My web site places emphasis on action – getting something done.
So here’s a bit of heresy against myself. Action is not always enough or appropriate to the moment!
How so and when?
Doing is not always a respectable word in therapy as action does not always ‘bring home the bacon’. Action can be be a substitute for ‘real’ change in some situations – a handy disguise – a diversion. We can pretend to be changing. Do you notice when you run around like the proverbial ‘headless chicken’, getting no-where very fast?
Ever heard of the French expression: “plus ça change, plus c’est la même chose“. Roughly: the more it changes, the more it’s the same thing.
One reason why safe experiments may not work is that our cunning minds find actions-of-convenience that are, in truth, sneaky avoidances. On my web site, I have included a useful experiment to reduce that possibility and one such is the Socratic Question – words, not actions.
Bear in mind that the first therapists were the ancient Greeks (oh, and probably sages from even more ancient civilisations). Socrates was a Greek philosopher and he had something useful to say about questioning ourselves and others. His famous sayings include:
An unexamined life is not worth living; and,
I cannot teach anybody anything, I can only make them think.
So, you see, he was keen on thinking before action! As I understand it, he was advising that actions assumes we have made a judgement that so-and-so is a ‘good’ action. He is saying that judgements assume we have thought enough to know what full range of options are open to us. Until this is done, we cannot make a judgement about which option to follow.
Therefore, we can act, but that’s best done after we’ve judged the situation and that’s best done when we’ve excersised on our ability to think on things.
So what other things did Socrates do that seemed to help others? For example, he used Ironic Modesty: once he was challenged by a claim that “No one is wiser than you.” He tried to disclaim the award, but ended up concluding that his wisdom was greater than many simply because he possessed awareness of his own ignorance.
His great skill was the Questioning Habit in his conversations with others. He was argumentative and cross-examined others to improve our self-knowledge. He was said to be devoted to the truth so much so that he died rather than give up his philosophy and his home. He was obliged to poison himself when a jury of his peers convicted him of being too clever by half! He believed in the power of reason and, after his conviction, he was said to have continued to argue about his fate after death.
He saw the sneakiness of his fellows and appeared to test himself to the death.
To become more aware of our own sneakiness requires us to pay attention to our thoughts, beliefs, values and attitudes. In these areas, the experiments you may have to do are thought-experiments. Albert Einstein was the celebrity thought-experimenter and you can find out more about them at:
To work on inoculating yourself, try saying ‘hello’ to your own sneakiness and just notice the ways in which you are sneaky. Notice all the benefits of sneakiness to you and consider whether sneaky may help you from time to time and, if so, how.
When you find a way in which sneaky is getting in the way of your preferred change, go back to this web site and design a safe experiment once more. Let Socrates keep whispering in your ear.
One of the principles I have mentioned is that no ‘safe experiment’ will always work for everybody or even work always for some people. The most sensible thing to expect is that all experiments can work for some people, some of the time.
Sometimes it helps to think about things and to just notice our thoughts. A problem, when designing your own safe experiments, may well be to decide what to record and how to record it. So, now back to actions, once more.
As my web site has been around for some time, the number of pages has increases. As I have gathered feedback from readers and experimenters, I notice a regular question that arises is: is there evidence for the effectiveness of ‘safe experiments’?
I’m going to say ‘yes’ and ‘no’, aren’t I!?
The ‘yes’ is that all the information recorded by readers and clients over many decades constitutes ‘evidence’ in my book. It’s how you use the information that will be improotant. Cognitive behavioural therapy (CBT) – a key model for encouraging experiments (or homework, as some call it) – encourages substantial record keeping. Such records provide detailed information about the outcomes of all our efforts. Further, there is a large body of formal research seeking to organise evidence in books and PhD theses.
I am not an expert in this literature; it increases at an alarming rate and I do not see keeping it all at my finger tips as one of my professional strengths. What I’d like to do on this page is to go back to that word – ‘evidence’. What is meant by it and in what way does it help us to design experiments and promote the changes we want in our lives? There are some misunderstandings to identify and I’d like to clarify what is useful ‘evidence’ when exploring human experience and relationships (as compared to evidence obtained in laboratories).
The dominance of medicine in ‘healing’ has meant there is pressure to define ‘evidence’ the same in both medicine and therapy. This is polticial pressure as much as anything, given the dominance of medical science in the field of research. The British Association for Counselling and Psychotherapy (BACP) is starting to question this approach to the term, evidence in the world of therapy.
Don’t get me wrong; medical bodies and regulators are quite right to place emphasis on obtaining very solid evidence before they let a new medicine loose on the general public. There, the outcomes are matters of life-or-death; often, there is no Plan B or an opportunity to step back and re-design; this latter feature is essential in the design and implementation of small, safe experiments as I am describing them.
The Thalidomide scandal of the 1950’s and 60’s served to drive up standards in research. There have been moves to improve the independence of staff involved in research studies as well. Despite all this, it is possible to manage, manoevre or plain manipulate rsearch findings. The history of research financed by parties with conflicts of interest, e.g. the pharmaceutical industry is littered with examples of this.
The problem for measuring the effectiveness of therapy is that using the tight controls associated with medical science means that:
useful data and results are sometimes excluded from research studies. For example, the experiments I am offering, and you will design, may have no visible result on some occasion. You can neither confirm nor deny your progress toward the objective under scrutiny at that time. Problem is, the same plan may well prodcue a different result on another day. What is ‘bad’ one time, may be ‘good’ or, at least, better another time.
methods applied to the test of a drug are very different from tests we should apply in therapy. You can objectify a drug and make it a ‘subject’ of study. You can control that subject as tightly as you want. Good therapists do not objectify their clients. Effective researchers into therapy are ill-advised to try to do so. The good therapist will negotiate a preferred outcome – one a client wants, and one a therapist is equipped to help on its way. Then the therapist can help a client find a way towards that outcome. Research has to be able to focus light on how that process is initiated and sustained.
Evidence-based researchers say they follow ethical guidelines and that is all well and proper. Those guidelines exist to see ‘subjects’ are not abused. Even so, the key focus of medical research will be: did what we do to our subjects – in applying a treatment in ethical fashion – make people better? In therapy, it is not enough to simply assist people to get better; the way therapists help people get better so clients can continue that work once therapy is terminated. Acheiving this outcome is central to the research in human relations. Ethics are more than a guideline to minimise the potential for abuse. How we behave towards one another is not an optional extra.
Ethical research into therapy should assess what works to ensure clients are respected. Furthermore, research could identify what negotiating and communications styles engage clients. The way a tablet is given to a patient does not usually impact on outcomes (but, again, there may well be evidence to contradict this assertion!).
Research into therapy could study the validity and reliability of experiments but are the criteria to define these terms identical in the scientific and therapeutic environment. Now that is a BIG question. My answer is, no, they are not.
The recording systems used by client and therapist could be assessed. Some may be more efficient than others in illuminating outcomes. But even then, effective therapeutic research identifies how the parties got where they did. It follows the journey from the design of a safe experiment through to observing its outcome. Research in medicine and science may ill-afford to study the journey; some people may die en route and that is not acceptable.
so the ‘danger’ to clients in therapy is of a different order to the risks involved in medicine. Some people do challenge this, say, in relation to reports of ‘false memory’ syndrome, but problems of that order say more about therapists pursuing their own ideas, rather than enabling ‘clients’ to make the move that is right for them. That is not ethical therapy.
Once we can recognise that ‘safe experimenting’ is not what some-one else does to you, then it becomes much easier to look for ‘evidence’ that fosters incremental and fluid outcomes you obtain.
Furthermore, taking small steps in the implementation of ‘safe experiments’ assumes that we can step back from the result and set off in a different direction. It is perfectly reasonable to consider that successful journeys depend on mistakes – or at least, noticing them. Some folk even say that there is no learning without mistakes: the bigger mistakes made, the bigger the lessons learned. Defining evidence in this situation means it is necessary to legitimise the ‘moving of the goal-posts’. That is a ‘no-no’ in strict research work.
even when an experiment is a ‘small defeat’, things can be learned from the outcomes. As seen above, the strict assessment of evidence puts a negative value on ‘failure’ – some people even turns their noses up at Placebo effects. That cuts off a very large chunk of helpful research into ‘what works for whom’.
Strict research looks askance at my assurance: if it works, don’t knock it. Therapeutic research needs systems to define what is meant by ‘what works’ as well as ‘works for whom’.
Research into therapy will find that what works with one person, and at one time, will not necessarily work for some-one else or a different time. Further, we learn much from apparent ‘failure’.
I have a suspicion that some researchers like to follow strict rules of research to affirm the neat and tidy outcomes needed to generate confidence in a new pill or procedure they have designed!! The world of therapy is rarely that tidy and it will miss important things if it tries to copy the ‘medical model’ (not a good term, but it will have to do for now!).
If you want to apply your thinking to this subject, how about seeking out your own definition of evidence-based research. The one offered by one web site is:
Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
What IS “best”? Notice how the practitioner is included here but it is his/her “expertise“, that seems central. Do you wonder if the client is really included in the sentiment that “external clinical evidence” should be matched up with clinical expertise? Sound research results are conclusions drawn from a conference of experts.
Too rarely is a client understood to be expert in themselves and that needs to be at the ethical core of any research into the impact of therapy and how it works.
For a more thorough review of ‘measuring’ the results of our work, have a look at Scott Miller’s blog on: