I think it’s an interesting and important question to ask.

Evidence can mean – and is often thought to mean, solely and entirely – the data gathered through third-person research and quantitative studies such as random controlled trials and systematic reviews. These are reviews that are largely designed to produce ‘objective,’ ‘third-person’ evidence.

However, can we really say this is true? RCTs are often, as Ben Goldcare often points out on his ‘Bad Science’ blog, trials designed to support our prejudices and biases. And when we hold a view about something, we can very often find a piece of ‘evidence’ to back it up.

Indeed, just yesterday I found ‘a small and very preliminary study’ that would support my personal view that dark chocolate is very good for me. Now I am not saying that this particular piece of research is not a good, solid piece of research. I really wouldn’t know unless I did a systematic review of all the studies that have ever been done on the health benefits of eating dark chocolate so that I could evaluate whether all the existing data contradicted or supported this study.

I merely point to this study as an interesting example of they way that I can find ‘evidence’ for pretty much anything I want to find evidence for.

Another kind of ‘evidence,’ which is perhaps less obvious to many people is what researchers refer to as qualitative evidence. This is often ‘first-person’ evidence: what people using the intervention – patients, clients, clinicians, health care professionals, hypnotherapists – feel or know or find out empirically through  first-person, qualitative and/or phenomenological evidence.

When I was researching a model for the use of writing in therapy, I had to create a methodology that gathered qualitative data – what the process of writing feels like for me and for other people engaged in similar processes – and then look for correlates of that data in the qualitative and quantitative studies in cognitive science, developmental psychology, neuroscience and various therapy traditions.

Because I was working in such a new area, I had to examine what we really mean by ‘evidence.’ So much research in therapeutic and expressive arts had not been, in the opinion of my supervisor and myself, very rigorous. (This is probably why arts-based research can so easily be dismissed by many hard scientists.) Doing my research really made me scrutunise the meaning and nature of evidence in therapy.

One of the problems is that, when we talk about the brain – and I wanted to do that because I wanted to identify possible neurophysiological correlates for the processes of change and transformation that I was seeing in my research – we often have to talk about in terms of metaphor. The term ‘mind’ is itself a metaphor. We can’t see the mind or touch it or isolate it to one particular area of the brain. Similarly, the self is a kind of metaphor. According to neuroscientist, Antonio Damasio (The Feeling of What Happens, 2000)  even our earliest pre-verbal sense of self is a kind of ongoing mapping or ’story without words’ created by our brains encounters with objects, internal and external. Bu that’s for another blog post.

Our field of hypnotherapy is changing. I love, embrace and applaud the fact that leading hypnotherapists  are demanding more rigorous training and evidence-based practice for our field. We need that rigour and that framework for our practice.

However, I also think that we need to remain mindful of what ‘evidence’ in therapy actually means.

Take any one therapist, a client, a problem or challenge, and an agreed outcome. My friends, colleagues and mentors in the field may work with that person in many different ways. We might draw on the ‘evidence’ from various quantitative studies where a particular model of therapy was used with one group and compared with a control group who did not receive therapy. So we would be engaged in evidence-based practice.

However, and this is crucial, each of us might apply this knowledge in different ways. Each one of the therapists that I respect or whom I have learned from or have been mentored by, works in a different way. Our way of being in the world, our more or less directive approaches, everything we can use and draw upon as therapists; and what the particular client presents to us at the time – their way of being, their verbal and non-verbal communication, metaphors, stories and experiences, abilities and qualities – will all inform how we work in a particular session. I am not at all sure that this kind of process can be turned into replicable ’steps’ to be used in exactly the same way with all clients, all the time. That seems to be the very opposite, to me, of what effective hypnotherapy can be.

So, whilst we need evidence and evidence-based practice and more reigorous research in the field, I personally feel that we should not be wary of becoming complacent about what the evidence tells us. Perhaps what is most replicable and measurable about hypnotherapy is a model of flexibility, of listening to and responding to and being with the client in ways that give that client sufficient safety and sufficient freedom to make the changes s/he wants to make.

Hypnotherapy should be subject to the smae rigorous standards as any medical intervention or procedure. (Actually, when we dig deeper, many drug therapies and medical procedures are subject to surprising few trials and tests; so maybe we should say that hypnotherapy should be subject to even greater standards of rigour?)

But surely, in the end, what ‘works’ is what works for that client on that particular day – informed and guided by our knowledge and research, yes – but, above all, informed by the person we are working with.