In Pursuit of Evidence-Based Clinical Training
The research presented by Whiston and Coker may provide the foundations for the reconstruction of the goals of clinical training. Their review suggests, for example, five goals to pursue in clinical training: (a) cognitively complex students who are (b) skillful at producing/facilitating the experiences common to successful behavior change, with (c) the ability to develop therapeutic relationships with clients by (d) matching to them, and (e) treating them with evidence-based treatment protocols. What is exciting about these goals is that they are evidence-based and therefore we can have increased confidence that if we pursue and achieve them, we will have produced counselors who are likely to become successful change agents. Because the research literature is an "open" system rather than "dogma," new findings will always be added such that the goals of clinical training will always be elaborated and further defined.
Adopting an evidence-based foundation for clinical training will require more than just identifying and adopting research results. Counselor educators will need to raise the value of "knowledge" based on scientific method to a primary position within the profession (Heppner et al., 1999). We will need to create a climate that values knowledge developed from clinical research in training and clinical decision making. According to Heppner et al. (1999), that will require us to foster the "scientific thinking" of counseling students, targeting their epistemological paradigm so that knowledge based on science and the systematic thinking processes characteristic of the scientific method become an integral part of the way they approach counseling. In an interesting way, this is a notion that is not unfamiliar to counselor educators. We have historically attempted to help students become "humanistic" thinkers, "behavioral" thinkers, or "systemic" thinkers. To promote "scientific thinking" is a move toward valuing knowledge based on systematic investigation with common methods, and systematic data gathered over time in unbiased ways. Thus, we will need to realize that it may be just as important to think systematically in the research process as it is to have final knowledge, which is the most helpful component of integrating research into practice.
Scientific thinking may have an additional benefit for clinical training. One of the characteristics of a "scientific thinker" is the ability to discover new ideas, systematically test those ideas, and integrate new knowledge into new explanations of phenomena. Thought of in this way, scientific thinking is a valuable component in helping counselors process information about specific clients in complex ways. According to Whiston and Coker, cognitively complex counselors are more effective counselors. There is also a self-corrective element in scientific clinical thinking in that counselors will have a natural inclination to evaluate the outcomes of their work. Those outcomes, whether they are positive or negative, can feed back into practice so that the next client benefits from the one who came before. In fact, Hoshmand and Martin (1995) argue that, with effort and time devoted to therapeutic research training, more innovative and creative counseling methods are very likely to develop.
Adopting an evidence-based approach will not eliminate the ambiguity in clinical training. There are well-documented problems with the research literature (Sexton et al., 1997). For example, adopting only a logical, positivist definition of science based exclusively on traditional quantitative inquiry methods will limit rather than enhance our understanding of human systems (Hoshmand & Martin, 1995). An evidence-based model will need to operationally define science to mean a systematic way of gathering and evaluating information based on diverse methods relevant to the topic (Sexton, 1996).
Even with diverse methods, the research evidence will never and should never be expected to yield a specific "paint by the numbers" guide to successful counseling practice. Counseling practice will always need to be a combination of reliable research knowledge and experienced clinical judgment. For example, Whiston and Coker make it clear that although there seems to be agreement that a skilled counselor is a critical factor in successful counseling, we have yet to define "skillfulness." The therapeutic relationship is the most important element of successful counseling practice. Even when a manual-based treatment is implemented, it is increasingly clear that the therapeutic relationship is central to the success of the technologies contained in the manual. However, we have an inadequate range of skills and models that define what is therapeutic about a counseling relationship.
I would argue that these gaps and deficiencies in the evidence-based knowledge base are normal, to be expected, and therefore a natural state of affairs rather than a reason to avoid research. An evidence-based approach to clinical training does not require a knowledge base that is complete. In fact, given the complexities of human and social interaction we will never fully understand all the variables, mediators, and processes involved in clinical change. If, however, we adopt a pragmatic approach, thinking of research as a probabilistic problem-solving activity that can, along with solid theoretical knowledge and clinical experience, guide practice, we will have an open system in which new knowledge is constantly integrated in training and practice (Sexton et al., 1997). - Sexton, Thomas L., Reconstructing Clinical Training: In Pursuit of Evidence-Based Clinical Training, Counselor Education & Supervision, Jun 2000, Vol. 39, Issue 4.
Boundaries and Dangers in the Supervisory Relationship
- Budd, Phillip, Boundaries and Dangers in the Supervisory Relationship , Saint Anthony Hospital Family Medicine Residency Program, 2018.
Reflection Exercise #3
The preceding section contained information
about reconstructing clinical training. Write three case study examples
regarding how you might use the content of this section in your practice.
QUESTION 10 Why is "scientific thinking" a valuable component in helping counselors-in-training process information about specific clients in complex ways?
Record the letter of the correct answer the Test