On “Practice Research Networks” and critical thinking

“How do people have their thinking changed?” is the topic of the first Collaborative Exploration (CE) in my graduate critical thinking course this semester. The scenario reads:

There are many approaches to teaching or coaching, each of which aims to improve the knowledge or thinking of students or some other audience. In other words, each aims to change their thinking… We might ask how strong the basis is for any given approach to teaching or coaching. We could, in the spirit of critical thinking, scrutinize the assumptions, evidence, and reasoning behind the approach. In this case, we want you to do this scrutinizing for a teaching/coaching approach “X” (where you choose X…), but also to go further: …consider how to change the thinking of an exponent of X so that they think more critically about their approach.

The approach X I chose to examine is the Human Givens approach to therapy and mental health (HG). This approach has been developed in England since the late 1990s and has exponents in a few other countries, but very few in the United States. From Minami (2013, 166):

The HG approach focuses uniquely on those unmet emotional needs of clients as specifically defined in this therapy leading to the understanding of how the client’s resources are malfunctioning or are inadequate in allowing the client to get their needs met in a healthy balanced manner (see www.hgi.org.uk/ archive/human-givens.htm#needs). For example, a client may be missing out on the need for connection with others because of crippling anxiety when in crowded places. Helping the client identify the original triggers for the anxiety, teaching management skills, helping to deactivate any earlier traumatic experiences that may have set up the anxiety response and encouraging reconnection with others, perhaps in a small way to begin with, would be a typical HG approach.

The relevance of this approach to the CE is that it aims to change people’s thinking in the sense that they no longer act on the basis of an earlier traumatic experience. I looked for reviews of the effectiveness of this approach and found the results of a five year study analyzed by Minami and colleagues. The analysis did not use a randomized controlled trial of a single component of the theory or practice. Instead it followed the idea that “field studies, carried out in regular clinics and treatment settings with typical patients, are more representative of standard behaviour in relevant populations” (p. 166). In this spirit they focused on the HG practice research network (PRN). PRNs are “collaborations of practitioners and services that are committed to systematic collection of practice-based data” (p. 166). They found a recovery rate of 54%—well above the target set by the Department of Health in the UK of 40%. They acknowledged some of the limitations of this study, which included “the lack of availability of much more information as to the specific elements of the HG approach, as used in these various settings by these treating practitioners” (p. 173).

The idea that the practice as a whole would be evaluated, and not each component separately, reminded me of the Dean Ornish approach to cardiac rehabilitation. This approach included several elements:

  • A smoking cessation program; and
  • A vegetarian diet with less than 10 % of calories from fat, with minimal amounts of saturated fat (the “Reversal Diet”); and
  • For the most part, no use of lipid-lowering drugs; and
  • Group support and psychological counseling to identify sources of stress and the development of tools that help manage stress more effectively; and
  • Moderate exercise, usually a walking program; and
  • Reliance on the daily use of stress management techniques including various stretching, breathing, meditation, yoga and relaxation exercises.

(from http://www.aetna.com/cpb/medical/data/200_299/0267.html)
My recollection was that the program was very effective, but some researchers wanted to know which components produce the result. Ornish or others responded in effect: “What does it matter? All of the components are good for you; none of them does your harm; people in the program feel a great sense of mastery of their lives in comparison to the earlier ways of living.” However, for this CE I looked for evaluations of the program and found the review (see link above) site that complicated my recollection. First, there were studies that showed the Ornish approach was not much better than more conventional, medically focused approaches. Secondly, there were studies that analyze specific components of the approach.

I noticed that I was resistant to both the strict evaluations and the analysis of specific components. I was not ready to jettison the holistic response which integrates all the components above. In other words, I was resisting doing critical thinking. I did have an argument for this resistance: in addition to the explicit components of any theory or practice, there are also implicit or unintended components. For example, there is often an effect of exponents of an approach paying attention to you – where you might be a patient or a student or a teacher doing a pilot run of their approach. And there is also the commitment that exponents have that derives in part from the integrated picture of components as a whole. Indeed the Minami study was in part motivated to counter the pressure for randomized controlled trials in the mental health area. Such approaches are only possible if practitioners strictly follow the manual – thus the name “manualized” treatment – and therefore squeezes out the insights and creative responses that experienced practitioners can have. (Irvin Yalom’s book Love’s Executioner describes many of his therapeutic cases, and concludes, somewhat humbly, that his successes and his failures as a therapist had little to do with his theory–based analysis of the clients.)

If I, like Minami and colleagues, want to emphasize the effectiveness of an approach to changing thinking on the basis of practice research networks then I need to concede how the commitment of exponents to implementing the approach is important and so be less critical when exponents lack evidence of the effectiveness of specific components. Conversely, when I look at a multifaceted practice of my own, for example the many Rs of the CCT experience, I need to be open to researchers or skeptics pointing out my unwillingness to tease apart and examine the effect of my own assumptions and theory.

Reference
Minami, T., W. P. Andrews, et al. (2013). “A five-year evaluation of the Human Givens therapy using a practice research network.” Mental Health Review Journal 18(3): 165-176.

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About Peter J. Taylor
Peter Taylor is a Professor at the University of Massachusetts Boston where he teaches and directs undergraduate and graduate programs on critical thinking, reflective practice, and science-in-society. His research and writing focuses on the complexity of environmental and health sciences in their social context, incl. Unruly Complexity: Ecology, Interpretation, Engagement (U. Chicago Press, 2005) and Nature-nurture? No (2014, http://bit.ly/NNN2014). On reflective practice, see Taking Yourself Seriously: Processes of Research & Engagement (with J. Szteiter, 2012, http://bit.ly/TYS2012).

2 Responses to On “Practice Research Networks” and critical thinking

  1. Pingback: What moves and motivates people to make changes when working within the framework of a profession or a particular form of practice? | Probe—Create Change—Reflect

  2. Pingback: On Practice Research Networks and the changing of thinking and practice | Probe—Create Change—Reflect

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