It is appropriate and timely to point out the many pitfalls and potholes associated with any evidence- based initiatives. The backlash against both evidence-based medicine and evidence-based psychotherapy is something more than just knee-jerk responses of reactionaries and recalcitrants who oppose any intrusion into their professional autonomy or any challenge to their deeply entrenched practices. The backlash also uncovers some very important cautionary notes regarding the collection of data about complex human service practices. In this essay I will identify some of these cautionary notes and suggest ways in which the pitfalls and potholes associated with this type of information gathering can best be addressed.
The Challenge—Gathering Information Regarding a Nested Problem
I begin by exploring the general challenge: human behavior typically operates in complex systems that are highly dynamic and not easy to assess or analyze (particularly regarding causal relationships). I propose that the assessment of a specific human-based process or event is what I describe as a nested problem. A problem is an issue that does not have a simple or single answer (as is the case with a puzzle). It is multi-disciplinary in nature: many different perspectives can be taken in viewing and seeking to analyze a problem. Furthermore, there are often competing (and even contradictory) goals associated with a problem. Polarities are prevalent and paradox is found in abundance when seeking to understand and successfully address a problem.
Nested problems are even more challenging, for there are typically several problems embedded in a nested problem that contribute to the “bigger problem.” For instance, in the field of medicine, there are economic issues (problems) regarding the tradeoff (polarity) of costs and quality of care that are nested in the broader issue (problem) of formulating an equitable and sustainable public policy regarding the provision of health care. There are additional issues (problems) nested inside the public policy problem that concern the acceptance of risk regarding new medical procedures: a polarity existing between the value of being sure a new medical procedure is safe and the value of accelerating approval of new procedures so that afflicted patients can receive the most advanced medical care.
Gathering Information in a “Messy” and Rugged Environment
The world in which most experts (and many professional coaches) work is quite “messy.” Another term that is sometimes used to describe this world is “wicked.” This world doesn’t become less “messy” or less “wicked” just because the expert remains in only one of C. P. Snow’s two cultures. There is great confusion within the 21st Century world of science—and within the 21st Century world of the humanities. It might actually be a bit less messy and wicked if folks from one culture listened to those from the other culture. Bridges can be of value and professional coaches can help to build these bridges.
What specifically does it mean for an environment to be messy or wicked? It means that this world is filled with the nested problems I identified earlier in this essay. It also means that everything in this world is interconnected with everything else in this world. John Miller and Scott Page (2007) describe this world as a complex system—and they contrast it with a complicated system. A complicated system is one which has many parts—but the parts all work in isolation from one another. A complex system is one in which all or most of the parts are interrelated and inter-dependent. Scott Page (2011) also uses the metaphor of landscape when describing complex system. He would suggest that complex systems closely resemble rugged landscapes (such as those found in the Appalachian Mountains) where there are many peaks and valleys.
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