Facts and values in psychotherapy—A critique of the empirical reduction of psychotherapy within evidence‐based practice

Abstract

This paper addresses an implicit presupposition in research-supported psychological treatments and evidence-based practice in psychology. It argues that the notion of research-supported psychological treatments is based on a reductive conceptualisation of psychotherapy. Research-supported psychological treatments hinge upon an empirical reduction where psychotherapy schools become conceptualized as mere collections of empirical propositions. However, this paper argues that the different psychotherapy schools have distinct ethoses that are constituted by normative claims. Consequently, the evaluation of the different psychotherapy schools and the practice of psychotherapy should include the underlying normative claims of these ethoses.

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…Returning to the issue of value within evidence‐based practice, Henrik Berg and Rasmus Slaatelid bring out the severe limitations placed upon practice in psychotherapy by the (philosophical) assumption of a sharp distinction between “fact” and “value,” and an associated “reductionism” which treats schools of psychotherapy as “mere collections of empirical propositions.” While conceding that it has traditionally (and often legitimately) been a core function of the scientific enterprise to “provide models and theories that reduce the abundant complexity of the world,” they note that some forms of reductionism risk undermining the purposes of practices in healthcare. The various psychotherapy schools “have distinct ethoses which are constituted by normative claims.” The whole purpose of psychotherapy is to “improve the quality of life for those affected by psychological distress or illnesses,” and this enterprise hinges on the assumption that some ways of living are preferable to others.…”

“…Just as many authors in our collection emphasize the social nature of knowledge and the centrality of context to practical reasoning, so many challenge, implicitly or explicitly, other modern dichotomies. The strict dichotomy between evidence and value—the former concerned with objective fact and the latter invariably reduced to matters of subjective “preference”—suggests a clear philosophical dividing line between epistemic questions (concerning knowledge, empirical data, and reason) and questions of an evaluative or moral nature (concerning what should be the case, what is preferable, matters of emotion and personal commitment).…”

“…The strict dichotomy between evidence and value—the former concerned with objective fact and the latter invariably reduced to matters of subjective “preference”—suggests a clear philosophical dividing line between epistemic questions (concerning knowledge, empirical data, and reason) and questions of an evaluative or moral nature (concerning what should be the case, what is preferable, matters of emotion and personal commitment). While this dichotomy may well have played an important role in intellectual progress and the development of numerous scientific specialisms, it is also possible that its influence now inhibits progress …”

“…In this edition, we present an array of up‐to‐date analyses of the problems of reason in practice, addressing a diverse range of healthcare contexts and methods, considering policy decisions as well as specific instances of clinical reasoning . Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a “modern” scientific enterprise, in the light of considerations of the relationship between science, context, and culture .…”

“…The edition includes important sections on mental health, where questions ranging from epistemic injustice to psychiatric nosology and validity are analysed—discussions given both specificity and depth via a range of papers from a significant conference on how we conceptualize a number of psychiatric disorders . There is also a significant section on causal reasoning, publishing papers delivered to a recent gathering of the CauseHealth collaboration . The growing interest in medical and health philosophy is illustrated by the number of important texts currently being published in this area, and we present reviews of some of the most recent work in this field .…”