Evidence Based Practice: Understanding Methods of Research

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In the first part of this essay, I would be sharing how I felt towards the subject of research in my learning. Followed by the my understanding of the origin of ‘Evidence Based Practice’ leading us to express what I think evidence based practise is. I would briefly explore some of the research methods used for research. I would look at why research is useful and also its limitations and disadvantages. Throughout, I would be giving my views and sharing my experiences where appropriate. This will then lead us into the conclusion.

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Before being introduced to this module, I have to admit I have not paid attention to research as a subject before. My assumption was that I perhaps needed to finish the Msc first so I can venture into thinking about a PHD where research and it’s components seems to be the focus subject. Hence, I felt uncomfortable that I will be starting the year with the modules about research, a topic I never thought I would be facing at this stage of my learning. This discomfort contributed to my resistance towards the reading materials and subject itself and in the first few weeks of study finding them boring and mainly struggled to find the relevance for the module. Also the suggestion of posting openly our thoughts about the weekly readings on moodle was terrifying at first. I noticed that I was in such a split state of mind during the first weeks of learning and this is demonstrated by my lack of congruence about how I really felt about the readings. For example, reading through my first weeks posts on moodle, it gives the impression that I enjoyed the reading which contradicted what I had written in my research diary.

For example, in my first moodle posting, I expressed that ‘In my practice, I think research is an invaluable tool which provides an in-depth understanding of what has been found to ‘work or not’ within the psychodynamic realm. This met with an inquisitive mind, I believe it will provide a fertile ground for me to challenge what was or is and hopefully in the process redefine the potential of what could be whilst being mindful of the complex unique needs of each client.’(CBE). In my diary however, I wrote, ‘ I struggled to understand the reading, the topic doesn’t interest me, I feel overwhelmed by it, maybe I should quit the course’. Also not to mention the venting I have been doing to my husband about the subject. I had anxieties about other people reading my postings and that it might reveal that I haven’t understood the readings for instance. I also felt envious and jealous of my colleagues who seemed to understand and enjoy the subject.

Anyway, my understanding of historical and origin of the Evidence Based Practice term is that it is an addition to Cochrane’s initial term Evidence Based Medicine. As a young medical officer, Cochrane (1972) describes how although he had liberty of choice regarding clinical therapy, his difficulty was that he had no idea when and which one to make use of’. This dilemma regarding Cochrane’s medical understanding remained with him and he later in his books explored the ‘ Effectiveness and Efficiency: Random Reflections on Health Services (1972). He used this platform to evaluate the modern medical organisations emphasising that the chaotic and mostly fruitless practices were the norm because the medicine entities had not compiled their knowledge ‘in any systematic, reliable and cumulative way’ (cited in Oakley et al, 2005: 7). He then proposed that instead of the current inefficient practice, it’ll be beneficial to initiate a structure of ‘evidence-based medicine’, in which evidence for the beneficial of medical involvements should be systematically evaluated and shape the foundation for therapy options.

Before I attempt to give my understanding of what ‘EBP’ is, I would first highlight that there seems to be a difficulty in the literature in giving a clear description of what Evidence based practice means. This makes it all quite vague and frustrating for me as a trainee. Anyway, According to Olsson the term ‘EBP on one hand refers to a set of practices and the extent to which these practices have empirical support linking them with measurable outcomes (2007,p274).’ And on the other, the term EBP is also used to define a set of actions, ‘concerned with how research evidence is incorporated into professional decision-making’ (p277

I think evidence based practice is the findings or product of what emerges when we for example embark on trying to know something new or challenge the existing notions. We start from a place of not knowing or curiosity. The process and the ways in which we try to acquire the wished for knowledge and skill, then creates the space to uncover new things perhaps confirming the existing notions or finding a new addition or simply coming into a new discovery. We then use these findings to help us make better decision looking at what is the best available findings about the treatment or topic which is proven to work through research that we can offer to our clients whilst taking into consideration other characteristics. Hence, it seems that in order to have ‘evidence based practice’, some kind of research needs to be conducted. Research processes ( containing sets of actions and practices) being used as the tool to help us uncover what we wish to know. Thus allowing us to demonstrate the findings we acquired through it. These findings from the research conducted in our clinical application for example, then becomes the ‘Evidence based practice’. Each individual type of research informs our clinical application in different ways and each also need different kinds of clinical proof by generating different outcomes as they are used for different purposes. Below I would name and give some brief descriptions to some of the different types of methodologies that can be used to conduct research in the psychoanalytic field which I have learned on this module.

Empirical research- research method conducted on the basis of using concrete experience or observations as opposed to theoretical assumptions. Qualitative method- it focuses on an individual’s lived experience and the social world conducted in a ‘natural setting’. It acknowledges, understands and accept the fact that the ‘lived world is too chaotic to have clear-cut ways and as such ambivalence is celebrated’. It also includes the researchers counter-transference feelings and thoughts as it is a relational process which engages both participants. The qualitative method appealed to me more because it operates in a similar way to how therapy operates except that the qualitative research method goal is more to ‘produce knowledge rather than enabling individual awareness or change’ which is the goal for therapy. Process research- it has an empirically based view on the nature of analytic process and is used to focus on locating and assessing themes or patterns lodged in the analytic processes through the therapist and client interactions (transference and counter-transference). In my CBE exercise I wrote that ‘I like the fact that it can be applied across different circumstances and different therapeutic modalities. Also, because this method does not concern itself with ‘ how an individual compares with another’, but rather looks at how numerous aspects are interconnected to one another within the same subject (case study), I feel I can relate to it as it is quite similar to the ways in which we analysed our case study for previous assignments.’

Now, perhaps the question arises as to why research is useful for counselling theory and practice? My understanding is that research is used for different purposes. For example, curiosity. Curiosity kickstarts the process of us exploring how certain things happen or why they don’t happen and based on which phenomenon. This is useful as it provides a chance to challenge the existing facts and give space for what’s challenged to bring about new information which can foster change etc. I think another purpose for research is that we come to a realisation that we don’t know something (but we are interested in knowing), research then creates the space to uncover new things. Hence, allowing us to move from a point where we didn’t know something and through the process of finding out about that thing we want to know (research) we arrive at a current point where we have gained some knowledge which we didn’t have before we started the process of finding out. Hence, research in Counselling theory and practice is useful in generating understanding something we didn’t understand before and perhaps in the absence of facts and data it can inform us of the chances of something happening which is of value. However I have to say that although I find the notion of being informed about the likelihood of something happening helpful, I also can’t help but wonder if it would not produce the danger of being tempted to always fit the client’s experience to the existing systematic processes instead of taking an individual account without attaching it to an existing notion and which could lead us to neglect the unique individual way of the process.

EBP also gives us an insight about therapy from a client’s view by really understanding what the client might be going through. It offers an opportunity for us to challenge our inelastic systems of belief and helps us reconsider our speculations and instead pay more attention to the client in front of us. In counselling theory and practice, research is also useful in informing our customers (funding bodies and clients) get an understanding of tangible evidence of what it is exactly that we do, how we do it and most importantly does what we do work? We need to give them proof of the value of what we do which explains and convinces them to fund our services or make use of them.

Like any other thing, research in the counselling field has its own limitations and implications. For example, the political hidden intentions directed at helping funding bodies make decisions of how limited funds are distributed in highly competing field. The funding point has prompted me to try and get a better understanding of research, because, I am currently going through a personal experience regarding my clinical placement. My placement (which mostly delivers counselling in a psychodynamic approach) lost their funding to another counselling service ( that uses a CBT approach). We are now facing closure at the end of this month. Perhaps this highlights the inevitable competition within the counselling field between different approaches for funds. Needless to say, this fund cutting is a blow both to me as a therapist and to my clients and it has greatly impacted our working alliance in the consulting room. Research discoveries are bound to be affected by the researchers own hidden goals and therefore we are cautioned to be alert to the context and background of the researcher and what their goals are. Research can be used with ill intentions for people to acquire power and especially when ‘there’s concern of how therapy research is often not presented or explained in a clear way ( Morrow-Bradley & Elliot 1986,193)’. Perhaps like how I was or felt at the beginning of the research module, in research, there’s an indication that therapist are not familiar with it and generally are not curious or interested in its findings.

In our practices, EBP is often seen as a rigid system that disallow ‘real world implementations’ in which decision are carried out when responding to cases which are complex. I would imagine this creates frustration within the practitioners and perhaps at times forces them to fit uniquely individual experiences into a box that can be ticket off in order to meet the criteria set out in the research setting instead of expanding the box to accommodate clients varied experiences which cannot be reduced to a simple measured concept because each individual experience is unique in its own right and the wish to quantify it to measure, I feel strips it of its own uniqueness ( perhaps this is also why I am not keen on the quantitative research methods). As such I feel research should not be about confining individuals experiences to fit their settings but rather to liberate them instead. Midgley also critics the EBP advocates who ‘suggest that all of these forms of decision-making are at best uncertain and at worst downright dangerous. Such views reflect a deep-seated distrust of subjectivity and a wish to promote a method of working governed purely by rationality and ‘objective’ truth’. I am in agreement with his critique as I don’t think there is such a thing as an objective truth. As even what’s observable has a unique subjective nature to the observer through his own lenses (counter-transference) which by default also impinges on the very essence of the ‘objective’ truth and also as we know that with time as we gain more knowledge and awareness about ourselves or certain areas of that specific subject.

On further reflection, I could feel the shift of how I view research happening. I started allowing myself to be open to research ideas especially in light of my placement closing due to funds being cut which I discussed before. I started being more open in the postings about my struggle to connect with the readings and acknowledging the overwhelming feeling of struggling to make sense of the reading. This was more congruent with the feelings I wrote in my diary too. Perhaps I was beginning to accept the difficulties of the learning but in a more authentic way. Here is an extract from my CBE postings demonstrating my shift of expressing my difficulties of learning in a more openly manner. ‘An ambivalent attitude towards psychoanalytic theory’, on a personal level, I can very much relate to it as at times I feel unsure about the theory and its application to practice, yet other times I feel I have a ‘good-enough’ understanding and then the understanding sort of magically disappears again (which I find frustrating to say the least)!! However, taking into consideration what Spurling mentions about Bion’s suggestion of the analyst to have ‘the capacity to forget…..’ I can kind of see the point, assuming that by ‘forgetting’, it opens up space to perhaps learn something new or relearn something in a different way. This reminded me of Alvin Tofflers’ quote, ‘ The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.’ CBE

In conclusion, here we looked at my initial thoughts and feelings about the topic of research. I gave a historical account of EBP and then my understanding of it. I described some methods of research used. Then looked at some pros and cons of EBP and then reflected further on how my initial feelings about research has evolved and leading us to conclusion.

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