As the daughter of a physicist, I have a great respect for the powers of science, and I believe asking my opinion about it is like asking my opinion about the moon. Science is merely a way of knowing. But perhaps it is not science or the evidence produced by the use of the scientific method, but rather its application that takes on values and is thus appropriate for opinion making. We see this in current bio-ethical controversies, certainly. And it is evident the field of psychology suffers from the misapplication and misunderstanding of the results of empirically supported treatments (EST’s) (Sanderson, 2003; Kaslow & Thompson, 1998). I have seen this in my counseling experience, where agency directors believe that a manual eliminates the need for training, that research means a treatment can be uncritically implemented across a range of conditions and populations for which it was not designed. Alternately, I have seen this in the political motivation that drives some ineffective treatments to be used rather than those that show research support.
Being trained in a “local-clinical-scientist-practitioner-scholar” model, aren’t we as students supposed to be moving away from opinion-based knowledge and towards evidence based knowledge? I guess I’m neutral with regards to evidence based practice – based on its positive aspects and motivation counterbalanced by its ham-fisted implementation, and codification into law before it has been fully developed or realized. I have read several articles now (Chambless & Ollendick, 2001; Follette & Beitz, 2003; Kaslow & Thompson, 1998; Persons, 2005; Sanderson, 2003; Shirk, 2004) and been exposed to several different perspectives. Many of these appear to be an all or nothing perspective, rather than a reasoned, measured approach that states, yes this is an imperfect system, but it is still evolving, it is still in its infancy. The developers of the programs seem to resist the idea that there could be anything wrong with it because its “scientifically based” while untested theories are lumped together with ineffective theories as “unscientific.” Everyone seems to have a viewpoint, an axe to grind, but isn’t the point of science to get away from all this? Isn’t the point of science to move away from opinions and biases that color the conclusions reached?
We simply don’t know everything yet. We are still learning. The history of medicine does not show a line of perfect treatments from Hippocrates forward. But this is how it evolves. We expect psychology to show the same reliability and validity as medical treatments, but in truth we cannot control for variables in the same way, and the field simply doesn’t have the centuries of research and knowledge that medicine has so far produced. Moreover, psychology appears to be seeking to take a model built around sciences with constant properties such as chemistry and physics (or so we thought before investigations into the properties of subatomic particles or the behavior of compounds in zero-gravity) so that variables can be isolated and reliable predictions can be made. It appears that human behavior is influenced by too many variables to be reliably predicted, but does that mean we should therefore not attempt to try? Add “free will” into the mix and human behavior is essentially a constant state of chaos upon which we try to impose order and rules.
Again, I am fairly neutral because I am waiting to read more studies, gain more experience, see how the field develops and evolves. Having read a mere six or seven articles over the past week hardly qualifies me to have an educated and informed opinion about EST’s. With regard to the application of EST’s to children and adolescents, what I have read indicates that evidence has been difficult to obtain, studies are tricky to conduct, and that while some treatments have been to shown to be effective, there are not nearly enough EST’s to treat the 200 or so disorders listed in the DSM. But again, though the system is imperfect and application is difficult, this does not mean that we must discard it, only that we must continue to help it evolve into a more perfect system.
0 comments:
Post a Comment