THE ROLE OF CLINICAL EXPERIENCE IN CHANGING THE EPISTEMOLOGICAL BELIEFS IN PSYCHOTHERAPY TRAINEES AND PROFESSIONALS

Introduction Epistemology refers to the critical investigation of the methodological and logical structure of knowledge about the world. Different epistemologies can produce various worldviews and justify the use and adoption of different methodologies, tools, and theories to investigate and understand reality. This study aimed to detect the epistemological assumptions of psychotherapy trainees at different stages of their training, investigating if a positivistic or complexity oriented epistemological approach was prevailing. Positivistic epistemology assumes that reality exists independently of the observer and that the truth can be directly and objectively revealed by applying scientific methods. This approach is realist and empiricist, presupposing a correspondence between scientific knowledge and external reality that can be explained through operational laws verified empirically. Scientific knowledge, therefore, progresses by accumulating new discoveries added to previous ones. On the other hand, complexity epistemology assumes that reality exists as a shared construction within a given sociocultural context. Observation thus becomes a complex action involving the possibility of multiple interpretations and viewpoints depending on the linguistic and cultural categories shared by the observer and the contexts they belong to. Awareness of the epistemology used by the observer/subject is extremely useful for identifying and giving meaning to reality, both in terms of the analysis of methodologies and tools admitted by the subject and the data collected and their different interpretations. The two epistemologies briefly described here are mutually exclusive. For the psychology and psychotherapy sciences it is crucial to discern which epistemology is more suitable and congruent with the distinctive features of their objects of intervention. We argue that intangible objects like human beings cannot be treated and investigated as tangible objects due to their intrinsic characteristics of subjectivity and variability, which take shape and are knowledgeable only within the context of intersubjective interaction. Consequently, we think that in this field the adoption of a complexity-oriented epistemology is more correct and useful than a positivistic epistemology because of the complexity required to understand and influence subjective and interpersonal phenomena, operations that imply the inclusion of the subjectivity of the observing subject. We hypothesized that adopting a complexity-oriented epistemological approach is not an easy task for therapists, in training or licensed; it depends on the theoretical orientation of their clinical orientation, their level of education and even more on the entity and kind of clinical experience they have gained in their training and professional career. A secondary hypothesis was that the degree of professionals’ epistemic trust and reflective function, as defined by Fonagy et al. (2002) was positively correlated with a more complexity-oriented epistemological approach, as the epistemic trust and mentalization presuppose greater openness to the experience and viewpoints of others. Methods To test the hypotheses, we proposed an anonymous online survey to psychotherapy trainees and professionals of different clinical orientation, asking their level of clinical experience and training and the field of their clinical intervention. The variables under investigation were measured by the following instruments: epistemological beliefs by Knowledge Style Questionnaire (KSQ) and Social Paradigm Belief Inventory (SPBI), epistemic trust and reflective function by Reflective Functioning Questionnaire (RFQ) and Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ), personality by Identity Style Inventory (ISI-5) and Ten Item Personality Inventory (TIPI), Clinical orientation and therapeutic intervention style by Cooper - Norcross Inventory of Preferences (C-NIP) and Therapeutic Orientation and Experiences Survey (TOES). The last task proposed to respondents was to read a clinical vignette retrieved by DSM-5 clinical cases and answer some open questions about its interpretation (diagnosis, therapy goals, causes of symptoms) revealing the epistemological beliefs indirectly. Respondents were 80 psychotherapy trainees, 10 experienced psychotherapy trainers, and 20 psychotherapists. Results The preliminary results seem to support our hypotheses. Years of experience as a psychotherapist correlated positively with higher scores on the scales indicating the adoption of a complex epistemology. In addition, professionals working in public settings and with more complex cases seem more likely to adopt more complex explanatory schemes. Furthermore, as expected, the scores for reflective function and epistemic trust correlated positively with the scales indicating the adoption of a complexity-oriented epistemology and vice versa correlated negatively with the scale more detecting a more positivistic approach. Conclusion These results indicate that the more experience therapists have with the complexity of real clinical phenomena, the more they adapt their epistemological beliefs to that complexity, abandoning the more positivistic and reductionist beliefs widely shared in our Western culture. A second indication that derives from the results is that the epistemological approach that practitioners choose is not independent of their relational experiences: the degree of mentalization and epistemic trust that they have developed within the interpersonal contexts in their history influences their choices at the epistemological level with implications for the methodological choices of the intervention they implement. These results represent useful directions for psychotherapy training, highlighting the importance of epistemological reflection on trainees' clinical practice and the usefulness of interventions aimed at improving psychotherapy trainees' capacity for mentalization and epistemic confidence, not only because these are useful clinical skills, but also because they create greater coherence between the complexity of clinical reality and the theoretical tools adopted to explain it and to guide intervention, which we assume to be more effective in this way. 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