This is the last post in this mini-series on why I use science when deciding what interventions to use as a therapist. As I did yesterday and the day before, I refer to William Palya’s book on research methods – it’s easy to read, available on the internet for free, and although it gives only one view of scientific method, it’s a good start.
After having discussed the first onus – which is to be ethical, and the second, which is to be pragmatic, the third is to use a method to help achieve one or both aims. There are two basic things you need to do:
(1) Demand truth and
(2) Have good understanding
So, what is truth?
Well this can get into murky waters – especially if you listen to the philosophers! But for practical purposes, we can assume that ‘truth is an accurate description of something that is real’. It’s process of building up evidence from many sources, at different times, in different places that describe the same thing, using the least number of assumptions or appeals to special factors that can’t be tested, and describing the majority of the thing under examination. We can use the word ‘phenomenon’ instead of ‘thing’, or ‘event’ or ‘factor’.
Empiricism is one way that is used to determine ‘truth’. Something that is empirical is observed – through technology, to be sure, but can in some way, correspond with something that exists in the real world. As Palya puts it ‘If we wish to claim that something we cannot experience is real then the burden is on us to prove it to a skeptical audience; that is only fair.’
The evidence needs to be reliable – that is, if you look at it more than once, it should be the same. It should also be the same if anyone looks at it.
There should be more than one source of evidence for the ‘thing’. Palya’s example may help – ‘The more evidence from the wider a variety of sources, the more believable. If the police find a finger print the same as yours at a murder scene, maybe it means you are guilty, maybe it doesn’t. However, if the police also find your wallet there, and the murder weapon in your house, and the tire tracks of your car at the murder scene, and the victim’s jewelry at your house, and your teeth marks on the victim’s throat, and a VCR tape of the murder with you in the starring role – well, then you’re in trouble.‘
You can’t be the only person to say it’s so – and the others that agree with you also need to hold to the same ideas about what is ‘true’ and ‘real’. ‘If several observers who abide by the “rules” of science all agree concerning an event then it is probably true. It is reliable, it is objective. If only one person observes something and others do not observe the same thing then it is subjective.’
The phenomenon needs to be carefully defined so we all agree on what it is and that it describes the essence of the phenomenon. ‘The concept of a horse is false if it includes the saddle or fails to include four legs; it is false if it includes speaking English or fails to include galloping.’
The implications of this aspect of ‘truth’ is that the words we use to describe need to include the critical or essential elements, while excluding those that are not essential. A good definition is unambiguous with respect to what is included and what is not.
The definition you provide must actually have an impact on something that can be measured – because if you can’t confirm that it affects something, it might as well not exist.
‘Things cannot be said to exist outside the impact they have on sensation (resulting measures) or the impact on other things (functional definition). If your idea of the correct concept of a thing exceeds its operational/functional definition, the burden of proof or burden of communication is on you to prove, explain, and communicate the difference.’
I leave the best summary again to Palya: ‘we start with the notion of empirical, reliable evidence with multiple converging support which is operationally/functionally defined and has consensual validation and ask what is beyond. If someone wants to offer something else as a “truth” it must be proven. Truth does not mean anything anybody wants it to mean. Anyone wanting to extend the meaning of truth to something beyond what science has already substantiated must explain to us what they are talking about.’
Some people say that because various ideas that were once strongly supported by scientists have been rebutted in recent years that there is no such thing as ‘truth’ and science is nothing more than a set of opinions that change all the time. (eg disc prolapses on MRI were once thought to indicate the source of back pain and therefore needed surgery, now they are thought to be incidental and possibly a ‘normal’ variant in many cases)
Some things do change over time – not because the ‘truth’ part changes, but because more information comes to hand that explains more, or explains more with fewer special assumptions, or has more robust support than the previous ‘truth’. This is, in part, why we describe ‘truths’ as theories – theories can be and should be continually tested and as a result, refined. If a theory cannot be tested – then it’s really a model and needs to be evaluated in terms of how useful it is. If it doesn’t help with making decisions that can be tested, then it’s not useful at all.
Whew!! That’s a lot of theory and philosophy of science!
I think though, that it’s really important that we, as therapists, work out why we use the interventions we do, and that we can point to a method that means we feel we can rely on the interventions – and that we really do understand what we mean by evidence and science. Otherwise we are only reciting by rote, or working by habit and convention rather than seeking to understand.
It means you can describe, predict, know how to influence, synthesise and explain what you are actually doing.
Have a great weekend – it’s Friday here, and I’m about to look for a Friday Funny. Be back soon!