In some circles there is a slightly strange belief that it is not possible to both be a scientist and be empathic, warm and value the ‘human touch’. I beg to disagree, and in this post I hope to put forward some of my thoughts about how these two ‘ways of being’ are not mutually exclusive.
I’m proud of being a scientist-practitioner. I use this term despite having been told at one point by a senior occupational therapist that if this is the case, then I can’t be practicing occupational therapy. Well at the time I would have quite happily given up the occupational therapy part! And now I’m tiptoeing back towards the values of my profession background while not always following the practises of my colleagues.
The term scientist-practitioner originated in the early years of clinical psychology. In 1949 this model was “proposed as the most appropriate framework for the training and professional practice of the then emerging profession of clinical psychology (Raimy, 1950),[and] its aim was to train psychologists to work as both practitioners and scientists.” Ever since then the debate has raged, but the original intention was to have a “partnership between science and practice [that] would ensure that psychologists achieved a rigor in their clinical work that typified the academic world”.
Critics of the scientist-practitioner model argue that the intentions have never been fulfilled, and to suggest that the ‘scientist’ aspect of the clinician is evident is almost fraudulent – after all, most clinical psychologists don’t directly contribute to research, most don’t confine their practice to strict empiricism, and while the priorities of the scientist are to identify phenomena that can be studied in order to develop generalisations, clinicians work with individuals and their unique and idiosyncratic presentations. In fact, some critics think that the two can’t be combined at all because of the different priorities.
In clinical psychology, the debate continues and there are schools of thought suggesting that it’s sufficient to be able to know about scientific methodology in order to critically appraise the literature – but completely unnecessary to actually have to conduct scientific work as part of a course of study; while others suggest that by developing good scientific skills there is insufficient emphasis on the clinical skills required to be good therapists; some say that the way therapists/clinicians work in the ‘real world’ is so different from the scientific work that research findings and the practice of research are poles apart and can’t be applied clinically, and still others firmly hold that it’s clinicians who fail to read the scientific literature and integrate findings from research into their practice. Does the latter sound familiar to occupational therapists and physiotherapists and others?
So, why do I uphold this as a model for my practice? Well it’s hard to work without some sort of framework, and for me, the desire to know that what I offer as a clinician is based on an evidence base, and to be able to critically appraise that evidence is a big part of that framework. I also apply the ‘hypothesis-testing’ model in my clinical formulations – see my posts on case formulation for more discussion of this – and on theory generation and ultimately theory testing by studying phenomena that occur in the ‘real’ world and systematically examining them using scientific methodologies. I particularly like a definition used by Corrie and Callanan (2001) where it was described as embodying “a spirit of enquiry whereby psychological evidence could be used in a … holistic way, according to the needs of a given enquiry.” I’m reminded here of a quote attributed to Einstein:
“the important thing is not to stop questioning. Curiosity has its own reason for existing. One cannot help but be in awe when he contemplates the mysteries of eternity, of life, of the marvelous structure of reality. It is enough if one tries merely to comprehend a little of this mystery every day. Never lose a holy curiosity.”
Now let me turn my attention to the human part.
To be scientific seems, in some people’s opinion, to lack emotion, or the desire to have empathy or warmth. This view seems to come about because of the need to put aside opinion and bias when drawing conclusions from scientific evidence. It doesn’t, however, mean that when using that information, I should similarly put aside my human empathy and communication skills. I’d argue too, that in order to be curious, scientists need to have a spark of emotion – and to have passion and commitment to carry out the work to really explore what they find!
One of the most scientific yet human approaches I know of is Acceptance and Commitment Therapy – as a clinician, to practice ACT requires active use of mindfulness, being present, cognitive defusion, values, committed action – all the facets of living fully. At the same time this therapy is constantly generating research questions – and finding answers which subsequently generate more questions, and is based on hard, cold facts.
Being human and caring is an essential part of my clinical practice. It’s one of my values – to be as authentic as I can be and to avoid being someone I’m not, and so if someone describes a traumatic situation, an incredibly sad situation, their anger at mistreatment, or frustration at their pain and how it has affected their goals – why shouldn’t I express my empathy for their situation? It doesn’t mean I necessarily agree with what they do, or why they feel that way – but it doesn’t need to stop me being there.
Being human also means I have values that guide what I aim for in my personal and professional life. My values shape what I view as important in my practice. For me, my values began with the values of occupation – that doing and being is important to health. That by helping people engage in the ‘occupations’ or ‘activities’ they value, they regain roles, feel positive about themselves, are able to experience a range of emotions and contribute to their community in positive way.
Can a scientist-practitioner incorporate these values into clinical practice? I hope so – and as the years have gone on I’ve started to see the evidence accumulate to support these values as actually contributing to human wellbeing. Who would have thought that ‘occupational therapy’ described by O’Malley in 1924 as starting in the days of Pinel and the moral reform of lunatic asylum might one day be promoted as a ‘new’ form of therapy called behavioural activation?
It’s worth remembering that being human, showing caring, and being empathic is about how we work with people not what treatments we use.
O’Malley, M. (1924). The psychiatric approach to occupational therapy. Discussion presented at the Occupational Therapy Association, District Of Columbia, St Elizabeth’s Hospital, 1924.
Lane, D., Corrie, S. What does it mean to be a scientist-practitioner? Working towards a new vision. Retrieved from http://www.coachingmentoring.co.nz/resources/articles/204-prof-david-lane-what-does-it-mean-to-be-a-scientist-practitioner-working-towards-a-new-vision Thursday, 26 August, 2010.