to uncover the possible reasons causing the specific behavior. 

The treatment planning phase — which can be ongoing throughout different phases of treatment — is useful to consistently test hypotheses in real time about the impact of interventions on clinical symptoms. 

Finally, the working phase of psychotherapy is important to have a balance between evidence-based treatments and research-informed psychotherapeutic models and interventions. In addition, hypothesis testing is ongoing as the client continues to change and grow beyond their initial presenting concerns. 

Above all, clinical research competencies and utilizing a scientist-practitioner model are necessary for providing effective clinical care.