Sunday, 3 April 2011

Standing on Solid Ground: Psychotherapy and Science

In my January blog I championed the view that all helping professions need to be based on sound first principles, particularly those which aspire to the status of “therapy”. In other words, they should be based on sound science, which can be defined as “…the organized, systematic enterprise that gathers knowledge about the world and condenses the knowledge into testable laws and principles” (E.O. Wilson 1998, p. 57, italics in the original). I also outlined some of the possible implications of Naturalism for therapists, and I want to expand on that here in relation to the scientific approach to gaining knowledge, which Paul Thagard (2010) reminds us differs from everyday reasoning “…in several important respects involving mechanisms, mathematics, social structures, systematic observations, instruments, and experimentation.”

I am suggesting that as psychotherapists we may need to take science more seriously than we currently do, and I list below what I believe to be the main practical implications of this for psychotherapists; I wonder how close any of us come to achieving these targets and working within what is called the “Scientist-Practitioner Model” in the fields of clinical and counselling psychology.

Therapy should consist, in part, of collaborative scientific exploration.

This means that the hunches, assumptions, intuitions, feelings and beliefs of both therapist and client should be explicitly clarified and jointly reality-tested. In this way, psychotherapy should be a self-correcting practice as far as is possible. There is no good reason to think that we can completely trust our feelings and intuitions (as modern psychology has clearly demonstrated; see Sutherland’s work, mentioned below) - our “gut feelings” are useful pointers, but they need to be concretely formulated and objectively tested. As therapists our gut feelings about a client can sometimes feel very compelling, but they are often just a result of our mental “filters”. The gut feelings that clients have can’t always be taken at face value either, if for instance their gut is telling them that they are no good or that there is danger everywhere. Intuitions should be tested, not just trusted.

Therapy practice should be based as far as possible on interventions which have shown their worth through rigorous testing processes.

This means that therapists should familiarise themselves with the latest “evidence-based” findings in relation to therapeutic change processes, and be open to incorporating them into therapeutic practice, if not directly then indirectly through referral or multidisciplinary teamwork. Some well-established examples are: the fact that certain antidepressants help to speed up some people’s recovery from moderate depression (NICE, 2004), and the fact that some anxiety problems, and especially specific phobias, respond much more quickly to a combination of talk therapy and behavioural experiment, than to talk therapy alone (Wells, 1997). Of course, the talk therapy that Wells is referring to here would be principally of a Cognitive-Behavioural kind, as the scientific evidence points to this being the most effective approach to date for working with anxiety problems. (For an Integrative perspective on CBT, check out my blog at

Therapy practice should be based as far as possible on up-to-date information on human psychology and physiology.

This means that therapists should familiarise themselves with the main well-established scientific discoveries in areas such as cognitive science, brain biology, and evolutionary psychology which are relevant to our understanding of human functioning and dysfunction. A good example of this is the work which has been done on the role of the amygdala in anxiety and arousal – a very accessible discussion of this can be found in “Flagging the Problem” by Irish GP Dr. Harry Barry.

Another important example is the work of Judith Rich Harris, who draws on up-to-date findings in behavioural genetics and evolutionary psychology to demonstrate the lack of evidence for any significant role played by nurture in personality development: “…whenever a research method is used that controls for, or is not much affected by, the genetic differences between families, the home environment and the parents’ style of child-rearing are found to be ineffective in shaping children’s personalities” (J.R Harris 2006, p.32).

Out of many other possible examples, I would finally like to draw attention to the huge amount of well-grounded psychological research which has been done on the unreliability of human judgment and decision-making. As I flagged earlier, these findings are nicely summarised in Stuart Sutherland’s entertaining and mind-opening book “Irrationality” (Sutherland, 1992). Therapists, of all people, need to know how unreliable many of our judgments are (and how we tend to stick to them in the face of evidence to the contrary), given that our clinical judgments are both so difficult and so important.

By its very nature, science will often give us different answers than our instincts will (Wolpert 2000; Pinker 1998), but that is exactly why we need it.

References, reading list:

Barry, H. & O’Keefe, S. (2007) Flagging the Problem: A New Approach to Mental Health. Liberties Press.

BrĂ¼ne, M. (2008) Textbook of Evolutionary Psychiatry: The origins of psychopathology. Oxford: OUP.

Harris, J.R. (1999) The Nurture Assumption. Bloomsbury Publishing.

Harris, J.R. (2006) No Two Alike: Human Nature and Human Individuality. W. W. Norton & Co.

Lane, D.A. & Corrie, S. (2006) The Modern Scientist-practitioner: A Guide to Practice in Psychology. Routledge.

Miller, W.R. & Carroll, K.M. (2006) Rethinking Substance Abuse: What the science shows, and what we should do about it. New York: Guilford Press.

NICE (National Institute for Clinical Excellence) (2004) National Clinical Practice Guideline Number 23, Depression: Management of depression in primary and secondary care

Pinker, S. (1998) How the Mind Works. London: Allen Lane.

Sutherland, S. (1992) Irrationality. London: Constable & Co.

Thagard, P. (2010). The Brain and the Meaning of Life. Princeton University Press.

Wells, A. (1997) Cognitive Therapy of Anxiety Disorders. Chichester: Wiley & Sons.

Wilson, E.O. (1998) Consilience: The Unity of Knowledge. Boston: Little, Brown.

Wolpert, L. (2000) The Unnatural Nature of Science. London: Faber & Faber.