Expert therapists say evidence alone cannot settle treatment decisions

Peer-nominated clinical psychologists do not reject research evidence, but they describe their everyday practice as a constant negotiation with it. That is the central finding of a qualitative study published in Humanities and Social Sciences Communications, in which 16 highly regarded psychotherapists explained how they combine different kinds of knowledge when treating patients. The researchers, Fredrik Moe, Per-Einar Binder and Henrik Berg, recruited participants who had been recommended by their own co-workers, a peer-nomination strategy designed to identify clinicians recognised for their expertise.

Each therapist took part in a semi-structured interview, and the transcripts were analysed using hermeneutic phenomenological thematic analysis, an approach that seeks to interpret lived experience while remaining anchored in the participants’ own words. Across the interviews, most of the therapists described tensions in how they integrated various knowledge types in psychotherapy. The researchers organised these tensions into four themes: evidence is not carved in stone; the individual beyond categories; embodied professional practice; and psychotherapy’s contextual dimension.

The first theme captures a nuanced relationship with research findings. The participants did not dismiss randomised trials or meta-analyses, but they treated group-level results as provisional rather than definitive. Evidence derived from averages across many patients could point in one direction, while a particular patient sitting in the consulting room could pull in another.

The tension emerged precisely at the point where trial-derived evidence was applied to a single individual. A related tension appeared when clinical guidelines met patients who did not fit the diagnostic categories for which those guidelines had been developed. The therapists reported that manuals and treatment protocols, however rigorous their underlying trials, presuppose categories that real patients sometimes transcend.

Deciding what to do when a person falls between categories required judgment that no guideline could supply. Finally, the therapists emphasised psychotherapy’s contextual dimension. The authors argue that these accounts suggest a conception of knowledge that differs from the one commonly associated with evidence-based practice in psychology, which describes integration as bringing together three forms of knowledge.

In the therapists’ descriptions, by contrast, integration was not a clean synthesis but a sustained engagement with tensions among these knowledge types that cannot be fully resolved. Even so, the researchers note that the work provides empirically grounded insight into real-world decision-making in a debate that has previously been shaped mainly by theoretical and normative arguments. The authors conclude that integration is not a straightforward process of combining elements but a dynamic, dialectical practice demanding continuous reflection and adjustment.

Understanding integration in terms of tension, they suggest, may preserve a space for clinical judgment that an emphasis on unification risks constraining. As a qualitative study of 16 therapists in a single peer-nominated sample, the findings offer grounded description rather than statistical generalisation, but they open a rare empirical window on how expert clinicians actually reason when research evidence, clinical experience and patient context collide.

Subject of Research: How expert clinical psychologists integrate different knowledge types in psychotherapy practice

Article Title: Tensions in integration: a qualitative exploration of clinical psychologists’ integration of various knowledge types in psychotherapy

Article References: Moe, F., Binder, P.-E., & Berg, H. (2026). Tensions in integration: a qualitative exploration of clinical psychologists’ integration of various knowledge types in psychotherapy. Humanities and Social Sciences Communications. https://doi.org/10.1057/s41599-026-09426-8

Image Credits: AI Generated

DOI: 10.1057/s41599-026-09426-8

Keywords: psychotherapy, clinical psychology, evidence-based practice, qualitative research, clinical expertise, thematic analysis, clinical guidelines, therapist decision-making, research evidence, professional practice, integration, Tensions