Starting Life as a Practitioner/Researcher. Arlene Vetere

Transcription

1 Starting Life as a Practitioner/Researcher Arlene Vetere drarlenevetere@hotmail.com

2 Objectives 1. To encourage reflection on the various types of therapeutic change in our work with couples & families, and how these changes could be measured. 2. To consider the outcomes that will appeal to the various stakeholders in psychotherapy/family therapy 3. To review some of the significant issues in family therapy outcome research, and the benefits of practice research networks 4. To familiarise you with the SCORE proposal

3 Issues (continued) Research wants to make the practice as consistent as possible. focus on the treatment Psychotherapy wants it to be as flexibly responsive as possible. focus on the (complex interpersonal and cultural) context. And anything that depends on measurement runs foul of Nash s law of inconsequentiality

4 Problems in generating evidence for everyday practice We often do not have clear diagnoses complex formulations We do not have large groups of clients, with the same condition, and with no co-morbidity Research grants often given by drug companies & medically oriented research councils We are not employed to do research??

5 Current Limitations: the relative failure to incorporate research into training either as a basis for what is taught, or as an inspiration that will carry past the end of the course into having practitioners committed to research. Weissman, M.M. & Sanderson, W.C. (2002). Problems and promises in modern psychotherapy: The need for increased training in evidence based treatments. In B. Hamburg (Ed), Modern Psychiatry: Challenges in Educating Health Professionals to Meet New Needs New York City: Josiah Macy Foundation.

6 SOME ISSUES FOR CONSTRUCTIONIST FAMILY THERAPY.. What does it mean to say couples & SFT worked? How can our belief that it works translate into reportable measures? Dilemma: We have an ethical responsibility to be effective. But we do not find it easy to specify what change is required.

7 Fast exercise in groups of 3 List some things that would indicate to you & your clients, that therapy has worked. Which of these is measurable? Which of these is researchable? Which of these would apply in the range of settings where SFT is used? These are our research measures

8 Check Would the chosen measures convince a family (children & parents, carers, kin)? Would the chosen measures convince a manager?

9 Different checks Which measure would: Satisfy an ethics committee Work consistently (give similar results in similar situation) Be acceptable to both clients and therapists.

10 Core quantitative criteria Reliability Work consistently Validity Would the chosen measures be convincing to all participants? Generalisability Which of these would apply in the range of settings where our therapies are used?

11 The research ? practice gap There is also a widespread problem of getting therapeutic practitioners to make use of research findings. One direction for a solution is to involve practitioners in the research. Much of the outcome research is done by non-family therapists!

12 Clinician identified barriers to clinical research o Time constraints o Outside limitations o Client concerns o Lack of understanding about and involvement in project There is also a widespread problem of getting therapeutic practitioners to make use of research findings. One direction for a solution is to involve practitioners in the research.

13 Practitioner Research networks What might encourage practitioners to play a more active part in designing and conducting research? Are they most likely to be engaged by outcome, process or some other kind of research?

14 Solutions in generating evidence for everyday practice The CORE (Clinical Outcomes in Routine Evaluation) system has worked well to gather data from practitioners in individual psychotherapy. So how about a systemic version of CORE?

15 SCORE: 5 dimensions of family functioning Danger/hostility Communication Atmosphere/mood Flexibility/adaptability Rules/roles/individuation

16 Systemic inquiry as research Is systemic training intrinsically research training and if there is so much common ground, why is research often seen as so difficult and unrewarding?

17 The self of the therapist Discussion about how aspects of the dialogical self of the therapist can be elaborated to include feelings of agency around research. Implications for our national professional associations (and EFTA s/eap s research and training standards committees)

18 Transferable Skills In discussion with your colleague, list those clinical/therapeutic skills that transfer to the research setting..

19 The relationship between outcome research and process research Outcome research is interested in evaluation, and in testing hypotheses about the effectiveness and efficacy of therapeutic methods/approaches does it work? Does it work more efficiently than another method? Process research is interested in change and how change happens exploratory, illuminative research mixed methods - how does it work? In what ways does change happen? What is the experience of change? Lay beliefs about change? The recursive relationship between outcome and process oriented research..

20 Process Moments as Outcomes Please work in pairs Think of a process moment in your therapy practice How can it be considered an outcome Turn it into a research question Hone the question How would you investigate it Present the moment to the group

21 Conclusion All trainers are researchers All trainees are being trained in research methods. But the connections from therapy need to be explicit, and the dialogues need to lead to a self definition as a competent researcher.

22 Stratton, P. (2010) The evidence base of systemic family and couples therapy. Report available from the Association for Family Therapy, UK.

23 Crane, DR and Christenson, JD (2012) A summary report of the cost-effectiveness of the profession and practice of marriage and family therapy. Contemporary Family Therapy, 34, DOI: /s

24 Some References Davey, M et al (2012) Second order change and evidence-based practice. Journal of Family Therapy, 34, Elliott, R, Slatick, E and Urman, M (2001) Qualitative change process research on psychotherapy: alternative strategies. In J Frommer and DL Rennie (Eds) Qualitative Psychotherapy Research: Methods and Methodology (pp69-111) Langerich, Germany: Pabst Science Stratton, P et al (2010) Developing an indicator of family function and a practicable outcome measure for systemic and couple therapy: the SCORE. Journal of Family Therapy, 32,

25 The shape of a research project The world The issue Research on the issue The research question The research methods The research The findings Interpreting the findings Discussing in relation to previous research and theory on the issue Implications for the wider context