Thursday 28 February 2013

Researching talking therapies and homeopathy

Researching talking therapies and homeopathy

Research involving people is challenging and even more so when it is not just focussed on their physical bodies. The NHS and NICE pretend to like ‘evidence based practice’ but it not as simple as that. And even if it was we don’t have the time or money to do Randomised Controlled Trails about all that we would like to. And when money is available for trials the money source often controls whether the results are published or even made available to other researchers. For example drug companies still repress findings they don’t like; the Home Office ignores research it has funded in prisons when it does not get the results it wants. And don’t get me started on Gove and education!

Back to topic. What works for whom sounds like a good idea – choose a problem and test out possible treatments. What we find with psychological research is that what happens in the lab is not always what happens in the clinic. For example to test out a psychotherapy or CBT on a problem then participants are carefully selected to only have that problem. This is atypical. Many people present with multiple problems. You might select 20 out of several hundred possibles for your actual study. And practitioners behave differently in research than outside. For example they are more likely to follow the manual in the research lab. But it is worse than that there is a lot of variation between individual practitioners using the same approach more so than between the averages of competing approaches. And we know that it the quality of the therapeutic alliance that is the biggest factor in successful outcome not the school of psychotherapy/CBT used. Arguably all work with whom up to a ppoint.

So probably (as Arbuckle suggested back in 1967) it would be better to research the individual practitioner rather than their modality and for me that means Who works with what? In other words focus on the practitioners getting the best outcomes with particular client problems and study them. (This has been done it is apparently how NLP got started) And it is how I do and maybe good practice managers do referral.

Onto homeopathy which does not appeal to me and doesn’t seem to work for me but it does sometimes very strikingly for my wife and did so for my daughter when she was a young toddler. The problem is that homeopathy will offer differing pills for the same client problem on the basis of their curious approach to diagnoses. So the pills offered will vary according to the individual client. (The same would be true for some kinds of psychotherapy in terms of how they work also). It is really a question of whether the treatment is intended to remove the symptom or regard the symptom as part of a bigger picture that might well need addressing. Thinking giving up smoking or drinking. Who knows what problems this might be masking, how this behaviour fits a particular individual’s patterns.

Interesting homeopathy and talking therapy give people plenty of time to share their problems, both listening very carefully. Your GP does not have the time and yet millions of us are presenting them with psychological/mental health issues. In this crazy modern world we all need a good listening to, sense of belonging of family and community, until that happens the mental health epidemic will continue.

But there is a horses for courses issue here. If I have a chronic infection I want antibiotics, a broken leg I want it setting, cancer I probably want surgery. But when it is not (just) physical, say when my life feels grey or I have fallen out badly with those I love, I need to talk, I need help not drugs or pills.

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