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Taking research into the real world

The world of psychotherapy outcomes research is changing. It’s not changing drastically, as when an apple pie becomes a New York steak, but it is changing. In the past great projects run out of university labs involved thousands of people and were funded by large grants from governments and private organisations. Subjects were assigned randomly to treatment groups or control groups, and then measures were taken using various scales, tests, and assessments. The condition of the subjects before treatment was compared statistically to the condition of subjects at the conclusion of treatment, and often then also at an interval subsequent to the end of treatment.Problems with that approach developed over time and the pattern of them became inescapable. The research questions became increasingly esoteric and unrelated to the clinical concerns of therapists practicing with real people. The research projects reflected the needs of the academic community — needs to gain tenure, needs to get grant money to pay salaries, etc. — but they did not address the concerns of people practicing in communities with living human beings. Also, the research conducted in academic settings, even when clinical concerns were the focus, did not represent real-world conditions. That is, so many possibly confusing variables were eliminated that the conditions under which the research was carried out were mismatched with conditions in mental health clinics and psychotherapy private practices. So, nobody in the clinical world was actually reading and utilising the results of psychotherapy research, because it was regarded to be largely irrelevant.Psychologists realised that the situation had to change. Now there is an emphasis on creating relevant research, which means not so much establishing THAT something works (even though that is still important of course) but what makes it work and what aspects of a particular therapeutic process are more powerful for change than others. The new emphasis is on process-outcomes research. Furthermore, there is a push to market research findings; so, good old-fashioned public relations tactics are being utilised to get clinicians to pay attention to research developed through university programmes. Something called “evidence-based practice” is also a big driver, and this does not actually refer to the type of therapy used but to the practice of any given therapist in using the best research available relevant to the treatment of a particular issue, together with clinical wisdom, and client preferences.Probably the most important shift in research, however, is that increasingly it is being carried out in real-world settings. Instead of creating research at the university and then asking the clinic to use it, researchers are moving into the clinic to create research right where they hope it will be utilised. Furthermore, clinicians are being trained to generate their own research and to organise into practice-based research networks.As an example of this in May of next year I will travel to Rome for several days of a training conference. Psychotherapists in Europe are gathering in order to consider practice-based evidence, practice-based research networks, and to learn four research methods they can participate in or utilise in their practices. In addition to speaking about the philosophy of science behind research, I’ll be teaching psychotherapists how to use the single case, timed series research design (SCTS), which is something individual practitioners can use to demonstrate that what they do when they practice psychotherapy is effective. In addition, I am coordinator for the North American division of an international research project using SCTS that will also run meta-studies aggregating the work of therapists in a practice-based research network including people from Chile, Italy, the Czech Republic, Canada, the USA, Germany, and France.Here in Bermuda I will be offering psychotherapy for highly reduced rates for people willing to participate in this research project. Public announcement will be made when the research project begins.When I became a psychologist, I never thought I would also one day become a researcher. I was trained to understand research, but my degree is not a research-oriented degree; it’s a clinical degree. I have extensive training and experience doing psychotherapy and psychological assessments. The field, however, changed right under my feet. Now, practitioners need to do research. It’s not good enough for them to understand what research is; practitioners need to be conversant with research literature, and they actually need to create original research of their own. Whereas previously I could talk theory and philosophy as these related to the practice of psychotherapy, now I can discuss various research findings and their implications for practice, and I have seen how research relates to the theories and philosophies I’ve been discussing.Like other clinicians who realise how things have changed, I have had to engage in a learning curve. I revisited my research design classes, read updated textbooks, talked over research design and evaluation of results with world-class researchers, and I’ve joined a growing community of practitioner-researchers from various parts of the world. I am not all that unusual in this respect. I was encouraged, actually, when I met with colleagues at a recent research conference and realised that I’m just one among many.Change is a constant. People, things, and conditions in our world are always changing. The Bible says that this world and the concerns of this world are in a state of passing away. We sometimes act as if the current moment and its nature will remain, but it doesn’t. It passes in the instant that it occurs, and people have to adapt. People also act as if their goals, once achieved, will last and suffice, but they won’t. There will always be new interests and needs, and what is once obtained will not last nor completely satisfy.When we are children we think like children. We think that people grow taller with each passing year, and it seems as if that will just keep going on, but it doesn’t. At some point we stop growing taller and we start growing wider. We age. It’s not just that different things happen, but the way they take place also changes. Our metabolism slows down. Our hair changes colour, and falls out. Our skin loses its elasticity. We start to forget. As our bodies get older our perspectives on life become more complex, and we realise that we don’t know as much as we thought we did. We may have a better understanding of technology or how things work than people did in previous generations, but we may not really have much wisdom. Wisdom grows through the assimilation of novel experience. Novel experience does not exist unless there is change. In psychotherapy the way we understand the process is becoming wiser through the development of practice-based research.