The art and science of clinical psychology

A trainee responds to Ron Roberts’ talk

Attending Ron Roberts’ seminar really got me thinking. In particular, his criticism on psychology’s mistaken attempt to be a science intrigued me. Don’t get me wrong, I actually agree with him on a few things. Our university case report assignment, for example, is graded in a very scientific manner, and understandably must be evidence-based and meet various scientific criteria. I remember lamenting to my supervisor about how the case report assignment was necessary but its validity is questionable. This is so because I am certain most students (me included!) endeavoured to ‘embellish’ our case report assignments, with the intention to score well and meet the university requirements. I understand the pros of writing a case report to guide our practise to be more evidence-based and structured. But, as aforementioned, I question the validity of it. I remember reading past case reports, which demonstrated how each trainee adhered strictly to the National Institute of Clinical Excellence (NICE) guidelines and Cognitive Behavioural Therapy (CBT) manuals, providing levels of hierarchy and impressive graphical representations of their work. But how true is that when we practise clinical psychology with clients on the ground?

Therapy is dynamic, many clients are different, and progress is not always that straight forward. Often we cannot rigidly follow a CBT manual for anxiety that science and research has shown to be effective. Sometimes things do not work for the client and things have to get worse before they get better. However, we do not go into such details in our case report for fear of being convoluted and pedantic. Besides, we are encouraged to provide a very scientific, evidence-based approach so as to fulfil the requirements of the university. One huge flaw about science is that the research that demonstrates the efficacy of various methods of intervention, CBT for example, is based on clinical trials and experiments, which cannot easily be generalised to the real world. Effectively, this was one of Ron Roberts’ critiques of science – the lack of ecological validity.

However, I was nonplussed when Ron Roberts spoke about his vision of merging art with psychology. I approached Ron Roberts after the seminar and asked if I was missing out on something because to me, the merging of art and psychology has already occurred in the Clinical Psychology field. I shared with him that my supervisor often emphasised that practising clinical psychology is a form of art, which we must master. Besides that, I believe that even though trainees are taught the scientific part of psychology in university and to be a scientist-practitioner, on the ground, we do actually merge art with psychotherapy. This is because we understand that every client is unique and we practise flexibly and do not strictly follow, say, the CBT manual/protocol for anxiety.

Personally, I find it quite ironic that we use science to inform our work but also carry it out in an art form, but for our case report, we strive to be as scientific as possible and do not elucidate the art that we practise. Then again, how do we clearly explain this art form, for example, by describing how we establish the therapeutic alliance with our clients? When we use art in our intervention, how do we then assess this form of art? How do we measure the efficacy of art or teach this form of art as every individual (trainee) is different? Furthermore, by measuring the efficacy of this art, won’t this attempt then turn art into science? This whole affair just seems so cyclical in nature and complicated. You can’t teach Picasso to be like Vincent van Gogh, as they each excel in their own ways.

I have no answers to my questions and this is my two pennies’ worth.

What is yours?

Ryan Nah, First Year Trainee, August 2015

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