psychotherapy and research

104 BRITISH JOURNAL OF PSYCHOTHERAPY (2009) 25(1)On the Alternative: Research That Fits the DisciplineRegardless of the fundamental critiques that can be given to the EBMparadigm and to the use of RCTs, we do need more critical and scientificthinking about what it is that happens in successful and unsuccessful psychotherapies,and about the effects that therapies can produce. If we thinkthat our psychotherapies are valuable, we need to be capable of demonstratingthat they indeed work, bear witness to how they work and to how changetakes place, and critically examine factors obstructing change. Only by doingthis, and by demonstrating that, in working the way we do, an importantsurplus value is added to culture and society, will psychotherapies be able tosurvive in our market-oriented societies without being reduced to justanother medical technique. Yet the primary reason for integrating researchin the field of psychotherapy should be intrinsic. Research should be one ofour tools for developing and ameliorating the stresses and strains inherentwithin the work we do – for both patient and therapist. That is why I thinkresearch into psychotherapeutic issues should be as interwoven as possiblewith clinical practice, and clinical practice in its turn should be connected toa forum where systematic reflection and critical examination take place.Theory can be situated as point of reference in the area of tension betweenboth. Research is relevant to the extent that problems and issues are firstconceptualized as sharply as possible, and then, starting from these theoreticalideas, investigations in clinical situations can usefully take place. Weshould resolutely start from this point, because philosophically spokenresearch and reflection that do not start from a theoretical framework orconceptual paradigm are not, in practice, possible: this despite the claimmade by both evidence-based medicine and the DSM (Kuhn 1962; Sturdee2001; Verhaeghe 2004).A problem with theoretical conceptualizations and with established practicesis that these tend to function as doxas (Nobus & Quinn 2005) – as setsof tenets and rituals that define what is true and what is erroneous, and whichblind us to clinical events that do not fit existing frameworks. Research canintervene and counteract this tendency, but only if it is designed to do so. Itcan then dynamize and dynamitize doxa and praxis, similar to the way inwhich good clinical work and conceptual elaboration can in relation to oneanother. In my reading of his work, Jacques Lacan is a major thinker whowas most sensitive to the pitfalls of doxa, and precisely his unorthodox wayof teaching might inspire us to connect research to practice. For example,Lacan held a weekly seminar that was clearly designed to counteract thistendency towards doxa by cultivating the dimension of investigation. ‘Investigationis research, research of the new’ (Miller 2007, p. 2). Irrespective ofthe phase at which his teaching was, Lacan questioned established ideas.In the 1950s he interrogated the dogmas of Freudian and post-Freudianpsychoanalysis, and, as he moved on, his own ideas became an object of