SEARCH

SEARCH BY CITATION

Abstract

  1. Top of page
  2. Abstract
  3. Suggestions for Reducing the Divide
  4. Conclusion
  5. References
  6. Biography

Evidenced-based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence-based treatments and suggest a broader, more clinically palatable view of evidenced-based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher–clinician divide in the best interest of all concerned.

At the beginning of the family therapy movement, the founders made little distinction between therapy practice and research. They observed patterns of family dysfunction and considered their clinical observations to be empirical evidence justifying their therapy models. In fact, sometimes, they used the term “action research” as the basis for their interventions (Broderick & Schrader, 1981; Dattilio, 2006; Sprenkle & Piercy, 2005).

However, as the evidence-based treatment movement gained momentum in the field of family therapy, many clinicians simply ignored the movement and continued to make treatment decisions based on their clinical training and experience. Some seasoned clinicians, in fact, have voiced concerns about whether practitioners will choose treatments based on scientific evidence even when there is compelling research to back them up (Gurman, 2011; Orlinsky, Botermans, & Rønnestad, 2001). Nowhere has this gap between researchers and clinicians been addressed more frequently than in the field of psychology where concerns about the scientist–practitioner divide have loomed for decades (Dattilio, Edwards and Fishman, 2010; Drabick & Goldfried, 2000; Kazdin, 2008).

Forty years ago Meehl (1973) remarked on how difficult it was for psychologists to apply research findings to their clinical practice. In his article, “When Should We Use Our Heads Instead of the Formula?” Meehl examined the complex relationship between research results and clinical knowledge and experience. Indeed, many researchers and clinicians continue to do their work largely uninformed by one another (Dattilio, 2002, 2006; Edwards, Dattilio, & Bromley, 2004; Sternberg, 2006; Stewart & Chambless, 2007). In instances where an empirically-based family therapy model such as emotionally-focused couple therapy (EFT; Greenberg & Johnson, 1988; Johnson, 1998) has gained popularity, it is not clear whether that popularity has derived from the model's empirical support, or the engaging clinical demonstrations of the founders of EFT. Given family therapy's history of fascination with vivid case presentations and engaging personalities, we suspect EFT's popularity has more to do with the latter. Regardless, the scientist–practitioner divide exists in many fields including medicine (Guyatt et al., 1992; Risahmawati, Emura, Nishi, & Koizumi, 2011), nursing (Moreno-Casbas, Fuentelsaz-Gallego, de Miguel, González-Maria, & Clarke, 2011), and dentistry (Madhavji, Araujo, Kim, & Buschang, 2011) where the complexities of actual cases often cannot be addressed by formulas based on outcome research (Barkil-Oteo, 2012; Upshur, 2005).

One of the problems that the field of family therapy faces is similar to that of other professions, which is that a large number of contemporary practitioners remain ambivalent about the role of research science and its application to clinical practice. While clinicians would likely welcome research supporting their approach, this research would likely be viewed as confirming what the clinician already believed to be true, whereas research disconfirming one's approach is easily (and often) ignored. Our primary goal in writing this article is to explore how therapists and clinicians can work together to more fully benefit from each other.

In their review of the literature, Košutić, Sanderson, and Anderson (2012) found that in the past three decades, only three published studies prior to their survey offered information addressing family therapists' consumption of outcome research in their field. Hertlein, Lambert-Shute, and Piercy (2009) examined journal reading habits of a small sample of clinicians (n = 42) and explored specific barriers to reading research-related articles. Respondents reported that journal articles were rated as most useful provided insights, discussed applicable research practices, and were easy to read. However, respondents consistently mentioned the “disconnect” between the research and clinical practice aspects of published articles, especially because of the difficulty they experienced in understanding the methodological and statistical jargon and because of the absence of “clinical implications and applications” of the article.

In another study, Sandberg, Johnson, Robila, and Miller (2002) examined barriers to clinicians reading research articles and found that participants in their survey reported that research articles would be more relevant to their clinical practice if employers valued research and allotted time for employees to read journal articles, and, once again, if the applications of the research results were described more clearly. Also, the dry, pedantic writing style used in many scientific journals likely presents too big a hurdle for many practitioners, some of whom are many years removed from their research training.

Some scientists use the term “pseudoscience” to describe traditional approaches in family therapy that have not met the rigors of empirical validation. Pseudoscience, they say, asserts clinical “truth” in a manner suggestive of science, but without employing sound scientific methods (Gardner, 2012). These methods generally are less behaviorally specific and thus more difficult to measure. However, many family therapists do not consider clinical knowledge to be “untested.” Quite the contrary, they consider it to be tested through years of clinical experience.

It may be that researchers and therapists tend to look to different epistemological authority, value different kinds of data, and take a different position on the necessity and validity of randomized controlled trials. Therefore, there may be wisdom in broadening the definition of valid research in ways that support its translation into meaningful therapeutic strategies. Also, it is important to remember that interventions that have not yet been studied in controlled trials may be revealed in subsequent research to be effective (APA Presidential Task Force on Evidence-Based Practices, 2006) and that most family therapy models that have been tested have been shown to be effective (Sprenkle, Davis, & Lebow, 2009).

Orlinsky et al. (2001) studied more than 4,000 psychotherapists, including several 100 family therapists, and found that the main influences on their professional development consisted of their experience with clients, supervisors, personal therapy, and life experiences, but not research findings. Another useful influence for many clinicians is case-based research. Case studies, for example, formed the basis for many prominent family therapies (e.g., Bowen Therapy, structural and strategic family therapy) and likely closely resemble the process many therapists already use informally to make clinical decisions. Yet, some researchers have criticized case studies as well (Kazdin, 2002).

While these exchanges make for interesting reading, the problem boils down to this: There are many practicing family therapists who are not reading or heeding the direction provided in the professional research literature. Some are even hostile to aspects of the evidence-based movement, particularly the implied notion that if a model enjoys empirical support, it (and perhaps even its “followers) is “better” than one that has yet to be studied. Also, there are not enough researchers presenting their findings in ways that can be easily applied by practicing clinicians. Whether one regards either side as arrogance or ignorance, the fact is that many family therapists are doing what they have been taught and feel comfortable with from years of clinical experience. They simply do not want to stop doing what they believe they already do effectively (Stewart & Chambless, 2007).

Furthermore, many clinicians believe that researchers are dictating how they should function in practice by developing treatment manuals based on randomized clinical trials (Addis, 2002; Schulte, Bochum, & Eifert, 2002). Clinicians' criticisms of standardized treatment protocols include their excessive emphasis on technique, inadequate attention to the therapeutic alliance, inflexibility, and a failure to recognize the importance of clinical innovation and the experience of the therapist (Carroll & Nuro, 2002).

We suspect that family therapists are much like professionals in other fields in the reasons they place relatively little emphasis on randomized clinical trials. For one thing, many feel that what goes on in a laboratory setting comes nowhere close to capturing what actually occurs in a clinician's office. Often, “therapists” in these research studies are doctoral students or neophytes who, although they work under supervision, still have very little clinical experience. Many clinicians also believe that university-based researchers are biased toward the treatments they are testing. This concern is echoed by Wampold (2001), who notes that researcher allegiance is one of the strongest correlates with outcome when reviewing meta-analytic studies of psychotherapy outcome research. Clinicians also believe that researchers dismiss too easily the “non-empirically tested” approaches they have little interest in evaluating.

Of course, therapists are at risk of the same observational bias as researchers. Researchers and clinicians alike are prone to seeing what they want to see, and the need to control for this phenomenon exists in both realms.

Treatments delivered during the course of randomized clinical trials may differ from treatment provided in a routine clinical setting because protocols may be artificially constrained to what a therapist does and when the therapist does it. A classic example of this is the considerable variability among clients' needs and the number of sessions required to obtain a clinically significant response to treatment. In real-world settings, treatment durations tend to be responsive to such client needs and are longer in length (Stiles, Barkham, Connell, & Mellor-Clark, 2008). On the other hand, clinicians often see the strictly set duration of therapy in many trials as rigid and unrealistic because treatment manuals may adhere to arbitrary time schedules. Many treatment manuals also may not include many of the important aspects of what makes therapy effective, such as therapeutic style of delivery and ways to develop a therapeutic relationship with clients.

For example, in a study by Walkup et al. (2008), cognitive behavior therapy and the drug sertraline were used to treat childhood anxiety. The cognitive behavior therapy protocol based on the “Coping Cat Program” developed by Kendall (1990) was reduced to half of the 24 weeks that Kendall recommends in his original program to match the schedule for the medication intervention. This was a research decision, not a clinical one. Thus, therapy was much different from how treatment would have unfolded in a true clinical setting. Such clinical studies may not generalize well to the “real world” because of researchers' reliance on arbitrary timelines and other metrics (Blanton & Jaccard, 2006; Upshur, 2005). Treatment manuals may become more palatable to clinicians if such limitations are acknowledged, along with the potential need for adaptation of the treatment.

Also, empirically based treatments are usually intended for a person with a particular disorder, whereas many clients meet the criteria for dual or multiple diagnoses (Wolfe, 2012). Of course, the clinician cannot exclude these clients from their practices the way a researcher can from a clinical trial. This raises the question of how transportable empirical outcome studies are to the clinical arena.

The disconnect we see relates to the fact that (a) family therapists realize, on some level, that evidence of treatment success is valuable; (b) they understand that they should keep up with the effectiveness literature; but (c) they simultaneously have learned to rely largely on their own time- and experience-tested clinical practices and not the evidence-based therapy literature (Mussel et al., 2000; Rain et al., 2004; Stewart & Chambless, 2007; VonRanson & Robinson, 2006; Košutić et al., 2012).

In their recent review of couples therapy research in the Journal of Marital and Family therapy, Lebow, Chambers, Christensen, and Johnson (2012) described some therapeutic interventions as “not empirically based.” The authors write, “It may well be that other therapies worthy of study are as effective as the variations of BCT, IBCT, and EFT, but simply because a therapist says that he or she practices marital therapy does not mean a good result is likely.” This type of thinking perpetuates a harmful dichotomy: trustworthy empirically tested therapies on the one hand and less-trustworthy “untested” therapies on the other. We suspect that many seasoned clinicians would take offense to this statement and consider their clinical experience as indeed tested and refined in the laboratory of day-to-day practice. Family therapy practitioners generally trust their own clinical experience above seemingly rigid, unfamiliar treatment protocols. We believe that both stereotyped extremes perpetuate this dichotomy. To move beyond it, it is important to remember that many empirically validated treatment protocols can be adapted to unique therapist and client settings. Also, therapists often arrive at their conclusions of effectiveness through a systematic, iterative process that includes elements of formal research.

These “other therapies” constitute the vast majority of the models used in the family therapy field. We suspect that, if polled, many family therapy practitioners would confirm that their own clinical success is based on what they have learned from clinical experience, the trust they have built-in their communities, and their clients' resultant satisfaction—all “empirical” criteria. After all, people are not typically referred to family therapists who have a bad reputation. Word of mouth referrals typically comes from clients and other colleagues who are satisfied with a practitioner's work, regardless of whether or not the clinician espouses to use evidenced-based treatment models. We go to therapists who we trust.

Family therapy clinicians are not likely to relinquish what they have been doing successfully for decades and what they have learned works simply because researchers in the field say that “x, y, and z” is what is effective today and, therefore, what therapists should use instead of their “untested” approaches. Such a mandate will only serve to widen the divide that presently exists between proponents of evidence-based treatments and practicing family therapists.

Suggestions for Reducing the Divide

  1. Top of page
  2. Abstract
  3. Suggestions for Reducing the Divide
  4. Conclusion
  5. References
  6. Biography

If the divide between researchers and practitioners of family therapy is going to be bridged successfully, individuals on both sides will need to realize what they can gain from one another. Each side has something worthwhile to contribute to the field (Teachman et al., 2012).

Suggestions for Researchers: Expanding Our View of Evidence-Based Research and Therapy

Both researchers and clinicians can benefit from expanding their definition of what constitutes evidence-based research and therapy. While randomized clinical trials represent one form of evidence-based research, there are other important ways to assess effectiveness (e.g., Karam & Sprenkle, 2010; Zeldow, 2009). In fact, multiple research methods are critical to provide the kinds of information that family therapists value and use in clinical practice (Gurman, 2011). Both researchers and clinicians need to expand their definition of “evidence based” to include the following:

Practice-based evidence

Duncan and Miller (2000) distinguish between evidence-based practice and practice-based evidence (Chenail, 2005; Sparks, Kisler, Adams, & Blumen, 2011). With practice-based evidence, therapists judge the effectiveness of their therapy through focused conversations with their clients about what is working and why. Similarly, Lambert (2012) measures progress session-by-session with a computer assisted self-report, as do Pinsof, Goldsmith, and Latta (2012) using a method that involves an online multisystemic and multidimensional client support system. We see such accountability procedures as informing ongoing therapy and as evidence based (e.g., Duncan & Miller, 2000; Hubble, Duncan, & Miller, 1999).

Qualitative research methods

Qualitative methods, according to Chenail (2005), play an important role in determining effective practices by examining the richness of the therapeutic process. Qualitative research methods (e.g., focus groups of therapists and their clients) can help researchers who conduct clinical trials to develop a more nuanced sensitivity to the therapy process. For example, qualitative researchers can explore and ultimately enhance culturally sensitive therapy (see Pote, Stratton, Cottrell, Shapiro, & Boston, 2003). Qualitative research also lessens the researcher–clinician divide by honoring the voices of therapists and their clients by, for example, exploring the role of therapists' clinical judgment in treatment planning and implementation (Zeldow, 2009).

Aesthetic forms of data representation

An increasing number of qualitative researchers are experimenting with representing their results through alternative, aesthetic forms of qualitative representation such as creative writing, art, music, performance, and poetry. Such methods, if performed well, can connect with both the head and the heart of the consumers of the research and can convey considerable credibility and impact (Piercy & Benson, 2005). Such data representation methods would seem to be particularly well suited for documenting the effectiveness of family therapy because of the personal and human dimensions of the work. According to Piercy and Benson (2005), there is “a fine tradition of powerful evocative writing in family therapy research, from Napier and Whitaker's (1978) Family Crucible, to Minuchin's (1984) Family Kaleidoscope, to Bowen's (1978) classic anonymous paper on differentiating from his own family of origin” (p. 115). Aesthetic forms of documentation could be used in a number o professional outlets, including trade and association magazines, newsletters, and conference presentations.

Case studies

Case studies can provide “experience-near” data that generally resonate with clinicians (Dattilio, 2002, 2006; Dattilio et al. 2010; Edwards et al., 2004; Wolfe, 2011). For example, a researcher examining a good-outcome case and poor-outcome case with the same method (Goldman, Watson, & Greenberg, 2001; Watson, Goldman, & Greenberg, 2007) may be able to tease out which factors make a difference and which do not.

Mixed-method research

Single studies involving both quantitative and qualitative methodologies are beginning to be used more readily in the field of family therapy because of their sensitivity on multiple levels. Regarding the advantages of mixed-method research to address the researcher–therapist gap, Gambrel and Butler (2013) state that:

Researchers no longer need to choose between understanding depth of human experience and generalizability, for mixed methods have the advantage of being able to account for both narratives and standardized data. As such, mixed methods (research) have much to offer the marriage and family therapy (MFT) field because it excels in areas that therapists want to understand: processes of change, evaluations of interventions, and therapeutic relationships.

Process research

The evidence-based movement would benefit from more research on the mechanisms of change. While outcome research examines if a therapeutic approach is effective, process research seeks to determine how an approach is effective. Such research moves us toward empirically supported principles of change, information that is particularly valuable to the average family therapist (Wolfe, 2011). Blow, Sprenkle, and Davis (2007) describe principles of change as:

“…concentrated ‘truths’ of therapeutic change, applicable to a wide variety of clinical circumstances and present across diverse models of therapy. An example of a principle of change in relationship therapies would be, ‘Couples enjoy greater relationship satisfaction as they free themselves from destructive interactional cycles by slowing down the process, standing meta to themselves and their partner, and taking personal responsibility for altering their role in the cycle’” (Davis & Piercy, 2007a, p. 309).

Systemic research methods

Oka and Whiting (2013) believe that more systemic research methods applicable to the practice of family therapy hold promise in addressing the clinician–researcher divide. They point specifically to process research, dyadic data analysis (also see Wittenborn, Dolbin-MacNab, & Keiley, 2013), and sequential analyses as methods that “fit” the systemic practice of family therapy; in that, they address the therapy process, the interdependence of couple data, and the sequencing of behaviors over time. The design and analysis behind these studies is admittedly dense and potentially alienating to clinicians, but the results are often highly relevant to clinical practice. Researchers could ensure that journal articles reporting these studies include a clinically relevant discussion section and could present their results through professional association and continuing education workshops. Sexton et al. (2011) similarly suggest that we look more at a range of levels of evidence and evidence of different kinds, as opposed to simply comparing outcome studies. This, they state, will support more constructive conversations between researchers and clinicians.

Research on treatment failures

As in most other aspects of life, we can learn from our treatment failures (Lampropoulos, 2011; Wells & Dattilio, 1992). Why we fail can help us modify our treatment protocols and theories which, again, is something of particular interest to family therapists. Such processes can be researched and disseminated via the same mechanisms as treatment successes.

Clinician-to-researcher feedback mechanisms

Clinician-to-researcher feedback loops allow clinicians to help evidence-based researchers refine their thinking and procedures and to improve their evidence-based models accordingly (e.g., Goldfried, 2011). Such feedback mechanisms support better clinical practice (e.g., Eubanks-Carter, Burkell, & Goldfried, 2010). Researchers and clinicians would both benefit from involving each other more directly in their work.

Common factors

Much of what makes therapy effective is likely shared across both empirically validated and untested models (Sprenkle et al., 2009). This is true of both general therapeutic processes (e.g., forming a therapeutic alliance, establishing hope) and specific family therapy treatment goals and mechanisms (e.g., slowing down couples' ineffective processes, helping each person see the role he or she plays in maintaining the process, and helping both learn and implement a different approach; Davis & Piercy, 2007a,b). Both clinicians and researchers could benefit from expanding their view of what makes therapy effective beyond the confines of a particular model. Doing so could allow researchers to focus at a more nuanced level on the processes of effective therapy regardless of approach. The results of these studies would likely focus on processes and mechanisms that the average clinician is already addressing—or at least make it easier for them to incorporate these common processes into their existing practice without having to learn a completely new model. Such research would also make it easier to tease out the core threads from a new model they are learning, so that they might integrate them into their current work.

Other areas not covered in this section pertain to interaction research and correlational studies that also carry clinical implications, as well as translational research involving information derived from neuroscience.

Additional Suggestions for Researchers

All family therapy researchers must understand that clinicians need to be able to make sense of empirical research and apply it to what they do on a daily basis. As Gurman (2011) stated, “Our research must touch the therapist where she lives experientially in everyday practice or we will have failed to create a truly collaborative relationship between clinicians and researchers as has been the major failing in the world of individual psychotherapy practice and research for the last half century” (p. 286). This can begin with researchers responding to clinicians' gripes about their often pedantic, rigid style. Researchers need to craft articles that appeal more to clinicians and focus on enhancing clinicians' understandings and applications of mechanisms and mediators of change. This includes adopting more user-friendly prose. Dattilio et al. (2010) also suggest writing complimentary, companion publications (one for clinicians and one for researchers), along with a review that offers a clear synthesis of the findings of research studies.

In addition, researchers should avoid attitudes that can reflect the belief that they know better than clinical practitioners who have been working in the field for decades. Statements made in research articles about the possible evils of interventions that are not “evidence based” tend to alienate clinicians from listening to researchers who they may perceive as having only a fraction of the clinical experience and skills that they do. Of course, the best way for either side to write in a more respectful manner is to appreciate the contributions of the other side. If we appear to tilt a bit toward the arguments of the clinician, it is because the allure of evidence-based therapies and randomized clinical trials already has plenty of vocal supporters in the literature.

Another divide may spring from the likelihood that few clinicians have the time, funds, or flexibility required to abandon what they are doing and master an entirely new empirically validated model. It may be that learning common factors of successful therapy (Fife, Whiting, Bradford, & Davis, ; Fraser, Solovey, Grove, Lee, & Greene, 2012; Sprenkle et al., 2009) might be more palatable, and respectful of multiple therapies, than being pressured to chase among the current evidence-based therapies of the day. A common factors approach bridges theoretical boundaries while maintaining an appreciation for important evidence-based therapeutic interventions (e.g., creating a productive therapeutic alliance, engendering hope) and conditions (e.g., therapist trust).

Recommendations for Clinicians

For clinicians, the advent of evidence-based practice does not have to represent an either or choice. Family therapists can improve their treatment by integrating aspects of empirically-based treatments that enhance what they already do effectively. Also, one does not have to use an empirically-based approach in its entirety to benefit from what it has to offer. One example of this relates to cognitive-behavioral therapy (CBT; Dattilio & Epstein, 2005). For example, a clinician might use one aspect of cognitive therapy, such as modifying and restructuring distorted thinking, prescribing specific behavioral changes, or building tolerance (Dattilio, 2010) without having to incorporate an entire CBT protocol.

Clinicians, like researchers, could benefit from learning the common factors across successful approaches (Karam & Sprenkle, 2010; Sprenkle et al., 2009). Much of what is key to the effectiveness of empirically validated approaches (e.g., the alliance, the therapist believing in and articulating his or her approach, etc.) is common to all approaches. While many approaches—empirically validated and otherwise—use different language to describe the process of successful therapy, many of these processes are strikingly similar when one looks beyond the language used to describe them. Narrative re-storying, for example, is similar to modifying distorted thinking in CBT. Consequently, what an advocate of one model might call evidence based may be a central factor that can be found across many models. Thus, clinicians can embrace evidence-based skills central to many approaches without necessarily giving up what they are already doing.

More basically, clinicians need to reconsider what they think of as evidence-based research. As stated above, the important issue is accountability, which can be achieved through a range of research, evaluation, and feedback methods. We are all—clinicians and researchers alike—committed to making a difference in the lives of couples and families. It is to all of our benefit to minimize unhealthy competitiveness and support a clinical repertoire that embraces both accountability and clinical wisdom. Clinicians need to realize that “evidence based” is a broad term. With this in mind, they should listen to researchers, read their work, and hold in check their own biases. We are on the same side. To paraphrase Benjamin Franklin, we can learn a lot from those with whom we disagree.

Recommendations for Family Therapy Educators

Most graduate students who enter family therapy programs do so because of their interest in therapy and in helping others (Crane, Wampler, Sprenkle, Sandberg, & Hovestadt, 2002). Most have a social service orientation; few are initially attracted to research. This creates a built-in gap between clinical work and research. Faculty in COAMFTE-accredited graduate training programs can serve an important role in bridging this gap.

For one, when faculty recruits family therapy graduate students, they can (a) look for those with more of an inclination toward research, (b) clearly advertise that their program values the connections between research and practice, and (c) incorporate research—including evidence-based research—more deliberately into their programs (cf., Karam & Sprenkle, 2010; Williams, Patterson, & Miller, 2006).

The primary goal of most family therapy master's programs is to prepare future family therapy clinicians. Karam and Sprenkle (2010) advocate a deliberate model to help these master's students become “research informed.” They believe that family therapy faculty should be models themselves of using research in their work (e.g., reading, referring to, and assigning research articles, using validated assessment instruments, learning evidence based treatments, and doing family therapy research themselves). Family therapy faculty also should show students how to supplement their own therapy by sharing with clients appropriate research findings (e.g., Gottman's [1999] findings that arguing itself is not the death knell of a couple's marriage) and demonstrating how ongoing clinical evaluation, such as progress research (Pinsof & Wynn, 2000), can support better, more informed therapy. Faculty should also show students how research findings can confirm or disconfirm clinical beliefs (e.g., what current research indicates about treating violent couples individually or conjointly) and teach them how to locate, comprehend, and critically evaluate family therapy research findings. Also, as we have tried to do in this article, program faculty should help graduate students appreciate the many forms of research evidence available to them. They should also support ways to give them experience in locating, evaluating, and applying research findings. For example, Williams et al. (2006) describe a six-step process that encourages master's students to become more conversant with the research literature by systematically reviewing it, better understanding it, and then applying it to specific clinical issues.

Doctoral program faculty should do all of the above, and more. They must be proactive in weaving research into the fabric of their doctoral program. This first means taking on research as a core value themselves and not farming out research courses to other departments or program areas (Crane et al., 2002). Their expected outcome should be researcher–clinicians that understand the many forms of family therapy research and who are prepared, not just to be consumers, but also leaders and participants in ongoing professional conversations regarding what it means to do excellent, accountable family therapy research. Undoubtedly, different doctoral programs will emphasize different aspects of “excellence,” depending on their mission (Wampler, 2010), and the research expertise of existing faculty members.

Instead of focusing on the minutia of what a graduate family therapy program should teach, we will instead reflect on the kind of culture family therapy educators can and should create to support a nurturing, collaborative environment, particularly for those family therapy graduate students who may indeed—at their core—value therapeutic skills and social action over quantitative inquiry. Sprenkle (2010) states that, by their very nature, doctoral programs have the potential to become “competitive and support individualism at the expense of community” (p. 277). What is the antidote? Sprenkle suggests a number of program activities that support a more humane, social, and research-friendly intellectual community. He suggests integrating social activities into the research environment, like regular research prosems, the expectation that faculty and students will publish and present research together, and supporting better integration of the MFT program within the research mission of the larger department.

A few years ago, the second author and his student and faculty co-authors explored how 14 doctoral students from 10 COAMFTE-accredited doctoral programs across the country experienced their doctoral MFT research training and what they suggested faculty might do to build a stronger research culture within these programs (Piercy, McWey, Tice, James, Morris, & Arthur, 2005). The researchers solicited rather unconventional aesthetic data such as metaphors, poetry, free associations, and critical experiences. Metaphors for the research experience of some participants included a maze, a marathon, a walk through a swamp, and learning a new language. These metaphors, and how the participants explained them, underlined the need to make research training less isolating and intimidating, and more supportive, meaningful, and engaging for graduate students. Piercy et al. 2005 stated:

We believe that one of the keys to meaningful research training in family therapy doctoral programs involves more of a focus on the relationship aspects of the research process—colleagueship, group effort, team building, group identity, and the rewards of a team effort. Most family therapists entered the field because they valued the relationship dimensions of their work (Crane et al., 2002). We need to find ways to incorporate this value into our research training as well.

We still believe this is true, particularly because, according to Piercy et al. (2005), “many doctoral students see their research and clinical training as disjointed and unrelated” (p. 375), a fact that parallels the gulf we discuss above between MFT clinicians and researchers.

What would a more supportive, collaborative, collegial research environment look like? It would undoubtedly be one in which the family therapy educators are research savvy and reflect enthusiasm for their own, their colleagues', and their students' research. It would be a program in which research training and mentoring results in the same spirit de corps and sense of mission that often characterizes the clinical aspects of programs. This may take the form of research as well as clinical practica and research teams as well as therapy teams. It also would include listserv discussions of promising research methods, regular prosems where faculty and students present on research topics, regular congratulatory (“way to go…”) emails, and even program rituals such as picnics, parties, and faculty roasts that involve safe ways to flatten the hierarchy and build a supportive community of scholars (Fontes, Piercy, Thomas, & Sprenkle, 1998). The critical issue is to create a generative team mentality around research.

Another way to make the research experience more personally meaningful is to find connections between students' personal values and experiences and the research they pursue. Many students, for example, enter programs with areas of expertise that they could be encouraged to tap into within the larger lens of family therapy. For example, we have known bankers, engineers, athletes, and philosophers who made a name for themselves by applying some aspect of their previous life's work to their research and scholarship in family therapy (not unlike some of the influential people in our field such as mathematician Norbert Weiner; anthropologist and linguist Gregory Bateson; playwright and communication expert Jay Haley; and Peace Corps volunteer, Froma Walsh). Similarly, many students who enter the field with a commitment to social justice may be attracted to research methods that facilitate and support meaningful grass-root action such as participatory action research (Piercy et al., 2005).

Similarly, family therapy educators should look for ways to bridge the academic worlds of therapy and research training. How, for example, can the family therapy clinic be used to support meaningful research? Are there batteries of instruments that clinical trainers would find useful?

Program faculty should also balance their own advancement with the research development of their students. Does the department consider research mentoring scholarship? Does it value co-authored publications with faculty and students? We recommend discussions among program faculty and administrators on such topics.

In sum, meaningful graduate research training in family therapy is about a lot more than learning the latest statistics, evidence-based treatment, or research method. It is about creating a world where those with both social and investigative personalities can find meaning, fit, and purpose.

Conclusion

  1. Top of page
  2. Abstract
  3. Suggestions for Reducing the Divide
  4. Conclusion
  5. References
  6. Biography

There is a significant divide between the increased dissemination of “evidenced-based” approaches and their use by clinicians. In fact, the relationship between researcher and clinician sometimes mirrors that of couple therapy in which both partners are so committed to their own “rightness” that neither change. Each of us—researchers and clinicians—must find it within ourselves to consider what we can do to bridge the divide in the name of our commitment to better, more informed, accountable family therapy practice. We urge both researchers and clinicians to meet each other halfway for common good of the field. We also call for family therapy educators to recommit to nurturing a research-friendly culture that will support the kind of research-practice rapprochement that we advocate in this article.

References

  1. Top of page
  2. Abstract
  3. Suggestions for Reducing the Divide
  4. Conclusion
  5. References
  6. Biography
  • Addis, M. E. (2002). Methods for disseminating research products and increasing evidenced-based practice: Promises, obstacles and future directions. Clinical Psychology: Science and Practice, 9, 367378.
  • APA Presidential Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271285. doi:10:1037/0003-066X61.4.271.
  • Barkil-Oteo, A. (2012). Psychiatry's identity crisis: Marginalized as prescribers; how psychiatry can save itself. Lancet, 379, 2428.
  • Blanton, H., & Jaccard, J. (2006). Arbitrary metrics in psychology. American Psychologist, 61, 2741.
  • Blow, A. J., Sprenkle, D. H., & Davis, S. D. (2007). Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors. Journal of Marital and Family Therapy, 33, 298317.
  • Bowen, M. (1978). On the differentiation of sel. In M. Bowen (Ed.), Family therapy in clinical practice (pp. 467528). New York: Jason Aronson.
  • Broderick, C. B., & Schrader, S. S. (1981). The history of professional marriage and family therapy. In A. S. Gruman & D. P. Kniskern (Eds.), Handbook of family therapy (pp. 535). New York: Brunner/Mazel.
  • Carroll, K. M., & Nuro, K. F. (2002). One size cannot fit all: A stage model of psychotherapy manual development. Clinical Psychology: Science and Practice, 9, 367378.
  • Chenail, R. (2005). Future directions for quantitative methods. In D. H. Sprenkle & F. P. Piercy (Eds.), Research methods in family therapy (pp. 191210). New York: Guilford.
  • Crane, R., Wampler, K. S., Sprenkle, D. H., Sandberg, J. G., & Hovestadt, A. J. (2002). The scientist-practitioner model in marriage and family therapy doctoral programs. Journal of Marital and Family Therapy, 28, 7583.
  • Dattilio, F. M. (2002). A bridge and a couple of fences? A response to Silverman. Psychotherapy: Theory, Research, Practice & Training, 39, 261263.
  • Dattilio, F. M. (2006). Case based research in family therapy. The Australian and New Zealand Journal of Family Therapy, 27, 208213.
  • Dattilio, F. M. (2010). Cognitive behavior therapy with couples and families: A comprehensive guide for clinicians. New York: Guilford.
  • Dattilio, F. M., Edwards, D. J. A., & Fishman, D. B. (2010). Case studies within a mixed methods paradigm: Toward a resolution of the alienation between researcher and practitioner in psychotherapy research. Psychotherapy: Theory, Research, Practice & Training, 47, 427441.
  • Dattilio, F. M., & Epstein, N. B. (2005). The role of cognitive-behavioral interventions in couple and family therapy (edited special section). Journal of Marital and Family therapy, 31(1), 713.
  • Davis, S. D., & Piercy, F. P. (2007a). What clients of MFT model developers and their former students say about change, Part I: Model dependent common factors across three models. Journal of Marital and Family Therapy, 33, 318343.
  • Davis, S. D., & Piercy, F. P. (2007b). What clients of MFT model developers and their former students say about change, Part II: Model independent common factors and an integrative framework. Journal of Marital and Family Therapy, 33, 344363.
  • Drabick, D. A., & Goldfried, M. R. (2000). Training the scientist practitioner for the 21st century: Putting the bloom back on the rose. Journal of Clinical Psychology, 56, 327340, doc:10.100z/(sici)1097-4679(200003)56:3 < 327::aid-jclpq>3.0.c0:2-y.
  • Duncan, B. L., & Miller, S. D. (2000). The heroic client: Doing client-directed, outcome-informed therapy. San Francisco: Jossey-Bass.
  • Edwards, D. J. A., Dattilio, F. M., & Bromley, D. B. (2004). Developing evidence-based practice: The role of case-based research. Professional Psychology: Research and Practice, 35, 589597.
  • Eubanks-Carter, C., Burkell, L. A., & Goldfried, M. R. (2010). Clinical consensus strategies for interpersonal problems between young adults and their parents. Journal of Consulting and Clinical Psychology, 78, 212224. doi:10.1037/a0018557.
  • Fife, S., Whiting, J., Bradford, K., & Davis, S. (in press). The therapeutic pyramid: A common factors synthesis of techniques, alliance, and way of being. Journal of Marital and Family Therapy.
  • Fontes, L., Piercy, F., Thomas, V., & Sprenkle, D. (1998). Self issues for family therapy educators. Journal of Marital and Family Therapy, 24, 305320.
  • Fraser, J. S., Solovey, A. D., Grove, D., Lee, M. Y., & Greene, G. J. (2012). Integrative families and systems treatment: A middle path toward integrating common and specific factors in evidence-based family therapy. Journal of Marital and Family Therapy, 38, 515528. doi:10.1111/j.1752-0606.2011.00228.x.
  • Gambrel, L. E. & Butler VI, J. L. (2013). Mixed methods research in marriage and family therapy: A content analysis. Journal of Marital and Family therapy, 39, 163181. doi:10.1111/j.1752-0606.2011.00260.x.
  • Gardner, F. L. (2012). Pseudoscience in scientific clothing: A response to McFall's “Psychological clinical science accreditation; FAQ's and facts”. The Behavior Therapist, 35(5), 9495.
  • Goldfried, M. (2011). Closing the gap between research and practice. Clinical Science, 14, 58.
  • Goldman, R. N., Watson, J. C., & Greenberg, L. S. (2001). Contrasting two clients in emotion-focused therapy for depression 1: The case of “Tom,” “Trapped in the Tunnel”. Pragmatic Case Studies in Psychotherapy, 7, Article 3, 305338.
  • Gottman, J. M. (1999). The marriage clinic: A scientifically based marital therapy. New York, NY: W. W. Norton.
  • Greenberg, L. S., & Johnson, S. M. (1988). Emotionally focused therapy for couples. New York: Guilford.
  • Gurman, A. S. (2011). Couple therapy research and the practice of couple therapy: Can we talk? Family Process, 5093, 280292.
  • Guyatt, G., Cairns, J., Churchill, D., Cook, D., Haynes, B., Hirsh, J., et al. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA, 268, 24202425.
  • Hertlein, K. M., Lambert-Shute, J., & Piercy, F. P. (2009). The journal-reading habits of practicing MFT's. Journal of Family Psychotherapy, 20, 2845.
  • Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.) (1999). The heart & soul of change: What works in therapy. Washington, DC: American Psychological Association.
  • Johnson, S. M. (1998). Emotionally focused couple therapy. In F. M. Dattilio (Ed.), Case studies in couple and family therapy: Systemic and cognitive perspectives (pp. 450472). New York: Guilford.
  • Karam, E. A., & Sprenkle, D. H. (2010). The research-informed clinician: A guide to training the next-generation MFT. Journal of Marital and Family Therapy, 36, 307319. doi:10.1111/j.1752-0606.2009.00141.x.
  • Kazdin, A. (2002). Research design in clinical psychology (4th ed.). New York: John Wiley & Sonx.
  • Kazdin, A. E. (2008). Evidenced based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146159. doi:10.1037/0003-066x.63.3.146.
  • Kendall, P. C. (1990). Coping cat workbook. Philadelphia, PA: Temple University.
  • Košutić, I., Sanderson, J., & Anderson, S. (2012). Who reads outcome research?: Outcome research consumption patterns among family therapists. Contemporary Family therapy, 34, 346361. doi: 10.1007/s10591-012-9192-8.
  • Lambert, M. J. (2012). Helping clinicians to use and learn from research-based systems: The OQ-Analyst. Psychotherapy, 49(2), 109114.
  • Lampropoulos, G. K. (2011). Failure in psychotherapy: An introduction. Journal of Clinical Psychology, 67, 10931095.
  • Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. N. (2012). Research on the treatment of couple distress. Journal of Marital and Family therapy, 38(1), 145168.
  • Madhavji, A., Araujo, E. A., Kim, K. B., & Buschang, P. H. (2011). Attitudes, awareness, and barriers toward evidence-based practice in orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics, 140, 309316.
  • Meehl, P. E. (Ed.) (1973). When shall we use our heads instead of our formula? In P. E. Meehl (Ed.), Psychodiagnostics: Selective papers (pp. 8189). Minneapolis: University of Minnesota Press (original work published in 1957).
  • Minuchin, S. (1984). Family kaleidoscope. Cambridge, MA: Harvard University Press.
  • Moreno-Casbas, T., Fuentelsaz-Gallego, C., de Miguel, A. C., González-Maria, E., & Clarke, S. P. (2011). Spanish nurses attitudes towards research and perceived barriers and facilitators of research utilisation: A comparative survey of nurses with and without experience as principal investigators. Journal of Clinical Nursing, 20, 19361947.
  • Mussel, M. P., Crosby, R. D., Crow, S. J., Knopke, A. J., Peterson, C. B., & Wonderlich, S. A. (2000). Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists. International Journal of Eating Disorders, 27, 230237.
  • Napier, A. Y., & Whitaker, C. (1978). The family crucible. New York: Harper & Row.
  • Oka, M., & Whiting, J. (2013). Bridging the clinician/researcher gap with systemic research: The case for process research, dyadic and sequential analysis. Journal of Marital and Family Therapy, 39, 1727. doi:10.1111/j.1752-0606.2012.00339.x.
  • Orlinsky, D. E., Botermans, J., & Rønnestad, M. H. (2001). Towards an empirically grounded model of psychotherapy training: Four thousand therapists rate influences on their development. Australian Psychologist, 36(2), 139148.
  • Piercy, F., & Benson, K. (2005). Aesthetic forms of data representation in qualitative family therapy research. Journal of Marital and Family Therapy, 31(1), 107119.
  • Piercy, F., McWey, L., Tice, S., James, E., Morris, M., & Arthur, K. (2005). It was the best of times, It was the worst of times: Doctoral students' experiences of family therapy research training through alternative forms of data representation. Family Process, 44(3), 363378.
  • Pinsof, W. M., Goldsmith, J. Z., & Latta, T. A. (2012). Information technology and feedback research can bridge the scientist-practitioner gap: A couple therapy example. Couple and Family Psychology: Research and Practice, 1, 253273.
  • Pinsof, W. M., & Wynn, L. C. (2000). Toward progress research: Closing the gap between family therapy practice and research. Journal of Marital and Family Therapy, 26, 18.
  • Pote, H., Stratton, P., Cottrell, D., Shapiro, D., & Boston, P. (2003). Systemic family therapy can be manualized: Research process and findings. Journal of Family Therapy, 25, 236262.
  • Rain, R., Sanderson, C., Hutchings, A., Carter, S., Larkin, K., & Black, N. (2004). An experimental study of determinants of group judgments in clinical guideline development. Lancet, 364, 429437.
  • Risahmawati, R. R., Emura, S. S., Nishi, T. T., & Koizumi, S. S. (2011). Japanese resident physicians' attitudes, knowledge, and perceived barriers on the practice of evidence based medicine: A survey. BMC Research Notes, 4, 374, 109.
  • Sandberg, J. G., Johnson, L. N., Robila, M., & Miller, R. B. (2002). Clinician identified barriers to clinical research. Journal of Marital and Family therapy, 28(1), 6167.
  • Schulte, D., Bochum, R. U., & Eifert, G. H. (2002). What to do when manuals fail? The dual model of psychotherapy. Clinical Psychology: Science and Practice, 9, 312328.
  • Sexton, T. L., Gordon, K. C., Gurman, A. S., Lebow, J. C., Johnson, S. M., & Holtzworth-Munroe, A. (2011). Guidelines for classifying evidence-based treatments in couple and family therapy. Family Process, 50, 377392.
  • Sparks, J. A., Kisler, T. S., Adams, J. F., & Blumen, D. G. (2011). Teaching accountability: Using client feedback to train effective family therapists. Journal of Marital and Family Therapy, 37, 452467. doi:10.1111/j.1752-0606.2011.00224.x.
  • Sprenkle, D. H., & Piercy, F. P. (Eds.) (2005). Research methods in family therapy. New York: Guilford.
  • Sprenkle, D. (2010). The present and future of MFT doctoral education in research-focused universities. Journal of Marital and Family Therapy, 36, 270281.
  • Sprenkle, D. H., Davis, S. D., & Lebow, J. L. (2009). Common factors of couple and family therapy: The overlooked foundation of effective practice. New York: Guilford.
  • Sternberg, R. J. (2006). Evidence-based practice: Gold standard, gold plated or fool's gold? In C. D. Goodheart, A. E. Kazdin & R. J. Sternberg (Eds.), Evidence-based psychotherapy: Where practice and research meet (pp. 261271). Washington, DC: American Psychological Association.
  • Stewart, R., & Chambless, D. H. (2007). Does psychotherapy research inform treatment decisions in private practice? Journal of Clinical Psychology, 63, 267281.
  • Stiles, W. B., Barkham, M., Connell, J., & Mellor-Clark, J. (2008). Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: Replication in a larger sample. Journal of Consulting and Clinical Psychology, 76, 298395.
  • Teachman, B. A., Drabik, D., Hershenberg, R., Vivian, D., Wolfe, B., & Goldfried, M. (2012). Bridging the gap between clinical research and clinical practice: Introduction to the special section. Psychotherapy, 49(2), 97100.
  • Upshur, R. E. G. (2005). Looking for rules in a world of exceptions: Reflections on evidence-based practice and case formulation. Journal of Clinical Psychology, 64, 10461068.
  • VonRanson, K. M., & Robinson, K. E. (2006). Who is providing what type of psychotherapy to eating disordered clients? A survey. International Journal of Eating Disorders, 39, 2734.
  • Walkup, J. T., Albano, A. M., Piacentini, J. P., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive-behavioral therapy, Sertraline, or a combination for childhood anxiety. New England Journal of Medicine, 359, 27532766.
  • Wampler, K. S. (2010). Challenge and urgency in defining doctoral education in marriage and family therapy: Valuing complementary models. Journal of Marital and Family Therapy, 36, 291306. doi:10.1111/j.1752-0606.2009.00145.x.
  • Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum.
  • Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2007). Case studies in emotion-focused therapy for depression: Comparing good and bad outcome. Washington: APA Books.
  • Wells, A., & Dattilio, F. M. (1992). Negative outcome in cognitive-behavior therapy: A case report. Behavioural Psychotherapy, 20, 291294.
  • Williams, L. M., Patterson, J. E., & Miller, R. B. (2006). Panning for gold: A clinician's guide to using research. Journal of Marital and Family Therapy, 29, 407426.
  • Wittenborn, A. K., Dolbin-MacNab, M. L., & Keiley, M. K. (2013). Dyadic research in marriage and family therapy: Methodological considerations. Journal of Marital and Family Therapy, 39, 516. doi:10.1111/j.1752-0606.2012.00306.x.
  • Wolfe, E. B. (2011). The case of Rachel: An integrative psychotherapy for panic disorder. Psychotherapy Bulletin, 46, 813.
  • Wolfe, B. (2012). Healing the research-practice split: Let's start with me. Psychotherapy, 49(2), 101108.
  • Zeldow, P. (2009). In defense of clinical judgment, credentialed clinicians, and reflective practice. Psychotherapy: Theory, research, and practice, 46(1), 110.

Biography

  1. Top of page
  2. Abstract
  3. Suggestions for Reducing the Divide
  4. Conclusion
  5. References
  6. Biography
  • Frank M. Dattilio, PhD, is a clinical instructor in psychiatry, Department of Psychiatry, Harvard Medical School; Fred P. Piercy, PhD, is professor of family therapy, Department of Human Development, Virginia Tech; Sean D. Davis, PhD, is an associate professor of couple and family therapy at Alliant International University.