Science and therapy


Yesterday I blogged about why I am so keen to use science to help me work ethically with clients. I talked about the basic onuses that we accept when we decide to become therapists, and showed how these are no more than what I would hope to receive if I saw a therapist or plumber or accountant.

I refer much to William Palya’s Research Methods pages not because it’s the last word on scientific methodology, but because it’s a starting point, and he writes in a very readable way.

Today I want to move on to being pragmatic.
This is the second onus that we usually accept – these are the skills that we need to be secure and successful in our clinical practice, and lead to the reason for using the scientific method as the way to meet both obligations. Once again, I’m quoting mainly from Palya’s work, but paraphrasing and applying it to health practice across all disciplines.

To be pragmatic, you need to:
a. Be a Good Consumer / Separate Illusion from Reality
All theories claim to be correct and all therapies claim to be right. If you are to become a good consumer or practitioner of health care knowledge you must be able to separate truth from fiction even when appearances are deceiving.
b. Ability to Implement Complex Information
You must be able to understand the advanced and sophisticated knowledge of health care in order to properly function as a therapist. Knowledge of people, health and therapy has exploded in the past 20 years and to sift through it all requires skill.
c. Solve Unique Problems by Applying Concepts
Technicians can cope with problems once they are trained to step through that particular solution. A professional on the other hand can solve problems which have never before occurred because they are trained how to identify underlying patterns and apply principles to novel situations. In general, a professional must have the analytical skills necessary to unravel complex behaviors into understood functional relationships, and the competency to design procedures which will clarify causal factors or which will alter behavior.
d. Make Consistent Progress
If you are to succeed at what you are doing you must be right more often than you are wrong. If you are to make consistent progress then you must know when things are getting better and when they are getting worse. With accurate feedback, errors can be eliminated and correct solutions obtained. ‘Common sense’ moves you back and forth in no consistent direction because there are so many competing and opposing ‘common beliefs’. (e.g., it’s never too late, you can’t teach an old dog new tricks / he who hesitates is lost, look before you leap).
e. Prove Effectiveness
You will be required to demonstrate the efficacy of what you do because when the people supplying your income become good consumers, they will demand it of you. This will include: Funding agencies, the Courts, to ensure ongoing employment.

To be both pragmatic and ethical, you’ll need to use a scientific perspective as the only perspective. Why?
Because you need good evidence that things are true before you believe in them. Think of the coin toss result hidden in my pocket – if I gain from your choice, why would you trust my word? You’d really want someone else (if not yourself) to check it out.

Finding ‘truth’ or what approximates it given the current state of knowledge is not as simple as it sounds.
1. Unfortunately, truth is not necessarily obvious, what you like, nor the easiest.
2. Neither is common sense an acceptable arbiter of reality. Common sense can be as dangerous as helpful. Common sense is often true only in the sense that ‘home truths’ predict everything, for example “opportunity knocks once”, and “it’s never too late.” One or the other is certainly true on any one occasion. The need is to know in advance not after the fact when it is too late.
3. Just because your mother, teacher, or best friend believes something does not make it true either. That your friends support your view is no help. Everyone, including a psychopathic murderer, has a mother, a best friend and a dog that believes in them.
4. The fact that something is popularly known is also no reason to believe in it. Everything that is now known to be wrong was once thought to be true by people in the street.
5. Knowing or feeling that you’re right is of no help. Even though most people do believe that they can be wrong, few people ever believe that they are wrong “this” time. Most people (including you) can be talked into believing a nonsensical theory especially if it’s full of jargon, and the person talking to you has power, seems charismatic and you’ve paid for their advice.

You need to accept that any special “inner ability to understand people and recognize the truth” could be the problem rather than the solution. The only way to move past guesswork or habit is to determine what in the past has been shown to produce truth as opposed to procedures which only produced strong emotional commitment but make little lasting change.

What’s truth? Now let’s leave the Great Debate to philosophers, simply put there must be rules to screen-out ‘knowing-that-you’re-right’, opinion, bias and conjecture from truth. Truth is an as-accurate-as-possible description of something that is real, or works, or explains the most with the fewest ‘special’ assumptions. If three people tell you three different combinations to a safe, the one that works is the truth. It means that the information has passed a reality test.

There are some tried and true ways to determine the truth of a claim: more on this next week.
In the meantime, let me know if this is interesting, challenging or just off the wall!  I know I never learned this when I trained as an occupational therapist years ago – I wish I had, because it has confirmed to me that in order to be honest and authentic in what I offer to people, I need to learn how to check the veracity of what I do.

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