The Practitioner’s Urgent Search for Answers: Knowledge from Research vs. Knowledge from Practice

by Thomas M. Skovholt

Somehow we have entered the 21st century with research and practice often operating in separate spheres…The styles of publications and presentations that focus on science and that focus on practice are so vastly different, and there is a relative paucity of efforts to translate between these domains….                

(Lebow, 2006. p. 3, 4)

One of my greatest frustrations as president of APA [American Psychological Association] is that I am not able to wave a magic wand and heal the science/practice divide.   

(Brehm, 2007, p.5) 

Therapy and counselling practitioners search far and wide for answers to match the complexity of their clients’ lives. Sitting with clients in agony, who are trying to recover from shattered lives, the practitioner urgently wonders: “How can I help this client manage his depression when, all of a sudden, his family’s financial life has sharply declined?” or “How can a female client go on after her child’s death?” or “What can I say when another client asks about meaning in life?” or “Is there a quicker way to ease crippling anxiety or pervasive depression or intense anger—I need answers for all of my clients!”

Into this void come answers from academic research. Supposedly. Research—that word tied to scientific respectability in our knowledge driven world. Research—that word that produces so many mixed feelings for the practicing therapist and counsellor. Interest, disinterest, attraction, anxiety.

A major epistemological (epistemology refers to where we get out ideas and beliefs) struggle for the practitioner concerns the sources of knowing. Often there is a clash between the objectivism of the lab vs. the subjectivism world of the client. It can be difficult for the practitioner to understand how the academic research culture and the practice culture connect with each other when they seem so disconnected. The deeper problem is not the confusion of the practitioner.

The deeper problem is the actual gap between the phenomenological world of the two cultures. Research and practice are often presented as seamlessly connected. The research vs. practice culture clash is seldom discussed and is most often below the surface; like an unarticulated dilemma; like a problem without words.

The practice world is not one of logical, linear thought where independent variables and error variance are to be controlled. It is a world of affect, great ambiguity, confusion, creative and fluid thought patterns, a language of words, not numbers, N=1 human stories, and an intense focus on the needs of the other. There is a shattered life in front of the practitioner, shattered like when glass breaks when hitting concrete. It is a scene of chaos, confusion, and great sadness with the practitioner’s task—repairing the glass—seemingly impossible. There is suffering and disappointment all around. The world of practice is captured in poetry, abstract art, movies, and the funeral home and other affect-filled realities.

Next I am going to explore the limitations of clinical knowledge coming exclusively from either just research or just practice.

Limitations on Practice Knowledge from Research   

Psychology researchers and other behavioral scientists operate mostly through the lens of the scientific method and live in a circle of knowledge development with their colleagues in this culture. Psychology, as a discipline, made a strategic move in the early part of the 20th century to leave its base in philosophy, and become a legitimate science by adopting a base in the scientific method. In the research universities, the scientific method is the most legitimate paradigm for psychological understanding and there have been enormous contributions to the basic science of psychology through research. To be valid empirically, many variables have to be controlled so that the investigator can see how the independent variable directly affects the dependent variable. This is how science has made tremendous strides in making discoveries and developing new ideas. The model of controlling variables often makes the lab a great contrast to the chaotic world of practice. This often means research that works in a lab, does not translate to practice.

Slife (2004) presents the philosophical assumptions of the empirical research side of the therapy and counseling professions. He says these fields, from the perspective of academic researchers, have adopted naturalism and empiricism, the central paradigm of the natural sciences, as the way to understand human life. He writes: “There is no empirical justification for empiricism, no scientific justification for science. Empiricism and the philosophies underlying science are just that –philosophies. Like all philosophies, they have philosophical axes to grind and pre-investigatory values to assert.”  (Slife, 2004, p. 50) His critique of the empirical method of naturalism; objectivism, materialism and universalism seem especially pertinent to this critique because the practice world does not operate on these theoretical assumptions. For example, human feelings are hard to quantify in an objective way. Another example, is that the unique experiences of an individual may not fit with universal principles but they are still central to the life of one person. Approaches that are not as observable, such as existential, psychodynamic, person-centered, and family, do not make the list because they do not produce data that is principally objective. (Messer, 2001)

Limitations of Practice Knowledge from Practice

The practitioner claims that expertise develops through practice. Does it?  A lot hinges on the answer to this question. If practice leads to expertise, then more practice is the right train to the right destination. If practice does not lead to more expertise then the best solution is to ask the academic researchers for answers. Then, the practitioner’s job is to implement those answers. Unfortunately, all the different perspectives may be partially right. Let’s review the topic and the evidence for ‘practice makes perfect.’

We have all had experiences where doing more of something improves our performance; cooking, learning how to greet others in a different culture, driving a car, using a hatchet, shaving, pronouncing words. And if we really know something well, then we can improvise, and with moment to moment creativity, perform well. George Winston, the pianist, starts his performance by sitting on the stool and then begins by letting his hands take him where they may. This, in my view, is how expert performers in the helping fields do their work.

The problem is that sometimes more practice does not improve performance. The same examples above of practice improving performance can be used as examples where practice may not improve performance: cooking, learning how to greet others in a different culture, driving a car, using a hatchet, shaving, pronouncing words. None of these necessarily get better with practice. Here is another example—when I was growing up my Dad talked about his auto mechanic as a person who year after year didn’t seem to get better at the work.

Without a scientific mindset toward the work, it is easy for practitioners to run with the theory and technique they get exclusively from their own ideas. The theory and technique used by the practitioner may be from knowledge from practice. However, there are other factors guiding the practitioner. The motivation for these ideas may be fame, money, self-healing strategies or the inventor’s own projections of what is important in human life. Sometimes it is all of them. There are all kinds of ideas in the world of practice that emerge with good face validity, but without a thread of external validity.

Practitioners do go off in directions that emphasize their own projections of what is important in human development e.g. Harry Stack Sullivan thought it was anxiety, Albert Ellis thought it was being rational, Victor Frankel thought it was meaning and purpose (Corsini and Wedding, 2007) Although each of these has been a significant contribution, each also has the limitation of not having an empirical base.

There is a powerful seduction to present an approach, theory or technique that works fast as an all-purpose balm. Just like the great new diet plan that supposedly works wonders, the simple, quick, all-purpose solution quickly gets attention. I remember one personality assessment method where the person would line up colors on cards, then get a code based on the order selected and read about one’s own personality. It was fun and engaging. Unfortunately, there was no construct validity. Another example–encounter groups seemed like a good idea at the time until research found that some participants got worse after participating. Oops!  See Encounter groups: First facts by Lieberman, Yalom and  Miles (1973)

Convergence between the Cultures of Science and Practice.. and Personal Life Too

Does it make any sense to engage in practice without reference to relevant research or to engage in research that fails to be informed by the work of clinicians and bears no relation to practice?           

(Lebow, 2006, p. 5)

Important data for therapy and counseling practice comes from an integration of three data sources. It is like a three-sided epistemology learning triangle. One side of the triangle is the enormous knowledge base that comes from the insights gained from reflective practice including clinical supervision and consultation. A second side comes from useful theory and research that is applied to helping clients live richer, more meaningful lives. The third side is the practitioner’s own life which offers wisdom about the human story. Together, these three sources provide the practitioner’s learning triangle of practice knowledge (Skovholt and Starkey, 2010)

Carl Rogers as a Learning Triangle Example

In two large surveys, in 1982 and twenty-five years later in 2006, Carl Rogers has been rated by practitioners as the most influential psychotherapist. (Psychotherapy Networker, 2007)  Rogers was not only a caring practitioner and talented writer. He was also a rigorous scientist who did extensive research on his methods using audiotape recordings to increase practice competence. See his chapter “Client-centered therapy in its context of research” in Rogers (1961) for more specific information. He lived in both cultures of research and practice. And he also used his personal life for insights. Again, see Rogers (1961)

Summary

I will end this article with an example of how the knowledge triangle can work in action. One expert, at age 68, and with decades of data from the knowledge triangle, described the pleasure and effectiveness of the work at the expert level. She said: 

With diminished anxiety, I became less and less afraid of my clients and with that came an ease for me in using my own wide repertoire of skills and procedures. They became more available to me when I needed them. And during those moments it became remarkable to me that someone would have the willingness to share their private world with me and that my work with them would bring very positive results for them. This brought a sense of immense pleasure to me.

                                                            ( Skovholt and Rønnestad, 2011, p. 77)

Tom Skovholt is a professor of counseling psychology at the University of Minnesota in the U.S.A. and a part-time psychology practitioner. He has also taught counseling in Turkey and Singapore and is the author of a variety of books including The Resilient Practitioner.

References

Brehm, S. S.( 2007) Neuroscience and prescriptive authority. American Psychologist, 38 (6), 5.

Corsini, R. and Wedding, D. (2007) Current  psychotherapies. Belmont, CA: Thompson.

Messer, S.B.(2001)Empirically supported treatments: What’s a neobehaviorist to do? In B. Slife, R.Williams, and. S. Barlow (Eds.), Critical issues in psychotherapy: Translating new ideas to practice (3-20) Thousand Oaks, CA: Sage.

Lebow, J. ( 2006) Research for the psychotherapist. New York: Routledge

Lieberman, M.A., Yalom, I.D., and Miles, M.B. (1973) Encounter groups: First facts. New York: Basic Books.

Psychotherapy Networker (2007) The top ten: The most influential therapists

Rogers, C. (1961) On becoming a person. Boston: Houghton Mifflin.

Schön, D. (1983) The reflective practitioner: How professional think in action. New York: Basic Books:

Skovholt, T. M. and Rønnestad, M. H. (2011) The long, textured path from novice to senior practitioner. In T. M. Skovholt and M.Trotter-Mathison (Eds.), The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists ,teachers and health professionals (pp. 39-77) New York: Routledge.

Skovholt, T. M., and Starkey, M. T. (2010) The three legs of the practitioner’s learning stool: Practice, research/theory, and personal life. Journal of Contemporary      Psychotherapy, 40 (3), 125-130.

Slife, B.D. Theoretical challenges to therapy practice and research: The constraint of naturalism. In M. Lambert, M. (2004) (Ed.) Bergin and Garfield’s  handbook of psychotherapy and behavior change. (44-83) New York: Wiley.