Evidence-Based Practice Isn’t What You Think: The Surprising Dance Between Science and Client Wisdom

What if the ‘gold standard’ treatment fails your client? Genuine evidence-based care isn’t following checklists or manualised therapies. It’s a collaborative approach with your client where science adapts to human needs. Relapses show us hidden truths and ethical practice means changing the rules as we go.

Coaches and psychologists need to base their client work on evidence. What does this mean? Coaches and psychologists don’t guess. We base our work on peer-reviewed studies, random trials, and meta-analyses. We source from interventions or assessments that have scientific rigour behind them.

Evidence. During and after our psychology training, psychologists review peer-reviewed journals. We understood and learned from studies with strong research designs and careful methods. We considered the evidence by looking at the hierarchy. This covers all research types. It includes single studies on treatments or assessments, randomised control trials, and meta-analyses. As coaches or psychologists, we know the evidence behind many therapies and assessments.

We review the literature instead of taking it at face value. This approach helps us become better consumers of scientific research. Yet bear in mind that coaching and psychology have both science and art. To help our clients, we must also understand their circumstances and preferences. This is where ethics are also important.

Yet science alone can’t predict what works for the human sitting across from you.

Ethics and Clients at the Centre. We must use evidence-based assessments and treatments because it’s our ethical responsibility. We explain our methods to clients and get their consent. Clients should contribute to shaping their treatment plans. We must ensure the client understands the treatment or assessment before we start. Also, we have an ethical duty to change the treatment if it isn’t practical. We may need to change evaluations to meet the client’s needs. This could be due to a much-needed modification or the client’s personal preference.

Using validated tools is both sensible and ethical. We carefully explain methods, get consent, and change direction when assessments trigger discomfort. For example, swapping a formal psychometric test for guided questioning).

Balancing “best practice” and the client’s voice. I’ve had clients who feel uneasy when they take a psychometric assessment. I’ll address that reluctance. We can change the evaluation or use questions to guide us. This way, we won’t force the evaluation on anyone. Also, it’s important to communicate some of the gold standard treatments. So for example, the first-line treatment for depression. Research on evidence-based depression treatments suggests that behavioural activation is the best way to treat depression. I need to explain behavioural activation in different ways for each client. This helps it resonate with them. I can tell them that behavioural activation is either an act of mastery or pleasure.

Tweaking the approach. For some clients, this might work. For others, I wouldn’t use the term “behavioural activation.” Instead, I would explain it in simpler terms, focusing on acts of mastery or enjoyment. You can offer excellent treatments, but you must sell them to clients in an ethical manner. The client can choose to accept or reject the treatment. It’s also important to consider the client’s views on what might work. Some of the best analogies and insights have come from the client. I’ve worked with clients who have severe presentations. They have spent years figuring out what works for them and what doesn’t.

Focusing on what works can help us pay more attention to our successes. We can also look at self-compassion and imperfection within the treatment. Treatment isn’t black and white. Speaking of focus, sometimes a client’s firm rejection of a particular treatment is interesting data. I remember laying out cards related to a treatment modality before a client. Each card had a different skill or practice for a client to choose from. Appreciating how unorthodox this approach looked to my client, I made a lame joke about being a fortune-teller as I laid the cards before them. Then, I walked through each relevant skill or type of practice on each card. They chose a couple of options. Then, I asked what skills or practices they strongly did not like. The skill the client did not like gave me another clue about their preferences … and fears. With gentle questioning, I tapped into the client’s fears about treatment. I could then work with these fears in helping my client with their treatment plan.

Relapses are data. It’s important to remind clients that relapses are okay. Progress is more important than perfection. Setbacks aren’t failures — they are feedback loops. A client reverting to old patterns reveals what’s missing in the plan. Normalise this: “Relapse means we’re pushing boundaries. Let’s discuss what happened and tweak.”

This view on relapses and setbacks lowers pressure. Clients don’t feel they need perfect treatment results. We can share effective coaching techniques and tools and provide models to help a specific client. Also, progress is not always upward and linear. We plateau, and sometimes, we also seem to “go backwards” for a while. We must support clients facing disappointment or unmet expectations about steady progress.

We want to share these approaches in a way that suits the client. We need to check that we understand what we’re saying and that the client understands. We need to work with the client to create something they can be part of in their own words. We need to adjust our approach if something isn’t working. Let’s focus on finding what works best for the client.