Reconsidering the Value Assigned to Counseling Research Paradigms and Outcomes

Abstract

There is a perspective haunting the counseling and psychotherapy research communities. We have worked for decades under the assumption that the gold standard for evidentiary support, and thus the usefulness of study results, is contingent on the implementation of randomized controlled trials (RCTs). Similarly, despite their pivotal role in yielding evidence that promotes best practices in primary care (Janosky, 2005; Schork & Goetz, 2017) and behavioral health settings (Cook, Codding, Silva, & Hayden, 2017; Lenz, 2015), single-case research designs (SCRDs) have been, in many respects, relegated to a yes, but still secondrate status. Meanwhile, hierarchies of evidentiary support (Evans, 2003; Rubin & Bellamy, 2012) have situated variations of these two paradigms as above a causal demarcation line and even the most sophisticated of alternative approaches to outcome research and program evaluation somewhere below. Still then, despite the implorations of many scholars to consider a broader, more holistic valuation of paradigm–evidence interactions (APA Presidential Task Force on Evidence-Based Practice, 2006; Wampold, Lichtenberg, & Waehler, 2002), the unsubtle fact remains that many counseling researchers are situated in systems wherein anachronistic views valuing some paradigms over others have limited our collective potential to promulgate diverse types of inquiry into client outcomes. To be sure, RCTs and SCRDs have helped us achieve great heights within professional counseling and related behavioral health care professions. The results of these studies have provided a basis for disseminating sophisticated technologies for mitigating the deleterious effects of complex experiences on well-being and development. Similarly, the fruits of these activities have led to evidence-based strategies for promoting actualization of strengths and use of resources across the life span. We are further along than ever before in our understanding of group differences and individual responses to interventions targeting important constructs such as anxiety, depression, and the trauma response. Yet, it is possible that the premium valuing of RCTs and SCRDs evaluating psychiatric symptom improvement, although leading us toward auspicious outcomes through experimental manipulation and control, has in some ways limited our potential. Namely, this valuing could be impeding our innovation of new pathways toward discovery and understanding about the brilliant constructions emerging within the estuaries where counselors meet people, couples, families, groups, and communities. Thus, a revaluing of the importance of alternative outcome research paradigms appears to be indicated in at least two ways. First, this revaluing involves a genuine, evenhanded embrace of the merits associated with methodological pluralism. Second, the investigation of