What role should empirical evidence have in determining contemporary
psychological practice?
Mick Cooper






Empirical evidence, including from RCTs and other quantitative research -both nomothetic and idiographic -- should have a key role in determining
therapeutic practice:
o both in terms of what practitioners do and what gets funded
This not from some reactionary, scientistic set of assumptions
My background
o Trained as an existential psychotherapist, went on to engage with
person-centred field
o Spent four years immersed in phenomenology, as well as existential
philosophy of Heidegger and others
o Most of my writing in existential-phenomenological and relational
approaches
 Still very committed to that perspective
o Also, came from progressive family background, with emphasis on
social justice and non-hierarchical relationships
 Critique of power-over stance
 Emphasis on mutuality
For me, key principle of therapeutic practice, from both phenomenology,
relational and social justice perspective, is bracketing:
o Don’t impose assumptions on client: e.g.,
 don’t meet client as ‘a borderline personality’,
 don’t assume we know their problems come from childhood
trauma
 don’t assume that a particular therapy the right one
o Rather, stay genuinely open to client and allow their narrative to
emerge
 As per pluralistic stance, find therapy that is right for that person
From this standpoint, empirical research is very problematic - at both
individual and social level
o Provides us with numerous assumptions about how people are what
will help them: e.g.,
 Depression is consequence of maladaptive thinking
 CBT is effective practice for anxiety disorders
o All based on extrapolating from means to general population
 Ignore the individuality and diversity of persons we’re working
with
o Also, Reduce people down to numbers
o Wellbeing and distress defined by measures
o Classic I-It relationship
So for many years, very critical of research
BUT
 Working on paper over a decade ago for the existential psychotherapy
conference…
 Came to recognise something….
1








Although it’s true that empirical research imposes assumptions on how we
engage with our clients
Would be entirely wrong to assume that, prior to knowing about
research (or without it), we are assumption free and unbiased
Rather, from moment we start training, and probably well before that, we have
a plethora of assumptions about why clients are the way they are, and what
can help them: e.g.,
o That it’s because of childhood, or existential meaning, or incongruence
o And that best way to help people is through interpretations, or helping
them find meaning, or through UPR
These come from very legitimate sources, such as theory and personal
experiences
But, at end of day, still assumptions that can get imposed on clients
And can often become ‘sedimented’ by need to prove truth of our
perspective
So, for me, issue is not whether evidence leads us to impose
assumptions on clients
Issue is whether evidence leads us to impose better or worse
assumptions on clients than what we would do if we didn’t have
evidence
Generally think, at minimum, it’s not a worse source
o And therefore worth engaging with, as much as experience or theory
 Both at practitioner and policy level
Why?
o First, expresses voice of client
 Therapists have many assumptions about what works for
clients, but always from therapists points of view
 Know from research that therapists, deeply-held
assumptions about what is going on for clients is often
wrong
 Research, qualitative, allows clients voices to be heard; and
even quantitative gives client outcomes that are outside of
therapists’ assumptions
o Second, expresses voice of many
 Our own experiences are just one person - danger of
generalising
 Or from our clients is just a handful of people
 Body of research presents us with experiences of 1000s of
people
 Opens us up more fully to what is likely
 And also the whole diversity of experiences
 E.g., may have had clients who really benefit from
empathy, but research can help us see that some clients
actually do less well with very empathic relationship
What does this mean in practical terms?
o Absolutely not about just doing whatever outcome or process research
says
o Is about drawing on research, as one source amongst many: a
research-informed approach
2
o
o
o
o
 Both at nomothetic level, and also idiographic one
Research, and research guidelines, can give us some good ideas
about where to start with a client: e.g.,
 Knowing that it’s important to start with a good alliance and
agreement on goals of therapy
 Or that, if client presenting with panic attacks, CBT might be
treatment of choice unless otherwise
Also, research can help us to challenge and question our own biases
and assumptions from theory and experience (just as vice versa can
happen): e.g.,
 From pluralistic field, assume really important to talk to clients
about what they want from therapy,
 But what we see is that some don’t want to do that
 Gives us chance to re-think and refine our approach
 Was going to call this talk: ‘The antithesis of evidence-based
practice is hubris’
 Without evidence, always danger of getting fixed in our
perspectives
At policy level:
 NICE guidelines are far from perfect
 Widely ignore evidence on common factors
 Overly-reliant on RCTs
 Ignore allegiance effects
 But, mistake to think that, if got rid of them, would be back to a
better, or more neutral, situation
 Then, guiding factor for practice would be practitioners’
own assumptions and biases
o Scientology, classical psychoanalysis, orgone
boxes?
 So some kind of research-informed, treatment guidelines are
needed
 If want to include qualitative and other research into it,
need to say how
o Easy to criticise, but much harder to come up with
concrete ideas for how they should be
reconfigured to incorporate this evidence.
To conclude:
‘if our aim is to engage with, and relate to, our clients as the unique
human beings that they are, then the process of constantly questioning
our a priori assumptions is a profoundly important one. Doctrines and
dogmas flourish in the absence of empirical evidence _ research findings
have the potential to call us back to the lived-reality of our clients’ lives, in
all their complexity and diversity. In this respect, research findings can
help us stay open to the multifaceted and ever-changing nature of our
clients’ experiences _ attuned, not to any one set of assumptions, but to
the unique, unpredictable, indefinable individuals that we meet in the
therapeutic encounter.’
3