Fostering Global Collaboration in Psychotherapy: The Development of Two Regional Consortia

Utilizing Practice-Based Evidence for Tailored Approaches

Reducing the gap between therapists and researchers is crucial to advancing mental health care. One effective strategy is generating practice-based evidence across various contexts. This approach involves systematically collecting data from real-world clinical settings, thereby allowing researchers to analyze treatment outcomes and therapeutic processes that are most directly relevant to them. By integrating practice-based evidence into the body of existing research, therapists can better understand what works in different environments and for diverse populations, leading to more tailored and effective interventions. Furthermore, this strategy ensures that research is grounded in practical realities, enhancing its relevance and applicability (Barkham & Lambert, 2021; Barkham & Mellor-Clark, 2003; Castonguay et al., 2021; Evans et al., 2003).

To foster the materialization of this strategy, it is essential to create collaborative networks for the successful implementation and utilization of the collected information. These global networks foster a bidirectional flow of knowledge, where therapists from various cultural and clinical backgrounds contribute valuable insights from their diverse experiences, while researchers provide evidence-based guidance and innovative methodologies. By connecting practitioners and researchers from different parts of the world, these partnerships facilitate the rapid dissemination and adoption of best practices across a wide array of settings, significantly reducing the lag between the publication of research findings and their clinical application. Furthermore, these international collaborations promote a culture of continuous learning and improvement, encouraging both therapists and researchers to stay informed about new developments and to refine their approaches based on the latest evidence. This global synergy enhances the quality of care provided to clients worldwide, effectively bridging the gap between theory and practice across different contexts.

Castonguay et al. (2013) eloquently expressed this synergy as, “work locally but collaborate globally,” emphasizing the importance of fostering a culture of active collaboration and comparison of results while maintaining the essential development of local infrastructures capable of producing context-sensitive knowledge. Different practice research networks have varying needs depending on their settings, cultures, and resources. However, actively collaborating to collect data on specific variables across different sites can significantly enrich scientific projects by providing larger sample sizes, comparability, and opportunities for cross-cultural research. In pursuit of improving psychotherapy practices through collaboration and the generation of practice-based evidence, two consortia emerged in different regions of the world framed as part of the regular meetings developed within the Society for Psychotherapy Research (SPR): the European Psychotherapy Consortium (EPoC) and the Latin American Consortium for Psychotherapy Research (CLIP).

European Psychotherapy Consortium (EPoC)

This initiative was launched by the European Chapter of the SPR in September 2022. The objective of this project was to facilitate the creation of European naturalistic psychotherapy samples, encouraging collaboration among countries, enriching the diversity of psychotherapy research, and facilitating the development of larger and more representative client samples (Gonçalves et al., 2024).

A self-organized group was formed with colleagues from different European countries who have met virtually on a number of occasions to define a strategic plan. As a first step, the group recognized the need for a survey to map the diversity of potential partners and to understand how their clinical services are organized and delivered.

For this survey, services from 16 different countries expressed their willingness to participate. The data provided access to approximately 5,000 clients, representing a diverse range of therapeutic approaches and patient populations. One key finding was the vast array of outcome measures that are used both at pre- and post-assessment and, to a lesser extent, on a session-to-session basis. Of those used, the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was the most adopted instrument and used in 13 clinics, while 63 different measures were employed for pre- and post-treatment review at only a single clinic. Despite this diversity, EPoC researchers agreed that researchers from different fields should work together to advance science by finding effective ways to share data and collaborate across countries and cultures (Gonçalves et al., 2024). 

Avenues of Collaboration Between EPoC Researchers

The EPoC has introduced various collaborative initiatives aimed at improving research consistency and fostering joint efforts across its network of researchers. These initiatives are designed to pool expertise, resources, and data, allowing for a more comprehensive approach to addressing key questions in psychotherapy. Currently, there are three avenues of collaboration between EPoC researchers described below.

Adoption of a single-item measure

To address the wide selection of measures used while respecting the historical and local choices implemented by clinics, it was decided to add a new single item, the Emotional and Psychological Outcome (EPO-1), into the ongoing data collection. The single item selected was adapted from the original item developed and published by Orlinsky and Howard (e.g., 1975, 1986) and has been employed successfully in several large-scale studies (e.g., Howard et al., 1996). The item asks the question: “At this moment, how well do you feel you are getting along emotionally and psychologically?” and is scored on a 5-point Likert scale . Data has been collected at the outpatient clinic of the University of Trier (Lutz et al., 2019) and robust correlations with various outcome measures have been demonstrated (Lutz et al., 2021), indicating that it has the potential to establish a common standard across diverse settings. In addition to the English version, there are currently 11 translations of the EPO-1 into European languages. An adapted version for children and adolescents is also planned for the future. EPoC members followed the International Test Commission guidelines (Hernández et al., 2020) in the process of translating and adapting the item to arrive at an equivalent measure across different countries and languages. There are no restrictions on its use, with some clinics administering it at every session and others at regular intervals. The adaptation of the EPO-1 is endorsed by Dr. Orlinsky and is freely available under a Creative Commons License upon a no-cost registration (Gonçalves et al., 2024). The item is freely available to SPR members here: EPoC Registration.

Crosswalks

This project involves converting raw scores to common metrics through the analysis of the existing questionnaires with the possibility of studying other issues, such as general effectiveness and therapists’ variability. This offers the potential of joint publications in the future. The main idea is to share raw and anonymized data to develop common metrics across different instruments. However, issues relating to ethics and data sharing agreements need to be set in place first, which may be challenging given the number of countries involved. Hence, an initial stage may involve the pooling of results of data from clinics rather than sharing actual data, but this in itself would be a small step forward.

Recommendations and suggestions

This project includes providing support to colleagues as they begin routine data collection. This would include support on commonly used measures, techniques, and implementation issues. For clinics starting data collection, this could be a way to explore the possibility of using some similar measures (as well as the single item).

Latin American Consortium for Psychotherapy Research (CLIP)

Researchers from the Latin American Chapter of SPR, at the 50th international SPR meeting in Buenos Aires in 2019, began generating ideas for collaboration. Many of these members joined the Red Latinoamericana Psicoterapia y Cambio for this purpose. In 2023, this network proposed a series of virtual meetings to learn about the research conducted by its members. In one of these meetings, the topic of ROM and the generation of practice-based evidence was proposed. Several members started to meet regularly to explore the possibilities of generating practice-based evidence in Latin America. Then the idea of generating the consortium emerged, replicating the structure and function of EPoC.

The CLIP welcomes participation from centers and independent therapists providing psychological care across Latin America. Centers are defined as institutions, whether public or private, that offer psychological care services. Independent therapists practicing privately, without institutional affiliation, are also encouraged to participate. The mission of the consortium is to foster collaboration among these independent members, enabling them to share implementation experiences, collaborate on enriching clinical practices, and collectively develop research proposals in their respective contexts (Consorcio Latinoamericano de Investigación en Psicoterapia, 2024).

The CLIP aims to standardize the collection of clinical information in everyday practice, thereby enhancing its quality and efficiency. Central to its aim are three primary functions (Consorcio Latinoamericano de Investigación en Psicoterapia, 2024):

1. Developing a collaborative practice-based database: This program involves developing and maintaining a comprehensive database containing essential details about all consortium members. This database will be updated annually to reflect the status of ROM implementation and ongoing research. It will also facilitate the formation of partnerships among members and support joint data analysis projects across different centers. The consortium aims to ensure transparency by publicizing agreements between members and providing regular updates on their status.

2. Collaboration in implementation and training: This program aims to create a virtual platform where consortium members can share implementation strategies, training materials, and best practices for outcome monitoring. This collaborative space will foster collective learning and continuous improvement among members.

3. Common framework for routine clinical data collection: This initiative seeks to standardize collection of information across various areas of interest. These include the characteristics of psychological therapies offered in multiple service centers across several countries in Latin America, the characteristics of the individuals seeking psychological therapies, the personal styles of therapists providing psychological care services, the relationships between clients and therapists (process), the outcomes of psychological interventions, and the features of the mental health care services where these interventions take place.

By focusing on these initiatives, CLIP endeavors to elevate clinical practice standards through improved data collection, collaboration, and transparency, benefiting both clinicians and clients alike.

Collaborating Across Continents: Two Different Regions, One Same Goal

Although both consortia pursue the same overarching goal, each group addresses the unique needs and characteristics of their respective regions. The EPoC was established to facilitate the creation of transnational and naturalistic psychotherapy samples, to encourage collaboration between European countries, and to enrich the diversity of psychotherapy research (Gonçalves et al., 2024) . This consortium focuses on harmonizing outcome measures, creating common metrics from different instruments, and integrating new data collection items into ongoing studies. EPoC’s strategy involves leveraging the already substantial involvement of European researchers in evidence collection at various levels, ranging from small local services to national projects. By promoting the sharing of raw and anonymized data, EPoC enables the development of comprehensive and comparable datasets that can be used to study general effectiveness, therapists’ variability, and other critical issues. This collaborative effort is designed to foster joint publications and research projects, ultimately improving the quality and applicability of psychotherapy practices across Europe.

In contrast, CLIP tackles the unique challenges in Latin America where ROM is less widespread. The region’s economic, cultural, and social diversity necessitates careful consideration when promoting ROM. Some initiatives have successfully implemented ROM in specific clinical centers (Gómez-Penedo et al., 2023; Valdiviezo-Oña et al., 2022), but resources to extend these efforts to additional centers and settings remain limited. CLIP’s mission is to standardize clinical data collection practices across the region while diagnosing psychotherapeutic practices in Latin America, highlighting the region’s unique characteristics. This initiative promotes systematic research in everyday settings, enhancing cultural understanding, research efforts, and the systematization of psychotherapeutic practices. The consortium’s initiatives include developing a collaborative practice-based database, facilitating the sharing of implementation strategies and training materials online, and ensuring the transparency and accountability of agreements between consortium members. By supporting the implementation and training of ROM practices, CLIP aims to elevate clinical standards and foster a culture of continuous improvement among practitioners. This collaborative network not only benefits clinicians by enhancing their data collection capabilities but also improves patient outcomes by ensuring that therapeutic practices are informed by robust and standardized evidence (Consorcio Latinoamericano de Investigación en Psicoterapia, 2024).

While EPoC and CLIP both strive to advance psychotherapy practices through practice-based evidence and collaboration, they tailor their approaches to the specific needs and conditions of their regions. EPoC leverages existing research efforts to create a unified framework for data analysis in Europe, whereas CLIP focuses on establishing and promoting standardized ROM practices to build a solid foundation for psychotherapy research in Latin America.

A key link between the EPoC and CLIP consortia is the adoption of the EPO-1 item. Both consortia have incorporated this item into their ongoing and new data collection efforts to improve the consistency and comparability of their research. The item offers, at minimal cost in time and no financial cost, a unified measure that enhances the understanding of therapeutic progress across various settings, fostering greater alignment and collaboration between EPoC and CLIP.

The first phase of the European project has recently been published, outlining the aims and future potential of the European Consortium, including the development and translations of the single item, procedures to allow cross-comparison of outcome measures, and the creation of a task force to be consulted when new data sets are collected. The aim of the consortium is to share and implement new common measures in the effort to increase collaboration and treatment alignment (Gonçalves et al., 2024).

Although this program of research began as an initiative of the EU-SPR Chapter, and was followed by the LA-SPR Chapter, both consortia would support researchers developing additional consortia in regions beyond LA and the EU, working towards global collaboration. The complete list of collaborators of the consortia can be found here. In the spirit of collaboration, colleagues within EU and LA who wish to participate are welcome to join their respective consortium. If you want to know more about EPoC, see (https://www.psychotherapyresearch.org/page/EPoC-About), and if you want to know more about CLIP, please see  (https://www.psychotherapyresearch.org/page/CLIP-About_engl). We understand that researchers often have demanding schedules and may be concerned about the time commitment required for participation in these consortia. Our expectation is that involvement will necessitate minimal time investment while being mutually beneficial for all participants. Furthermore, we anticipate that this collaboration could eventually lead to exciting outcomes for everyone involved, including new projects and publications. Most importantly, we believe that through small and flexible steps, we can collectively enhance our scientific endeavors!

Conclusion

In each region there coexist several realities that demand contextual adaptations. This is true not only at a continental level (Europe versus Latin America) but also within each continent and even within each country. The opportunity to work in collective efforts by no means should lose perspective of the importance of these contextual differences and needs, which are especially important when generating practice-based evidence. A significant amount of work has to be done, particularly in Latin America, in terms of creating the basis for assessing therapeutic processes and outcomes. The creation of the EPO-1 item represents a significant first step toward fostering collaboration and the possibility for comparison, which could be crucial for understanding the dynamics of real-life psychotherapy. By doing so, we aspire to improve both processes and outcomes, grounded in solid empirical support while incorporating the lessons learned from practice-based evidence.