Chapter

A systematic narrative review of discursive therapies research: considering the value of circumstantial evidence

Chenail Ronald J, Melissa DeVincentis, Kiviat Harriet E and Cynthia Somers

in Discursive Perspectives in Therapeutic Practice

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199592753
Published online February 2013 | e-ISBN: 9780191754715 | DOI: http://dx.doi.org/10.1093/med/9780199592753.003.0013

Series: International Perspectives in Philosophy & Psychiatry

A systematic narrative review of discursive therapies research: considering the value of circumstantial evidence

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In contemporary psychotherapy practice and research, the word ‘evidence’ has both methodological and political qualities (Sackett et al. 1996). From a methodological perspective, evidence can be the foundational information on which people base their beliefs in the usefulness and effectiveness of an intervention. In this vein, evidence can also be seen by some to offer proof or to establish truth or falsehood in a clinical approach. Methodologically this evidence can be derived from any of a variety of sense-making activities on the part of an observer or participant or yielded from a number of investigative designs ranging from the reflections of therapists on their clinical cases to highly controlled experiments wherein researchers conduct statistical analyses of effect size differences between the measured outcomes of participants who are randomly assigned to different treatments delivered by therapists operating from procedural manuals (Heneghan and Badennoch 2006).

From a political perspective, evidence can be a privileging and marginalizing process by which producers and consumers of clinical evidence establish hierarchies valuing one type of evidence over another (Walach et al. 2006). In these scenarios, a term like ‘gold standard’ can be used to create favouritism for the worth of evidence generated from ‘highly controlled’ experimental research designs such as randomized controlled trials and, at the same time, these imposed standards can be utilized to generate less partiality for the value of evidence constructed from more naturalistic, discovery-oriented studies of therapists and clients’ experiences of their clinical encounters (Walach et al. 2006).

Over the last 30 years, a sizable body of evidence has been generated about a group of innovative psychotherapies known collectively as discursive therapies have gained prominence in the mental health arena (Strong and Paré 2004). These therapies go by many names including solution-focused brief therapy (SFBT; de Shazer 1982), narrative therapy (White and Epston 1990), and collaborative therapy (Anderson and Gehart 2007), as well as more generic monikers such as discursive therapy. Therapists who utilize these approaches emphasize the social construction of problems and solutions and explore how engaging relationally in conversation with each other and can positively change the way we see and act in the world (Gergen 2009).

For many practitioners and researchers the social constructional aspects of these discursive therapies seemed to encourage the use of case study, qualitative, and reflective methodologies to conduct investigations into the exploration of outcomes, processes, and experiences (e.g. De Haene 2010). For other curious observers, discursive therapies presented an opportunity to apply research designs more readily associated with positivistic or post-positivistic worldviews (e.g. Vromans and Schweitzer 2011). These researchers conduct their research to explore questions of fidelity, efficacy, effectiveness, mechanisms of change, moderators, and mediators. One outcome we see as being unfortunate with these two groups of investigators, both interested in learning about discursive therapies, is that political differences seem to have created two separate worlds of epistemological and methodological proponents who do not seem to be in ready conversation with each other.

In deciding how we wanted to approach our review of clinical research conducted on discursive therapies, we sought to minimize the political aspects of evidence and maximize our attention to studying those accounts in which investigators, in the broadest sense of the word, attempted to make something evident, plain, or clear regarding outcome, process, or experience of a discursive theory encounter. We sought to be methodologically pluralistic in this review in order to celebrate what we envision as the diversity of designs and vitality of difference in the contemporary landscape of discourse therapy research and evidence (APA Presidential Task Force on Evidence-Based Practice 2006). By making this choice, we were able to search, select, review, and report publications in which authors made assertions regarding some aspect of discursive therapy and presented indications or signs that were plain or clear to them and which provided them with the evidential confidence they required to make their pronouncements, results, findings, or understanding public.

Chapter.  10198 words. 

Subjects: Psychiatry

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