From its earliest foundation, psychology has taken upon itself the task of merging science and the human experience (McReynolds, 1997). The intention was, and has been, to provide the best available care and have credibility for such care in a field where clear results and standardized variables are minimal if not non-existent.
When working with human beings, very little seems to be clear and evident. Culture, neurobiological factors, attachment, genetics, gender, religion, etc. all have independent and collective impacts on each of us as humans, whether these factors themselves or our perceptions of them.
As defined by the APA Presidential Task Force on Evidenced Based Practice (2006), Evidenced Based Practice in Psychology is defined as the “integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.”
In layman’s terms, it means that we, as therapists, are to use methods that have been found to be effective with clients/patients through empirical research. These treatments must be relevant to the client/patient’s presenting issues and must take into account their cultural influence and self-determination.
To gain credibility in a “hard” science world of medicine, we must show scientific evidence for scientific outcomes, right? This is, of course, dependent upon the definition of the therapeutic process. Is it medical or something else? Is treating a condition in humans that concerns perception, interpretation and a long list of confounds as cut and dry as any scientific equation of “do this to get this?”
Movement in Psychotherapy
Within the past few decades, we have seen a significant movement in the field of psychotherapy; a shift from medical to relational and experiential. Methodologies, such as Emotionally Focused Therapy and Imago Relationship Therapy have emerged as practices that touch on the foundation of all human existence – attachment.
They suggest that healthy, strong attachments lead to healthier functioning, while the reverse leads to emotional distress and learned behaviors associated with reactions to the absence of said attachment.
From an attachment perspective, what happens in the room during a session is more indicative of unconscious connections formed between the therapist and client. It’s in this space where clients learn and gain increased comfort with vulnerability that has, likely up to this point, not served them well.
We have found that, beyond anything else, the relationship is what matters. Whether in the context of individual, family, couples, children or adults, we, as therapists, are creating a safe space for our clients to feel connection, to experiment with these feelings without judgment or conditional regard and to learn boundaries to take care of themselves without fear of losing perceived value.
Embracing Mindfulness Practices
Also having its time in the spotlight are mindfulness practices, and rightfully so. The Eastern philosophies of Buddhism have been welcomed into Western culture as the distant cousin we all knew and loved, but were reluctant to embrace until our friends thought he or she was cool.
I find it interesting how we are finally embracing practices once used in ancient times and seeing them as new or “alternative.” Make no mistake, mindfulness practices are not new. They are not even new to Western culture. However, only in the last decade (or less) have they been more widely accepted.
Before the introduction of scientific study, these spiritual and experiential methods were the only things available. For clarification, spiritual does not mean religious. Religion can most certainly be spiritual, but my use of the word is in reference to a deeper, metaphysical existence.
At its core, mindfulness work is about paying attention to right now (Kabat-Zinn, 2012). We allow ourselves to be present in our current experience, separating past trauma or any fixation on “what if” in some distant future.
This experience is also what happens beyond the limitations of talking. In fact, yoga and meditation require no talking at all, yet are the fundamental exercises through which we can find balance and connection. Can we accurately measure and put into empirical writing an unconscious experience that is, in fact, beyond language? If it cannot be measured, can it ever be EBP?
Well, some certainly think so. Jon Kabat-Zinn has been a pivotal player in the use of mindfulness practices for mental and emotional health with Mindfulness-Based Stress Reduction being taught all around the country to clinicians and non-clinicians alike.
Bessel van der Kolk has been in almost every conversation concerning trauma for the past several years. His work surrounding practical and effective treatments for trauma recovery have openly advocated for meditation and yoga (Emerson, Sharma, Chaudry, Turner).
Art Therapy Shows Promise
Even art therapy, perhaps a lesser known and younger discipline in mental health treatment, has shown impressive results in treating a spectrum of issues, including sexual trauma (Pifalo, 2006) and attachment-related issues (Ball, 2002), just to name a few.
Have they found some way of miraculously making unconscious, spiritual levels of functioning scientific? I wouldn’t be so quick to minimize these processes to science. You see, what is actually being measured are the occurrences of the stressors or symptoms pre and post treatment.
The application of practices, such as yoga, meditation, clinical hypnotherapy, art therapy, etc. is measured in effectiveness by how they impact the presence of psychological symptoms for distress in clients, which is exactly what EVP entails, according to the definition previously stated in this article.
If someone presents with night terrors, severe anxiety, avoidance and reliving a violent event, we know the above methodology is working when this client’s symptoms are significantly reduced or no longer present.
Measure What We See
The fact is, we cannot make something as deep and spiritual as connection and inner balance scientific or measurable. What we can do, however, is measure what we can tangibly see, the negative symptoms of distress.
Evidenced based practice has its place. Without it, we open the door to every person with a “good idea” to attempt projecting what worked for them onto others. Maybe that would be fine. Perhaps one could say that is what’s missing in current treatments. I’m a bit cautions and apprehensive to join that campaign just yet.
Another component for consideration in evidenced-based practice is managed care. How many clinicians are incorporating yoga, meditation, hypnotherapy, art therapy, etc. into their practice, but only billing for the CBT aspects of that treatment or only doing fee for service, because managed care will not reimburse these techniques?
Why no reimbursement?
Their claim has frequently been a lack of Evidenced Based Practice. If nothing else is to be gained from the five minutes spent reading this article, my hope is that we at least come together to understand and advocate for our field, accepting that it is science, but also much more than that.
Effective psychotherapy is the inclusion of both science and human/spiritual experience. In order to use the most effective treatments, we must be confidently given the space to do so, even if the results are unspeakable, even if clients don’t have words or tangible, measurable accounts of what has happened, but feel differently in a way that works for them.
APA Presidential Task Force on Evidence-Based Practice. Evidence-Based Practice in Psychology. American Psychologist, 61(4), 2006. pp. 271-285. Retrieved June 15, 2015, from http://www.apa.org/practice/resources/evidence/evidence-based-statement.pdf
Ball, B. Moments of Change in the Art Therapy Process. The Arts in Psychotherapy, 2002. pp. 79-92.
Emerson, D., Sharma, R., Chaudry, S., Turner, J., International Journal of Yoga Therapy, No. 19, 2009, pp. 123-128
Mindfulness for Life: An interview with Jon Kabat-Zinn [Motion picture]. (2012). Psychotherapy.net.
Pifalo, T. Art Therapy with Sexually Abused Children and Adolescents: Extended Research Study. Art Therapy, 23(4), 2006. pp. 181-185.
Weis, L., & Hickman, S. Mindfulness Definition. Retrieved June 15, 2015, from http://greatergood.berkeley.edu/topic/mindfulness/definition. 2010
Therapy session photo available from Shutterstock