Abstract
The professional context in which clinical psychologists and psychotherapists work is characterized by uniqueness, uncertainty and value-conflicts. Given this context, what kind of evidence can they use to orient their interventions in a reasonable and purposeful way? In this paper, the author addresses the question of the epistemological underpinning of clinical reasoning. On the basis of current concepts in philosophy of science, a distinction is made between statistical thinking and thinking in cases as two epistemic approaches relevant to the field of clinical psychology and psychotherapy. Each of these thinking styles is a unique mode of investigating, conceptualizing and interacting with objects of interest. The author argues that statistical thinking and evidence in terms of probabilistic knowledge are epistemically less suited to support clinical reasoning and decision-making in practicing psychologists and therapists. Thinking in cases relies on evidence from within the case and evidence from clinical experience. This epistemic mode permits the practitioner to address unique situations by understanding the case from within and in reference to other cases, and to address uncertainty by intervening in causal processes that are at work at the level of the case. Thinking in cases is epistemically more coherent with the context in which clinicians work. In the conclusion, suggestions are made for bridging the gap between science and practice.
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References
American Psychological Association. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271.
American Psychological Association. (2021). Professional practice guidelines for evidence-based psychological practice in health care. American Psychological Association.
Berg, H. (2019a). Evidence-based practice in psychology fails to be tripartite: A conceptual critique of the scientocentrism in evidence-based practice in psychology. Frontiers in Psychology, 10, 2253. https://doi.org/10.3389/fpsyg.2019.02253
Berg, H. (2019b). How does evidence-based practice in psychology work? – As an ethical demarcation. Philosophical Psychology, 32(6), 853–873. https://doi.org/10.1080/09515089.2019.1632424
Castonguay, L. G., Barkham, M., Yuon, S. J., & Page, A. C. (2021). Practice-based evidence—Findings from routine clinical settings. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 191–222). Wiley.
Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Social Science & Medicine, 210, 2–21. https://doi.org/10.1016/j.socscimed.2017.12.005
Erekson, D. M., Janis, R., Bailey, R. J., Cattani, K., & Pederson, T. R. (2017). A longitudinal investigation of the impact of psychotherapist training: Does training improve client outcomes? Journal of Counseling Psychology, 64(5), 514–524. https://doi.org/10.1037/cou0000252
Forrester, J. (1996). If p, then what? Thinking in cases. History of the Human Sciences, 9(3), 1–25. https://doi.org/10.1177/095269519600900301
Forrester, J. (2017). Thinking in cases. Polity.
Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., & Hoyt, W. T. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. https://doi.org/10.1037/cou0000131
Hacking, I. (1975). The emergence of probability: A philosophical study of early ideas about probability, induction and statistical inference. Cambridge University Press.
Hacking, I. (1992). ‘Style’ for historians and philosophers. Studies in History and Philosophy of Science, 23(1), 1–20. https://doi.org/10.1016/0039-3681(92)90024-Z
Hacking, I. (2012). ‘Language, truth and reason’ 30 years later. Studies in History and Philosophy of Science, 43(4), 599–609. https://doi.org/10.1016/j.shpsa.2012.07.002
Hacking, I. (2015). Probable reasoning and its novelties. In T. Arabatzis, J. Renn, & A. Simões (Eds.), Relocating the history of science. Boston studies in the philosophy and history of science, volume 312 (pp. 177–192). Springer.
Haig, B. D. (2018). An abductive perspective on clinical reasoning and case formulation. In B. D. Haig (Ed.), Method matters in psychology. Studies in applied philosophy, epistemology and rational ethics, volume 45 (pp. 109–133). Springer. https://doi.org/10.1007/978-3-030-01051-5_6.
Kahneman, D. (2011). Thinking, fast and slow. Penguin Books.
Kaluzeviciute, G., & Willemsen, J. (2020). Scientific thinking styles: The different ways of thinking in psychoanalytic case studies. The International Journal of Psychoanalysis, 101(5), 900–922. https://doi.org/10.1080/00207578.2020.1796491
Kuhn, T. (2012). The structure of scientific revolutions (4th ed.). University of Chicago Press.
Levitt, H. M., Surace, F. I., Wu, M. B., Chapin, B., Hargrove, J. G., Herbitter, C., Lu, E. C., Maroney, M. R., Hochman, A.L. (2020). The meaning of scientific objectivity and subjectivity: From the perspective of methodologists. Psychological Methods. https://doi.org/10.1037/met0000363.
Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33(7), 883–900. https://doi.org/10.1016/j.cpr.2012.09.008
Meehl, P. E. (1973). Why I do not attend case conferences. In P. E. Meehl (Ed.), Psychodiagnosis: Selected papers (pp. 225–302). University of Minnesota Press.
Meehl, P. E. (1996). Clinical versus statistical prediction: A theoretical analysis and a review of the evidence. Rowan & Littlefield/Jason Aronson.
Meganck, R., Krivzov, J., Notaerts, L., Willemsen, J., Kaluzeviciute, G., Dewaele, A., & Desmet, M. (2022). The single case archive: Review of a multitheoretical online database of published peer-reviewed single-case studies. Psychotherapy. https://doi.org/10.1037/pst0000431.
Morgan, M. S. (2020). ‘If p? Then what ?’ Thinking within, with, and from cases. History of the Human Sciences, 33(3–4), 198–217. https://doi.org/10.1177/0952695119899349
Orlinsky, D. E., & Ronnestad, M. H. (2005). How psychotherapists develop. American Psychological Association. https://doi.org/10.1037/11157-000.
Overholser, J. C. (2020). 50 years of psychotherapy: Erudition, evolution, and evaluation. Journal of Contemporary Psychotherapy, 50(2), 87–93. https://doi.org/10.1007/s10879-019-09441-8
Rober, P., Elliott, R., Buysse, A., Loots, G., & De Corte, K. (2008). What’s on the therapist’s mind? A grounded theory analysis of family therapist reflections during individual therapy sessions. Psychotherapy Research, 18(1), 48–57. https://doi.org/10.1080/10503300701324183
Schön, D. A. (1991). The reflective practitioner: How professionals think in action. Ashgate Publishing.
Sciortino, L. (2021). The emergence of objectivity: Fleck, Foucault, Kuhn and Hacking. Studies in History and Philosophy of Science Part A, 88, 128–137. https://doi.org/10.1016/j.shpsa.2021.06.005
Storck, T., Volkert, J., Brauner, F., & Sell, C. (2021). Psychotherapeutische Arbeitsmodelle in unterschiedlichen Verfahren—Skizze einer konzeptvergleichenden Psychotherapieforschung. Forum der Psychanalyse, 37(2), 149–163. https://doi.org/10.1007/s00451-021-00435-8.
Truijens, F. L., Van Nieuwenhove, K., De Smet, M. M., Desmet, M., & Meganck, R. (2021). How questionnaires shape experienced symptoms. A qualitative case comparison study of questionnaire administration in psychotherapy research. Qualitative Research in Psychology. https://doi.org/10.1080/14780887.2021.1886383.
Westen, D., & Weinberger, J. (2005). In praise of clinical judgment: Meehl’s forgotten legacy. Journal of Clinical Psychology, 61(10), 1257–1276. https://doi.org/10.1002/jclp.20181
Zeldow, P. B. (2009). In defense of clinical judgment, credentialed clinicians, and reflective practice. Psychotherapy, 46(1), 1–10. https://doi.org/10.1037/a0015132
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I would like to thank professor Emmanuelle Zech, Hubert de Condé and Niccolò Polipo for their feedback on an earlier version of this manuscript.
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Willemsen, J. The Use of Evidence in Clinical Reasoning. J Contemp Psychother 52, 293–302 (2022). https://doi.org/10.1007/s10879-022-09544-9
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DOI: https://doi.org/10.1007/s10879-022-09544-9