Practitioner's Guide to Using Research for Evidence-Informed Practice. Allen Rubin
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decisions or are not well trained in EIP. In their own practice, as well as in their influences on newer practitioners, older and more experienced practitioners may resist notions that they should be influenced by such evidence to change the way they intervene (Sanderson, 2002). These practitioners – including many who provide practicum training in professional education – may have been trained and feel proficient in only a small number of treatment approaches – approaches that may not be supported by the best evidence. Not only might they be dogmatically wedded to those approaches, research evidence might have little credibility in influencing them to reconsider what they do. Instead, they might be much more predisposed to value the testimonials of esteemed practitioner colleagues or luminaries renowned for their practice expertise (Bilsker & Goldner, 2004; Chwalisz, 2003; Dulcan, 2005; Lwin & Beltrano, 2020; Sanderson, 2002).
Some practitioners may feel uncomfortable with EIP because of its emphasis on evaluation, the need for continuous development of new proficiency in skills in practice, and continuous reevaluation of current practices. Experienced practitioners may feel threatened or defensive about the “unproven” practices that they currently use, or feel that they already know how to provide services expertly and do not want to consider other options. Trainees may feel uncertain, anxious, or even embarrassed about their lack of skills in delivering new interventions and feel uncomfortable questioning the practices of senior colleagues. It's important to acknowledge and address these attitudes and fears – as they pose real barriers to the EIP process. Adopting an EIP outlook means fostering your comfort with self-critique and an openness to questioning and changing practices.
1.6.1 Critical Thinking
Gambrill (1999), for example, contrasts EIP with authority-informed practice. Rather than rely on testimonials from esteemed practitioner authorities, EIP requires critical thinking. Doing so means being vigilant in trying to recognize testimonials and traditions that are based on unfounded beliefs and assumptions – no matter how prestigious the source of such testimonials and no matter how long the traditions have been in vogue in a practice setting. Although it is advisable for practitioners – especially inexperienced ones – to respect the “practice wisdom” of their superiors, if they are critical thinkers engaged in EIP, they will not just blindly accept and blindly conform to what esteemed others tell them about practice and how to intervene – solely on the basis of authority or tradition.
In addition to questioning the logic and evidentiary grounds for what luminaries might promulgate as practice wisdom, critical thinkers engaged in EIP will want to be informed in their practice decisions by the best scientific evidence available. If that evidence supports the wisdom of authorities, then the critical thinkers will be more predisposed to be guided by that wisdom. Otherwise, they will be more skeptical about that wisdom and more likely to be guided by the best evidence. By emphasizing the importance of evidence in informing practice, practitioners are thus being more scientific and less authority based in their practice.
A couple of critical thinking experiences in our practice careers illustrate these points. When Allen Rubin was first trained in family therapy many decades ago, he was instructed to treat all individual mental health problems as symptomatic of dysfunctional family dynamics and to try to help families see the problems as a reflection of sick families, not sick individuals. This instruction came from several esteemed psychiatrists in a prestigious psychiatric training institute and from the readings and films they provided – readings and films depicting the ideas and practice of other notable family therapists. When he asked one prestigious trainer what evidence existed as to the effectiveness of the intervention approaches being espoused, the trainer had none to offer. Instead, he just rubbed his beard and wondered aloud about what personal dynamics might be prompting Rubin to need such certainty.
As a green trainee, his reaction intimidated Rubin, who said no more. However, shortly after concluding the training, various scientifically rigorous studies emerged showing that taking the approach espoused in his training is actually harmful to people suffering from schizophrenia as well as to their families. Telling families that schizophrenia is not an individual (and largely biological) illness, but rather a reflection of dysfunctional family dynamics, makes matters worse. It makes family members feel culpable for causing their loved one's illness. In addition to the emotional pain induced in family members, this sense of culpability exacerbates the negatively charged emotional intensity expressed in the family. People suffering from schizophrenia have difficulty tolerating this increased negative emotional intensity and are more likely to experience a relapse as a result of it. Thus, the authorities guiding Rubin's training were wrong in their generalizations about treating all mental health problems as a reflection of sick families.
Much later in his career, after many years of teaching research, Rubin decided to try his hand at practice again by volunteering in his spare time as a therapist at a child guidance center, working with traumatized children. The long-standing tradition at the center was to emphasize nondirective play therapy. Being new to play therapy, he began reading about it and learned that there were directive approaches to it as well. He then asked one of the center's psychologists about her perspective on directive play therapy. She responded as if he had asked for her opinion on the merits of spanking clients. “We never take a directive approach here!” she said with an admonishing tone in her voice and rather snobby facial expression. Once again, Rubin was intimidated. But he kept searching the literature for studies on play therapy and found several supporting the superior effectiveness of directive approaches for traumatized children. Although more research in this area was needed, what he found showed him that there was no basis for the psychologist's intimidating reaction to his question. Instead, there was a good scientific basis for the center to question its long-standing tradition, at least in regard to treating traumatized clients.
1.7 EIP as a Client-Centered, Compassionate Means, Not an End unto Itself
Rubin's experiences illustrate that being scientific is not an end unto itself in EIP. More importantly, it is a means. That is, proponents of EIP don't urge practitioners to engage in the process just because they want them to be scientific. They want them to be more scientifically oriented and less authority based because they believe that being informed by evidence is the best way to help clients. In that sense, EIP is seen as both a client-centered and compassionate endeavor.
Imagine, for example, that you have developed some pain from overdoing your exercising. You've stopped exercising for several weeks, but the pain does not subside. So you ask a few of your exercise companions if they know of any health professionals who are good at treating the pain you are experiencing. One friend recommends an acupuncturist who will stick needles in you near various nerve endings. The other recommends a chiropractor who will manipulate your bones and zap you with a laser device. On what grounds will you choose to see either or neither of these professionals? Our guess is that before you subject yourself to either treatment you'll inquire as to the scientific evidence about its potential to cure you or perhaps harm you. You'll do so not because you worship science as an end unto itself, but because you want to get better and not be harmed.
Needless to say, you have some self-compassion. What about the compassion of the two professionals? Suppose you make a preliminary visit to both to discuss what they do before you decide on a treatment. Suppose you ask them about the research evidence regarding the likelihood that their treatment will help you or harm you. Suppose one pooh-poohs the need for research studies and instead says he is too busy to pay attention to such studies – too busy providing a treatment that he has been trained in, has always done, and that he believes in. Suppose the other responds in a manner showing that she has taken the time to keep up on all the latest studies and explains clearly to you the likely benefits of the approaches she uses versus other treatment options that you might pursue. We suspect that because the latter professional took the time and effort to be informed by the evidence, and transparent about the reasons why she delivers the intervention that she does, you would perceive her to be more compassionate. You might therefore be more predisposed to choose her.
But human service interventions, such as alternative forms of psychotherapy, don't involve