Clinically representative research in the psychological therapies: an emerging paradigm

Abstract

This paper considers the tension between the ‘biology’ and the ‘therapeutic relationship’ camps within mental health nursing, which is focussed on differing conceptualisations of what it is that constitutes evidence and appropriate lines of inquiry. I argue that the struggle that mental health nurses have experienced in delivering evidence-based practice also resides in the thorny issue of methodological inquiry and how it is written into nursing practice. I would suggest that what is alienating to practitioners is the way in which evidence and evidence-based enquiry is generated. This paper offers a line of methodological inquiry that is based in clinical representativeness, a way of conducting and evaluating research to produce an evidence base that is informed from the ‘bottom up’ by ‘practice’. This paper not only contributes to the knowledge base of clinically representative research (CRR) but examines the ways in which this knowledge base has been produced and is currently perpetuated. The following themes are addressed: Processes and outcomes in CRR: I identify key treatment outcomes and processes operating in practice settings and consider with what confidence we can make conclusions on observed outcomes in these settings. I also examine key moderating and mediating processes influencing such outcomes. Practice of CRR: I reflect on the paradigm of CRR giving particular attention to how the paradigm has developed and is maintained. I look at how the relationship of CRR to effifficacy research has influenced paradigm development. Future directions of CRR: I summarise the conclusions of CRR to date and identify points of consensus, disagreement and clarity suggesting in what areas the field has moved forward and whether there are instances where points of conflict have contributed to growth.