Psychotherapy is a scientific profession. Research in the field of psychotherapy can be considered a continuous, structured, methodological process of reflection on clinical practice, connected with knowledge based on research on human functioning.
Scientific foundation means that the theory has a scientific basis, that there are case descriptions, qualitative research, empirical processes and outcome research, as well as combinations of qualitative and empirical research.
The concept of evidence-based medicine (EbM), which was primarily developed for the purpose of testing pharmaceuticals, describes and originally contains all these types of research. If the concept contains all categories of research design, it is a useful concept. Unfortunately, some research professionals from certain countries tend to view only randomized controlled trials (RCT) as the “gold standard” within evidence-based medicine. This is a very controversial topic in the scientific community. Some researchers consider it a misuse of the evidence-based medicine concept[1] and absolutely inappropriate for psychotherapy research.
The wide range of research conducted over the past few decades has produced evidence supporting the efficacy of psychotherapy as such. [2] However, there are many unanswered questions, such as “How does psychotherapy work?”, “What are the mechanisms of change?”, “What are the fundamental and specific competencies of therapists that result in successful therapies?”, which obligates all psychotherapy modalities to continue with research.
Such questions can only be answered if both qualitative and quantitative methods are used within the research design framework and if the dynamics and process of the relationship between therapist and client are properly observed. This cannot be achieved through simple randomized controlled trials.
For public health, it is important to have research with a high level of external validity, which means results obtained within everyday practice (this is called naturalistic design), not in laboratories with well-allocated patient groups.
European psychotherapy laws should insist on accepting a broad spectrum of research designs for scientific validation that are appropriate for the specific process of psychotherapy, that is the interaction between therapist and client as co-creation of the healing process.
[1] Kriz, J. (2014.) How evident is it to base science on evidence? About a good concept – and its misuse. (Wie evident ist Evidenzbasierung? Über ein gutes Konzept – und seine missbräuchliche Verwendung.) In: S. Sulz (Ed.), Psychotherapy is more than science. Is outstanding expertise endangered by reform? (Psychotherapie ist mehr als eine Wissenschaft. Ist hervorragendes Expertentum durch die Reform gefährdet?) (pp. 154–185). Munich: CIP
[2] Wampold B, Imel. Z.E. (2015): The Great Psychotherapy Debate, 2nd edition. London, Routledge
RESEARCH – One of the Ethical Principles
The decision to conduct research is based on a thoughtful assessment by individual psychotherapists/supervisors (researcher) of how they can best contribute to science and human welfare. Research is conducted with respect and care for the dignity and welfare of people who participate and with knowledge of the rules and professional standards that apply when conducting research with people as participants.
When planning research, the researcher is responsible for conducting a careful assessment of its ethical acceptability. If consideration of scientific and human values points to a violation of any principle, the researcher must distance themselves in relation to it. The researcher’s primary ethical concern consists of thinking about whether, in relation to accepted standards, the participant in the planned research will be a “at-risk subject” or a “minimal risk subject”.
Except when it is research in which there is minimal risk, the researcher with participants in the research, before their participation, conducts a clear and fair agreement that explains the obligations and responsibilities of each of them. The researcher should respect all promises and obligations in that agreement. The researcher informs participants about all aspects of the research that could possibly affect their willingness to participate and explains to them, in accordance with their questions, all other aspects of the research as well.
The researcher respects the individual freedom of the person to refuse to participate in the research or to withdraw from it at any time.
The researcher protects the participant from physical and mental discomfort, harm and danger that could result from the research procedure. If there is a risk of such consequences, the researcher informs the participant about it. Research procedures that can cause permanent or serious harm to participants are not used. The participant must be informed of procedures for contacting the researcher within a reasonable time period after the research in case stress, potential harm, or questions or concerns related to it arise.
After collecting data, the researcher informs participants about the nature of the research and attempts to remove any misconception that may have arisen. Information obtained during the research about individual participants is confidential, unless it has been previously agreed otherwise.
Their work with children and minors, the psychotherapist will carry out with respect for the personality of the child in accordance with the United Nations Convention on the Rights of the Child (New York 1989) and with written consent of the parents or guardians.