Читать книгу Practitioner's Guide to Using Research for Evidence-Informed Practice - Allen Rubin - Страница 27

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.