Nightingale Research Clinic

At Nightingale, we believe that private practice has enormous potential to contribute to theory and best practice in the field of counselling therapy. Our goal is to create fundamental change in the way that psychotherapy knowledge is produced, disseminated, implemented, and practiced.  

The Nightingale Counselling Research Clinic is the only private practice organization of its kind. The clinic is assembled at the systems-level as a bidirectional knowledge production and translation entity. This is different from either a teaching/training clinic or a traditional research laboratory. At Nightingale, research, learning, teaching, and healthcare delivery are entirely interwoven. 

The Problem

Private practice counselling therapy is not merely the for-profit arm of a sprawling mental healthcare system—it is an integral pillar of support in Canada, and the only place for a large portion of the dilemma to access care. Clients have an expectation that healthcare delivery will reflect the best practices contemporaneously available. But in counselling therapy, improving the quality of that care—beyond basic ethical standards—is the responsibility of individual Counsellors rather than the institutions which organize the field. 

Clients…

suffer from outdated quality of care. For many counsellors, the state-of-the-art means training in 20 — 40 year old modalities.

Counsellors…

suffer from a lack of professional infrastructure to support and nurture their development.

Psychotherapy…

suffers because there is no mechanism to leverage the millions of hours of private practice counselling into knowledge products.

The Four Pillars of “Mental Health:” 

Non-Profit: Improving accessibility

Hospital Improving psychopharmacology, psychiatry, and emergency care, which does not “trickle down” to improved care for psychotherapeutic dilemmas. 

University: Traditional clinical trials, which are typically conducted in experimental settings with specialized populations. The traditional approach can work well for conducting “gold standard” randomized controlled trials (but both replicability problems and problems once they cross the threshold from research to everyday care leave more research desired)

Private Practice: Embedding the work of designing, evaluating, and implementing health care innovations into the very systems where most people get their care.

The Implementation Gap

There is a 17 year lag between the development and implementation of healthcare practice and theory. In counselling therapy, the most common training today is based on ~30—40-year-old models of practice.

The “Training” Model of “Professional Development”

The responsibility for healthcare improvement is individuated to the practitioner, (e.g. collecting client feedback, building collegial support networks, engaging in supervision, being deliberate in practice).

The process is unidirectional, measured by a therapist’s acceptance and fidelity to teachings. 

A Static and Unidirectional Model of Knowledge Production

Counselling modalities are packaged as completed objects—a complete and finished theory with a manual for practice.

How do we do it?

Bi-directional Learning

Creating bi-directional learning and training channels based on the recognition of  the value of therapeutic insights to the knowledge community as a whole. (Theory must respond to practice, not the other way around.)

Systematized Support

Creating systems level facilitative support based on the recognition that continuous individual learning requires deliberate practice and not just repetition of experience.

Capture Insights

Creating a platform for the capture of qualitative insights.

Recursion

Creating a feedback loop between

a) knowledge capture,

b) knowledge formulation,

c) implementation strategy,

d) reality testing,

e) feedback/new knowledge capture

What is the solution?

Private Practice Learning Health System — A systems-level process model of knowledge generation and implementation, wherein research as an automatic outcome of service delivery, and implementation in practice as an automatic outcome of research.

A Process Model of Psychotherapeutic Knowledge — Rather than orienting towards static, closed and complete theories or techniques, we recognize knowledge-construction as always-ongoing, responsive to research and practice (rather than the other way around).

A Common Language Framework — (particle psychology) to facilitate dialogue, sharing, and comparison of new knowledges with extant knowledge.

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