Tuesday, 8 May 2012

Can Process Research Help Bridge the Science Practitioner Divide?

One of the major contributions of clinical psychology to the helping professions has been the scientist practitioner model. This model, first developed at the Boulder Conference in 1949 (Petersen, 2007), stipulates that clinicians both rely on empirical evidence to guide their choice of treatments and contribute towards the research endeavour (Jones & Mehr, 2007). The primary aim of the Boulder Conference was to develop guidelines for the training of clinical psychologists, setting a standard approach, given the diversity of training curriculum in the United States at the time. This conference was successful in ensuring that the majority of clinical training programmes include astrong research dimension.

Despite this contribution there is a growing consensus that the ideals of the Boulder Conference have failed to be realized (Chwalisz, 2003; Stricker, 2002, 2003). Of particular concern is an emphasis on the use of randomized controlled trials as the primary research methodology. This method relies on a uniform sample of clients and a strict adherence to techniques and the timing of sessions, circumstances that do not mirror the complexity of the real world of clinical practice (Rothwell, 2005). There is also increasing recognition that a reliance on manualized treatments can fail to recognize the critical role of the therapeutic relationship in determining efficacy (Wampold et al., 1997), a factor that has been found to be responsible for a much as 30 percent of variance (Lambert & Barley, 2001). In addition, manuals do not adequately consider the role of the clinician in guiding the client to recovery (Duncan & Miller, 2005), including dealing with common obstacles, such as ‘non-compliance’, clinical impasses or difficulties between therapist and client (Pachankis & Goldfried, 2007; Persons & Silberschatz, 1998). 

Sackett, Strauss, Richardson, Rosenberg and Haynes’s (2000) tripartite model of evidence based medicine allows for a greater integration of science and practice, by recognizing the role of clinical wisdom in the implementation of treatment techniques. These notions are far from novel, with Kuhn (1962) proposing that scientific theory is insufficient and that ‘puzzle solving’ was required for a scientist to be considered as competent. The American Psychological Society (APA) (2006) also recognizes this approach, stating that practitioners need to consider research findings, clinical expertise and patient characteristics in decision making. Clinical expertise is seen to include self-reflection, interpersonal skills and patient characteristics, including their unique strengths, cultural context and preferences.

The APA also recommends greater methodological diversity in research, with methods based on the research question being asked. These questions include the exploration of how clinicians make decisions in a sensitive and flexible manner, the effects of race and culture on the treatment process, how the psychologist manages the therapeutic relationship and its connection to outcomeand more. Norcross, Beutler and Levant (2005) mirror this recommendation in their important edited book, Evidence-based practices: Debate and dialogue on the fundamental questions. The authors represented call for greater recognition of a host of methodologies, including single-participant designs (Hurst & Nelson-Gray, 2005), qualitative research (Hill, 2005) and process studies(Greenberg & Watson, 2005). Critics from counselling and family therapy (Chwalisz, 2003;Sexton, Kinser, & Hanes, 2008) argue that such endeavours imply an expansion of what is considered evidence. From the APA’s perspective, however, this simply implies a more faithful and open-minded interpretation of the existing definition. 

Process research can play a critical role in supporting the further integration of science and clinical practice. Greenberg and Watson (2005) argue for this eloquently, stating that the interplay of therapist and patient variables needs to be studied in all its complexity if we are to understand the means by which outcomes are established. This is reinforced by Duncan and Miller’s (2005) statement that ‘the manual is not the territory,’ a reference to Bateson (1972) and an assertion that structured protocols do not describe the dynamic of psychotherapeutic change. 

Excerpt from paper: Link
Rhodes, P. (2011). Why we need process research in Clinical Psychology. Journal of Clinical Child Psychology and Psychiatry

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