Science and Research
Psychotherapy is a scientific profession. Research in the domain of psychotherapy can be understood as an ongoing structured, methodological process of reflecting on clinical practice, connected with knowledge from research on the functioning of human beings.
Scientific validation means, that the theory has a scientific base, that there are case descriptions, qualitative research, empiric process and outcome research and combinations of qualitative with empiric deigns.
The concept of Evidence based Medicine (EbM), that first was developed for testing pharmacies, describes and contains originally all these kinds of researches. If the concept contains all categories of research designs, it is a useful concept. But unfortunately some research experts in some countries tend to count only so called randomised controlled trials (RCT) as a the “gold standard” in EbM. This is highly controversial discussed in the scientific community. Some researchers say that this is an abuse of the concept of EbM (1) and absolutely not suitable for psychotherapy research.
There has been a wide spectrum of research done in the last few decades that has generated evidence supporting the effectiveness of psychotherapy in general.(2) However, there are a lot of questions not yet answered, such as “How does psychotherapy work?” “What are the change mechanisms?”, “What are the core and specific competencies of therapists that lead to successful therapies?” which oblige all psychotherapy modalities to engage in further research.
Such questions can only be answered if qualitative methods and quantitative methods are getting mixed in a research design and if the dynamic and process of the relation between therapist and client are properly observed. This cannot be done with simple RCT designs.
For public health it is necessary to have research with a high external validation, which means results that are gained in everyday practice (this is called a naturalistic design) and not in laboratories with well sorted out patient groups.
European laws on psychotherapy should insist in accepting a wide range of research designs for scientific validation, that are appropriate to the specific process of psychotherapy in interaction between therapist and client as a co-creation of a healing process.
[1] Kriz, J. (2014.) Koliko je očigledno zasnivati znanost na dokazima? O dobrom konceptu – i njegovoj zloupotrebi. (Wie evident ist Evidenzbasierung? Über ein gutes Konzept – und seine missbräuchliche Verwendung.) u: S. Sulz (izd.), Psihoterapija je više od znanosti. Je li izvanredna stručnost ugrožena reformom? (Psychotherapie ist mehr als eine Wissenschaft. Ist hervorragendes Expertentum durch die Reform gefährdet?) (str. 154–185). München: CIP
[2] Wampold B, Imel. Z.E. (2015): Velika psihoterapijska debata, 2. izdanje. (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 well-being. The research is conducted with respect and concern for the dignity and well-being of the people involved and knowing 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 the consideration of scientific and human values indicates a violation of any principle, the researcher must, in this regard, distance himself. The primary ethical concern of the researcher is to consider whether, in relation to accepted standards, the participant in the planned research will be a “risk subject” or a “minimal risk subject”. Except in the case of research with minimal risk, the researcher conducts a clear and fair agreement
with the participants in the research, before their participation, which clarifies the obligations and responsibilities of each of them. The researcher should respect all the promises and obligations in that agreement. The researcher informs the 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.
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 arise from the research process. If there is a risk of such consequences, the researcher informs the participant. Research procedures that may cause permanent or serious harm to participants are not used. The participant must be informed of the procedures for contacting the researcher within a reasonable period of time after the research in the event of stress, potential harm, or related issues or concerns.
After collecting the data, the researcher informs the participants about the nature of the research and tries to eliminate any misconceptions that may have arisen. The information obtained during the research about individual participants is confidential, unless otherwise agreed in advance.
The psychotherapist will work with children and minors with respect for the child’s personality in accordance with the United Nations Convention on the Rights of the Child (New York 1989) and with the written consent of the parent or guardian.