The idea of ‘evidence-based practice’ has been turned into a blunt instrument to designate different ways therapeutic approaches into ‘good vs bad’ or ‘ethical vs unethical’. Or ‘funded vs unfounded’.
Understandably, this has lead to the criticism that research is limited in its ability to accurately assess what works in the complexity of the real world. Which is fair. Research into the nature of research lays bare a myriad of flaws, artefacts and overreach in how we conduct and interpret the studies we then rely on.
But to dismiss ‘evidence-based’ entirely is just as unhelpful. Imperfect as the research may be, it still offers insights we would struggle to achieve from our individual experience alone.
There is, however, a biased cherry-picking of what evidence is attended to in the first place that prioritises what we can standardise, measure and put into a manual. And we risk ignoring other bodies of research that can inform our approach to complex human problems.
The process or ‘what works’ literature highlights the significance of therapist and therapeutic relationship factors that may contribute more to outcome than the specific therapy being offered. How we treat people matters.
We have whole disciplines beyond talk-therapy psychology that study what helps humans to thrive within themselves, within communities, within societies, within our ecosystems.
We also have rich wells of indigenous knowledge and systems that have been tested and refined not over 5 or 50 or 100 years, but over thousands and tens of thousands years.
We don’t need to throw out the idea of ‘evidence-based practice’, we need to be more discerning about what evidence we pay attention to, and be realistic about how much value we can place on any one part of the bigger picture.
Helen Mentha 