CLINICAL PERSPECTIVES
Evidence-Based Thinking and the Alliance With Parents

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FOUR WAYS EBT STRENGTHENS THE ALLIANCE WITH PARENTS

A rigorous but comprehensible discussion of relevant evidence can strengthen the alliance with parents in several ways. First, evidence-based dialogs help to create transparent thinking, where parents understand the reasoning as well as the evidence for and against a particular choice. Second, evidence-based dialogs provide a structure to settle disagreements. When resolving disputes, what relative weight should we give to cohort studies, randomized trials, case reports, anecdotes, and hearsay?

THE SUBSET OF PARENTS RESPONSIVE TO EBT

Despite these examples, factual evidence may have minimal effect in some situations. When parents are angry, agitated, or hostile, EBT may be quite useless. For example, the father of an adolescent boy suffering from major depression was himself an intensely angry divorced construction worker who belittled both his son and any efforts to help. His hopeless view of his son as worthless overpowered the evidence presented by the physician regarding the value of fluoxetine in major depression.

CONCLUSIONS

The rapidly expanding and improving child psychiatric literature, made more accessible with low-cost computers, high-speed modems, and widely available electronic databases, can join with explicit methods for appraising evidence derived from academic epidemiologists to strengthen the alliance with adolescents and their parents. Human warmth, empathy, and interest in psychodynamic understanding retain their central place. Blending in EBT adds transparency, facilitates shared decision-making

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Supported by Kaiser Foundation Research Institute grant CN-01JHami-02-H. The author acknowledges the assistance of faculty and fellow students at Kellogg College, University of Oxford Department for Continuing Education, Master's Programme in Evidence-Based Health Care (Ms. Janet Harris, Director), in learning evidence-based medicine (http://www.conted.ox.ac.uk/health/htmlfiles/master/masterfr.htm). The author also appreciates the editorial input of Dr. Michael Jellinek and Dr. Peter Szatmari in reviewing earlier drafts.

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