Psychotherapists as Scientist Practitioners
Research is important in the scientific field of psychotherapy, where we tend to think of ourselves as “scientist-practitioners” (Overholser, 2012). Although some psychologists are active researchers and clinicians, the importance of consuming research and research productivity as well as the attitudes toward science and research evidence might differ per setting (e.g., academic or private practice; Llewelyn, Hardy, & Aafjes-van Doorn, 2015). Conducting research can be an enjoyable and intellectually stimulating endeavor, especially if the findings leave our personal laptops and research labs, and are read and used by others in the field. Therefore, researchers share their findings with other professionals in peer-reviewed journals, on listservs, as well as in press releases for popular magazines and social media. With a bit of luck, this research evidence then gets used by clinicians, policymakers, insurance companies, and psychology professors who educate our students. Ultimately, we hope our research will enhance the efficacy and effectiveness of the treatments we offer our patients, and help patients reduce their suffering.
Even if we are not active researchers ourselves, as clinicians we are reflective “scientist– practitioners” who strive to offer the best evidence-based practice to our patients (Llewelyn & Aafjes-van Doorn, 2017). Moreover, many clinicians take the role of “curious scientist”; involving patients in their road to recovery as “expert by experience,” increasing agency and eliciting more realistic views by challenging irrational thoughts or Socratic questioning. We often roll our eyes when patients tell us they have been given (incorrect) treatment diagnoses by their friends or when patients have been browsing the internet to find an answer to their multitude of worries. So why do we not help them along and present our patients with the research findings they are looking for to understand themselves better and inform their decisions? In this world of alternative facts, would it not be our responsibility to identify and share the most relevant and robust research evidence with our patients?
Sharing Research With Patients
Why we don’t. There might be several reasons why we as scientist-practitioners decide not to share research findings with our patients, either by deliberate choice or for more implicit reasons. First, we might hold ethical objections. For example, some clinicians hold the view that they should be the people who digest research findings and not burden patients with this. They argue that, given our training in searching, reading, digesting, and interpreting relevant research, making decisions about care is our professional responsibility, and this should not be expected of the less educated lay patient (e.g., Garcia, 1987; Shalowitz & Miller, 2008). Similarly, others might argue that sharing common research findings with patients does not have therapeutic benefit. For example, the research evidence on the modest effectiveness and efficacy of most psychological treatments, as well as data on patients who deteriorate, or the fact that more experienced and expensive therapists are no more effective than their students (e.g. Tracey, Wampold, Lichtenberg, & Goodyear, 2014), might not be something the clinician wants to share. Indeed, sharing these findings might not make our treatments more effective, especially since research tells us that positive patient expectations, hope, and belief in the therapist and therapeutic methods is crucial for treatment outcome (e.g., Constantino, 2012).
In addition, we may be reluctant to share research with our patients for reasons of which we are less consciously aware. We know, for example, that research is not everyone’s cup of tea. Most clinicians joined the profession with an interest in people rather than research, have not actually published their dissertation research, and have had negative experiences with trying to get research projects published (Llewelyn et al., 2015). Moreover, some more clinicians might not be convinced by the quality or relevance of the current psychotherapy “evidence-base” and may see research as an intrusive threat to the intimate therapeutic encounter rather than a tool for treatment improvement; these clinicians may prefer to be guided by their clinical intuition instead (Taubner, Klasen, & Munder, 2016). Also, more practically, in our busy practices time is taken up by urgent clinical issues that need our immediate attention, and research might not be on the top of our agenda (Llewelyn et al., 2015). On a more personal level, the thought of sharing research findings (either our own or those of our colleagues) might make us feel insecure and vulnerable about our own scientific expertise. We might, for example, find the study results difficult to understand ourselves, and we might not be sure what they mean or how they relate to our individual patients. And even if we do understand the research and want to share it with our patients, we might doubt ourselves (Taubner et al., 2016), be afraid to fall off our pedestal and lose the position of expert, or not know how to go about sharing it in the most therapeutic way.
Why we should. Dissemination of research findings with patients may be important for a number of ethical, research, and therapeutic reasons. First, patients in the community deserve access to the knowledge they have made possible through participation or other forms of engagement in a study. And if they have not participated yet, they might be more inclined to do so when they can see how research participation might be used to improve clinical practice. Second, community dissemination creates opportunities to explore the implications of research findings from a local perspective (McDavitt et al., 2016). This means that by sharing the latest research findings with our patients, new evidence-base is more likely to be considered, implemented, and immediately applied—there and then. Third, involving patients in discussions about new findings is particularly crucial for addressing health disparities and may guide future clinically-relevant research, bridging the practice-research gap (Goldfried, 2012).
But sharing research evidence with patients is not only beneficial for the long-term greater good of patients at large; sharing research, including its flaws, contradictions, and limitations might be helpful to our immediate patients in treatment, too. First, it seems unethical to expect patients to choose a particular therapy approach, treatment, or therapist when they do not have access to the evidence-base and do not understand the scientific jargon. Arguably, it is therefore therapists’ responsibility to share the honest, unbiased research findings, as well as their opinions based on particular patients.
Besides the obvious benefit of the gained knowledge itself, one could argue that the process of sharing research findings might also be therapeutic to our patients. Patients often come to therapy because they want to learn how to change their old ways. Patients have often developed their maladaptive coping mechanisms for a good reason, and letting go of old patterns is hard. Therefore, clinicians with a “curious scientist” approach might provide great examples of curiosity toward new information, openness to trying out new methods, and life-long personal development. This is not to say that we should accept research findings as given truths or that research findings are the only source of evidence in clinical practice. When the research evidence is unclear or we feel uncertain, this might provide the perfect opportunity to role-model how to tolerate not-knowing exact answers, as this uncertainty in life and relationships is exactly why patients come to us.
Patients who participated in research. The most obvious situation in which scientist-practitioners may share research findings is when they provide feedback to participants in their research. Providing feedback to participants is usually required by ethical research review committees (Shalowitz & Miller, 2008), and is a nice gesture of appreciation to the people who were kind enough to give their time to participate in our research, increasing their likelihood of participation in the future. In practice, sharing findings with participants might not be so easy, however. By the time the research is conducted, written up for a dissertation and/or publication—often months or years later—the lack of up-to-date contact details and confidentiality issues (if no explicit permission is given beforehand) might provide practical obstacles. If research is conducted as part of larger scale Practice Research Networks, the process of providing regular feedback to participants might be more streamlined as participants stay involved for a longer period, and might, for example, opt in to receive publication updates.
However, one does not have to wait for research projects to be completed before sharing information with participants. For example, in some qualitative research projects, researchers may return to participants while research is being conducted to ensure that their categories, constructs, explanations, and interpretations “seem right” or “ring true,” and to discover if something is missing (Goldblatt, Karnieli-Miller, & Neumann, 2011). This “member-check” process has a twofold intent: from a methodological perspective, to minimize misinterpretations of participants’ accounts; from an ethical standpoint, to empower participants, through their active involvement in the study. Regardless of research method, the service user involvement movement that has been implemented across mental health services in the United Kingdom promotes the participation of patients in all parts of the research process, including focus groups to help generate research ideas and patient-led research review meetings in universities and clinics (Kara, 2013).
Patients at large. Outside the context of research projects, psychologists can also use their teaching, consulting, and presenting skills to share research findings with patients and their families at community services, nonprofits, and informal support groups. Due to our all-round scientific and clinical training, we might be particularly well placed to digest and translate findings from dense research papers into understandable, palatable, and relevant suggestions for clinical practice (Llewelyn et al., 2015). Presenting research evidence to larger groups of (prospective) patients and their families might have a ripple effect in reducing stigma, supporting prevention, and raising the profile of psychological treatment.
Our own patients. Many psychology researchers are also clinicians and therefore have the dilemma of how much and what of their research work to share with their patients. In treatment sessions with our own patients, we may choose to share findings from research that we conducted ourselves, recruit our patients for our current research projects, or explain our reasons for proposing an experimental treatment approach. Also, we might want to share our own track record of treatment results. As more clinicians are now measuring progress on a regular basis, we can provide prospective patients with information on our own practice outcome data. A great example of this can be found on the website of clinician-researcher Tony Rousmaniere (www.drtonyr.com), where he clearly states his treatment outcomes for patients to judge and interpret.
Besides sharing our own research, we might decide to tell our own patients about research findings from experts in the field. During a therapy session, we may choose to discuss general psychotherapy research findings or refer to books, papers, or presentations, with the aim of giving our interventions increased face validity or helping our patient decide between different treatment options. Patients might ask for the evidence-base of treatments themselves, or clinicians might choose to initiate these topics at a particular time in treatment. Without any empirical evidence, we cannot know if and how this research sharing might be productive therapeutically. It is likely that its effect is dependent on the therapist, patient, therapeutic relationship, timing, and service context. Research-sharing might, for example, be experienced as unnecessarily patronizing, creating distance and ruptures in the alliance. A reference to a research publication might show how up to date and knowledgeable a therapist is or might serve as proof to the patient that the therapist does not really see the patient as an individual. It is also possible that research-sharing is experienced by patients as a humanizing and normalizing self-disclosure of not-knowing exact answers, a type of “gift giving” of knowledge, a collaborative team effort in finding the best solution, or simply a welcome intellectual distraction from the therapeutic work at hand. And even if patients are helped by knowing general research findings, are patients actually interested in their clinician’s’ research endeavors? From my own experience as a patient in psychoanalysis, I remember reading a few of my analyst’s journal publications with the desperate hope of getting to know the person behind the therapist. Somehow this seemed within the professional realm and more acceptable than trying to search for him on Facebook or Linkedin. But what did it tell me? My analyst had other interests? Other areas of expertise that did not involve me and my problems? I am not sure that was what I wanted to know.
Considerations Moving Forward
As scientist practitioners, we should at least consider the opportunities and possible benefits of sharing research findings with our patients. Whether we decide to share research evidence in a therapy session might depend on our patients’ therapeutic needs. However, regardless of what we deem best for our individual patients at a given point in time in their treatment, this should not deter us from disseminating research findings to research participants and mental health patients more generally. We could, for example, see our patients as experts by experience, and involve them in developing research questions or checking research findings. Also, we could share our understanding of the current evidence-base at patient support groups, give presentations through mental health services, or use our professional website to guide our patients through the world of evidence-based practice. Besides the ethical responsibility of involving our participant-patients, the potential benefits for future patients, and the direct benefit of the gained knowledge to our patients, the research sharing process itself might provide an additional implicit learning experience that could have important therapeutic value. Future empirical investigations on the effect of sharing research with our patients on treatment outcome is warranted, and might help us understand how, when, and with whom different ways of research sharing might be beneficial. As psychotherapists, we are both a “scientist” and a “practitioner,” so sharing research with our patients might not be too far-fetched!