Current research dilemmas in the aftermath of modernity
As mentioned earlier, child psychotherapy has come late to the field of research and to allowing for greater transparency with respect to its work and effectiveness. Given that this poses a dilemma, it would be unfortunate if in their anxiety to prove their relevance, child psychotherapists would be lured into a research methodology that inherently represents a ‘modernity bias’, and is therefore already dated. That is, research that is almost always concerned with trying to demonstrate how to eliminate problems within the individual child and adolescent. In fact this modernist position is one of espousing a de-contextualised and non-situated epistemology which is at odds with up to date research methodology in a variety of fields.
An exclusive focus on psychopathology that tries to fit the adolescent into an adultist framework, in which their pathology is separately identified without recourse to context, has severe limitations. It would also substantially limit the potential for positive outcomes. The neuropsychologist Ray Sugarman (2004) describes this as the ‘linear epistemological trap that surrounds so much of the current biobehavioural diagnoses of the child and young person’. As Sugarman argues, the focus on the ‘single causative agent’ within a bio-behavioural diagnosis, asks what makes the child ill, rather than asking the question, ‘Why has this child/young person produced these symptoms at this stage of his/her life?’ With respect to research on adolescent depression for example, we should proceed with caution in de-coupling the adolescent from their family, either through believing that adolescents should only be seen without parental involvement, or as mentioned earlier by placing parental involvement at the margins. Ultimately, it is the critical work involved in helping the adolescent and young person make sense of their relationships within the family that will help them to make sense of themselves.
In our post-modern era, despite what appears to be the continual quest for unified standards of measurement as a kind of holy grail, we need to acknowledge that this quest is in reality one of futility. There can no longer be any single universal criterion, truth, formula or set of standards and measurement, that can be applicable across the board, particularly when this relates to psychotherapeutic practice and its outcome. The notion that researchers can devise some global grand design to encompass these issues may be understood at least to some extent as a defence against the anxiety of having to live with uncertainty. Professor Sir Michael David Rawlins (2011), Chairman of the National Institute for Health and Clinical Excellence (NICE) argues that we should be sceptical of using hierarchies of evidence where they replace the capacity for judgement, and result in evidence that is in fact ‘an over-simplistic pseudo quantitative assessment of the quality of available evidence’, (Rawlins, p.6). In his Harveian Oration address (2008) to the Royal College of Physicians, he states that investigators need to shift from their entrenched positions, and that hierarchies of evidence need to be ‘replaced by accepting - indeed embracing - a diversity of approaches’ (p.34). These above all should reflect a sophisticated capacity for judgement that is essential to the interpretation of evidence and its ultimate value.
What kind of research inquiry is helpful for the promotion of child and family wellbeing?
As described above, we would need to be wary of the linear epistemological trap of conventional RCT as the sole mode of research inquiry. Mary Target (2012), prolific researcher and psychoanalyst, warns of the illusion of believing that that which cannot be measured is unimportant or does not exist. This resonates with the view of the economist and philosopher Friedrich August von Hayek (1974) who likens this to ‘perpetuating a fiction that factors that can be measured are the only ones that are relevant’. This leads, as he states, to ignoring phenomena that may appear too complex for conventional measurement, but if ignored lead to an acceptance of ‘measurable’ evidence for what may be a false theory.
Target has made the case for combining research methods both quantitative and qualitative, and how this combination can enrich both the therapeutic as well as the research inquiry (Target, 2012). She refers in particular to the sub-section of the IMPACT study called IMPACT ME - My Experience which will report on the experiences of a subgroup of patients focusing particularly on the meaning attributed to their depression, as well as their experience of treatment. Target also takes the view that trying to prove the relevance of psychodynamic work cannot be done solely by carrying out research, but requires engaging in discussion and debate about different types of evidence with the policy decision-makers, and those who recruit therapeutic services.
However, even here there appears to be confusion about what exactly is being represented to decision-makers; is it the psychoanalytic enterprise with its need to justify the expense involved in long-term treatment for children and young people, or is it altogether a different way of configuring a psychodynamic approach? It is interesting to note in this respect that according to Target, studies of ‘psychoanalytic’ child psychotherapy have not demonstrated to date the longer term improved functioning or ‘sleeper effect’ which has been found in studies of adult psychotherapy (Abbass et al., 2006; Leichsenring et al., 2004). This may be due at least in part to the fact that we cannot take an adult-centric approach to research on adolescent depression and expect it to give us the same results as depression in adults. A methodology that focuses primarily on individual pathology, and that does not take into account the contextual and relational experience of the young person, is bound to have limited outcomes.