Feedback Informed Treatment: Evidence‐Based Practice Meets Social Construction

• Date: 01 March 2015
• DOI: http://doi.org/10.1111/famp.12111
• Published date: 01 March 2015
• Author: Sheila McNamee,Julie Tilsen

Feedback Informed Treatment: Evidence-Based

Practice Meets Social Construction

JULIE TILSEN*

SHEILA MCNAMEE

†

This article explores the challenges presented by the mandate for evidence-based practice

for family therapists who identify with the philosophical stance of social construction. The

history of psychotherapy outcome research is reviewed, as are current findings that prov ide

empirical evidence for an engaged, dialogic practice. The authors suggest that the binary

between empiricism and social construction may be unhinged by understanding empiri-

cism as a particular discursive frame (i.e., a particular way of talking, acting, and being in

the world), one of many available as a way of understanding and talking about our work.

Through a case vignette, the authors introduce the evidence-based practice of Feedback

Informed Treatment as an elaboration of social construction, and as an example of bridg-

ing the gap between the discursive frames of empiricism and social construction.

Keywords: Social Construction; Evidence-Based Practice; Feedback Informed Treatment;

Outcome Measurement

Fam Proc 54:124–137, 2015

Evidence-based practice (EBP) poses a problem for family therapists who embrace the

philosophical stance of social construction,

1

as the attempt to answer the call to be

accountable, efficient, and outcome oriented is often heard as incompatible with the pro-

cess orientation of discursive practices. This dichotomy between a focus on process and a

focus on outcome is one of the central features that distinguish traditional, modernist ori-

entations to therapy from what we will refer to in this article as “systemic/constructionist/

dialogic” (SCD) family therapy. SCD is a term that embraces a long and important history

in the family therapy world. This history started with the early systems models where

focus on the family (as opposed to the individual) centered our attention on interactive pat-

terns and properties of systems (Haley, 1971; Minuchin, 1974; Watzlawick, Beavin, &

Jackson, 1967). This work evolved into what was, at the time, referred to as second-order

cybernetics, where inclusion of the therapist/observer became central (Selvini Palazzoli,

Boscolo, Cecchin, & Prata, 1978). In turn, second-order cybernetic approaches to therapy

served as the generative soil upon which current practices of family therapy, informed by

a social constructionist philosophical stance, emerged. Therapy as social construction

*International Center for Clinical Excellence, Minneapolis, MN.

†

University of New Hampshire, Department of Communication, Durham, NH.

Correspondence concerning this article should be addressed to Julie Tilsen, International Center for

Clinical Excellence, 3609 Harriet Ave, Minneapolis, MN 55409. E-mail: julie@2stories.com

1

We intentionally use the term social construction rather than postmodern because we are specifically

talking about McNamee and Gergen’s (1992) notion of therapy as social construction. We do not intend to

label any particular model or practice as a “constructionist therapy.” Thus, we understand any and all

discursive frames (and therefore, methods of practice) as potentially meaningful and productive ways

of engaging.

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Family Process, Vol. 54, No. 1, 2015 ©2014 Family Process Institute

doi: 10.1111/famp.12111