Which is More Critical: Science-Based Treatment? Or Skilled Therapists?

by Kimberly on January 26, 2010 · 6 comments

Over the weekend, I listened to a very interesting debate on NPR Science Friday. The three guests were psychotherapists discussing whether there should be a scientific basis to clinical psychology.

I’ve summarized the three viewpoints below. I wanted to share this debate with you, because I think we have similar discussions in the music therapy field.

What do you think? After reading the summaries, please leave a comment. Join the debate!

View 1: We need to improve the scientific basis.

We need to improve the scientific basis for clinical psychology. The public should receive treatment that’s based on the best science available. If a therapist makes a claim that they helped someone, they ought to be able to say what they did and be able to point to the evidence that supports their treatment is effective and not harmful. There is currently no accountability standard in psychotherapy. Practitioners should be held to a standard of evidence.

Many current training programs train practitioners who do not understand science. We want programs that will turn out graduates who advance the field and further our understanding of what works. Several surveys of current practitioners have found that most of them still rely on their own or their colleagues’ experiences when choosing a treatment, instead of the research literature. Psychologists need proper science training, not necessarily to do their own research, but to be able to read and evaluate the research done by others. The science should guide what we do in practice.

View 2: The skill of the therapist is what makes the difference.

The skill of the therapist is what makes the different in treatment, not the particular intervention used. We ought to be accountable for the outcomes we obtain from our patients, not the treatment applied. There’s currently a movement in the field for individual practitioners to collect evidence in their own practice so they can evaluate their effectiveness.

Scientific training is already a part of an American Psychological Association (APA)-approved program. Psychologists are not ignoring the evidence. More science training will only reduce the amount of clinical training and supervision time, which may ultimately decrease the effectiveness of the therapist. The treatments we are giving now are effective. Why change the model?

View 3: We need more science training…for certain situations.

The skill of the therapist is fine for most clients who just need help with basic problems of living and need to talk it out with someone objective whom they trust. But for people with significant psychological disorders, it’s much more important to know the research and whether the treatment we’re going to provide works. Of course we know that the therapeutic relationship is important, but we need to adapt how we evaluate effectiveness based on the disorder.

It’s a great first step to evaluate the results of your own practice. But that may not be enough. How do you really know what is making your client better? It could just be time, relationship changes than occur outside of therapy, medicine, etc. Therefore, we also need more controlled scientific studies.

And we need therapists who understand the science. People in practice need to know when there are treatments that are effective, so they can either get trained in the treatment themselves or refer the client to someone who is. Eventually, students trained in science will begin to infuse their own practice with science. They will read the literature to know what’s out there and what works. They will take care to document the effects of their practice. It doesn’t make sense to say: “This treatment has not yet been tested with this particular group, so I’ll just do what I think is best.” Instead, you should generalize from the best science available and try to determine whether that will work for that particular group. So, yes, it matters for people to know about the science.

What do you think?

So, what do you think? Do you think music therapists should have an understanding of science and be research-savvy? Or do you think it’s more important to focus on clinical (and for us, musical) skills, since that’s what is making the biggest difference for our clients?

If you have thoughts, please leave a comment in the box below. Join the discussion!

And click here if you’re interesting in listening to the debate.

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{ 5 comments… read them below or add one }

Adelaide Dupont January 26, 2010 at 10:41 pm

I very much support View One. A skilled therapist is so because of the science which backs her up.

We need more studies, and more good ones.

I also think that people could understand better that science is a method and not an ideology.

Kimberly January 27, 2010 at 4:20 pm

Thanks for putting in your input, Adelaide! ~Kimberly

Jennifer Sokira January 28, 2010 at 7:59 pm

Good post Kimberly!

I think that perhaps this NPR debate is a little bit reductionistic, and an integration of these views is needed here, and perhaps a couple of additions….I am making the jump to the field of MT here as well, it is definitely a hot topic in our profession, and one that has created a lot of division among our field as well! Overall, though I think we need all three views to truly move our field forward.

Do we need more good scientific research? Yes, for sure!

Is the skill of the MT what makes the difference? Also yes. Music therapy creates opportunities for relationships between the client and music and between the client and thereapist….Many (myself included!) feel that therapy happens in and through these relationships! (Aside: we also need to find more good ways to study these relationships- using BOTH quantitative and qualitative methods) I acknowledge that there are different schools of thought on this in our field, but when it comes down to a discussion of the “skill” of the MT I believe that we might agree that we are speaking of a subjective topic.

Do we need more science training…in certain situations? Yes as well, I think! But I would just as quickly say that in “certain situations” we need other types of training to manage the various aspects of more intense clinical situations and the relationships that come with them. We need to get guidance in these situations. We look to the research, we look to the experts, we look to supervisors, peers and mentors. At the end of the day, if we honestly don’t have the knowledge or ability, ethically we should refer the case to someone who does.

To me, it really is the integration of our clinical experience, understanding of the research and literature, our own musical skills and abilities that all come together to help us effectively work as music therapists— we need to nurture ALL of these things (and research them!) to best serve our clients.

Kimberly January 29, 2010 at 4:34 pm

Wow, Jennifer–what a thoughtful, thorough response! I agree that the NPR debate was too short–it’s hard to gather all the nuances of each argument in a 20 minute podcast. I don’t think I have anything else to add. Thank you for contributing. ~Kimberly

Lindsay Marsh February 3, 2010 at 11:06 pm

Thanks for posting this!

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