Dennis Wendt and Dr. Brent D. Slife, Psychology
The modern age is an age of evidence. A library search of “evidence-based” returns hundreds of entries: evidence-based auditing, social work, wound management, crime prevention, educational methods—the list goes on and on. Virtually any discipline or industry is receiving increased pressure to justify their methods and practices with evidence. Perhaps nowhere is this pressure more evident than in the healthcare arena, including mental health services such as psychotherapy.
Psychotherapy researchers and practitioners agree that psychological practices should be justified by evidence; however, there has been much disagreement about what qualifies as evidence. A growing movement, the empirically supported treatment (EST) movement, has insisted that treatments be empirically validated through the “gold standard” of medical research, the randomized controlled trial (RCT). Others have argued that psychotherapy is often inconsistent with a medical-model approach such as the RCT; therefore, other methods of validation are more appropriate. In the midst of the conflict, in 2005, a Presidential Task Force of the American Psychological Association (APA) sought to reach consensus on a “middle ground” policy for APA. A key purpose for the policy was to reflect “the diverse perspectives within the field” (APA, 2006, p. 273). The result was a policy for evidence-based practice in psychology (EBPP) that was approved by a near-unanimous vote by APA’s Council of Representatives.
Using the new APA policy as a central document, I investigated the strengths and weaknesses of EBPP from a philosophy of science perspective. This endeavor involved library research, as well as attending presentations and symposia at two APA conventions. My central argument, which is elaborated briefly in this report, is that although the APA policy is a step forward for evidence-based practice, it contradicts its fundamental goals of objectivity and diversity. In fact, the policy makes the same fundamental error as the EST movement: it is based upon an implicit framework that commits a preinvestigatory bias against certain conceptions of evidence and the methods they imply. Although the APA policy claims to be committed to diversity, its assumptions are too narrow for it to consider and recognize the legitimacy certain conceptions of evidence.
A primary reason for the narrowness of the APA policy is its failure to explicitly address and justify its empiricist framework. A likely reason for this omission is the implicit assumption that empiricism is “a transparent window to objective reality” (Wendt, 2006, p. 91), rather than one philosophy among many, each with inherit weaknesses and biases. As a result, the Task Force (APA, 2006) equates “evidence” with “empirical,” without justification, throughout its explanatory report of the policy. In fact, in the same way that an EST framework restricts acceptable evidence to a single method (RCT), the APA policy restricts acceptable evidence to a single epistemology (empiricism).
Ironically, an exclusively empiricist framework is not justified with evidence or rationale; it is merely assumed a priori. As a result, unobservable (not strictly observable or empirical, yet experienced) phenomena that are reported by therapists and patients to be essential for effective therapy (e.g., therapeutic relationship) are either ignored or forced into empirical categories (i.e., “operationalized”). In fact, the Task Force explicitly requires for the operationalization of evidence-based practices (APA, p. 274).
This a priori empiricist assumption ignores the existence of qualitative methods, which were developed to enable the investigation of unobservable phenomena, without making such phenomena observable via operationalizations. Although the Task Force includes qualitative research as an acceptable method, it does so in a marginalized and misunderstood fashion that exposes the policy’s empiricist framework. For example, in the Task Force’s descriptions of acceptable methods, the word “subjective” is reserved for qualitative research only, implying that all other methods are “objective.” These subjective/objective categories make sense only from an empiricist framework—and “subjective” is clearly the second-class citizen (Wendt & Slife, in press). More importantly, such categories fail to account for the diverse perspectives within the entire discipline, including qualitative researchers who do not view their research as a “subjective” endeavor.
Considering the failure of the APA policy to achieve its goals of unbiased objectivity and diversity, Dr. Slife and I articulated an alternative framework for evidence-based practice—objective methodological pluralism (OMP). Unlike the APA policy, OMP requires an epistemological pluralism that better considers the epistemological diversity of psychotherapy. Rather than being driven by a particular method (e.g., RCT) or epistemology (e.g., empiricism), OMP would be driven by the object of study (hence the term, “objective”) or, in other words, “the truth of our practical experience” (Slife, 2006). Such a pragmatic framework is modeled after the philosophy of William James, one of the fathers of psychology. The details of OMP are beyond the scope of this brief report; in short, OMP is designed to better incorporate the diverse perspectives of the discipline, and it avoids being driven by a prized method or epistemology. We are currently developing OMP in further detail, and plan to publish our work.
References
- APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.
- Slife, B. D. (2006, April). A practical alternative to the EBPP framework: Objective methodological pluralism. Paper presented at the meeting of the Rocky Mountain Psychological Association, Park City, UT.
- Wendt, D. C. (2006). The unevaluated framework of APA’s policy on evidence-based practice in psychology (EBPP). New School Psychology Bulletin, 4(1), 89-99.
- Wendt D. C., & Slife, B. D. (in press). Is evidence-based practice diverse enough? Philosophy of science considerations [Comment]. American Psychologist, 62.