Clinical Innovation and Evaluation: Integrating Practice with Inquiry Gerald C. Davison, University of Southern California Arnold A. Lazarus, Rutgers University We explore the complex interplay of clinical discovery and controlled evaluation, demonstrating how experi- ence in the applied arena provides invaluable insights and ideas about the complexity of the human condition and of ways to intervene effectively. Case studies have features that earn them a firm place in psychological research, and to ignore their potential contributions is to limit severely the kind of knowledge that can be generated by more systematic modes of inquiry. Some li mitations of group designs in comparative therapy re- search are also reviewed, again highlighting the impor- tance of idiographic analyses of single cases. Innovation and creative advancement are most readily nurtured via immersion in clinical/applied work, but at the same time the nature of that work is inevitably shaped by theories and hypotheses that clinicians bring into the applied setting. These abstractions are themselves in- fluenced by the clinician's interpretations of data, which interpretations are molded by theoretical and metatheoretical preconceptions. In this complex and i nteractive fashion, clinical innovation is part of a non- linear network of forces that includes personal biases, professional allegiances, epistemological assumptions, theoretical preferences, and familiarity with and use of certain bodies of data. Key words: case studies, psychotherapy outcome research. [Clin Psycho) Sci Prac 1:157-168, 1994] At a recent professional meeting, a colleague was dis- cussing a new and unusual clinical procedure that its pro- Address correspondence to Gerald C. Davison, Department of Psychology, University of Southern California, Los Angeles, CA 90089-1061. ponents had reported the previous year in a clinical case study-a technique that, it was claimed, could eliminate long-standing fears that had proven recalcitrant to other interventions. "How could such a thing be possible?" we asked with the utmost skepticism and even derision, all the while harboring the hope that the clinical results were valid and replicable. The response from our trusted friend: "Look, who knows if it works or not, or how it works if it does work? But I do know two things: First, we can't afford to ignore a promising finding; and second, the people making the claims have their heads screwed on straight." Continued our friend: "So I've begun doing some controlled laboratory research on the procedure. I'll call you next year when my results are in." Our own reply to him: "Fine, Tom, we're impressed that you're im- pressed enough to spend some time on it. If your experi- ments tell us that the clinical reports are probably true or at least believable, we'll be after you to teach us how to do it." There are a couple of points we wish to make with this little exchange. First, innovations by clinicians are the lifeblood of advances in the development of new thera- peutic interventions. Second, whether or not attention is paid to a discovery-especially if that discovery borders on the unbelievable-depends in large measure on a prior pro hominem judgment we have made about the integrity and standing of the creative clinician. And third, clinical innovations are often (though definitely not invariably or even primarily) investigated by more exper- i mentally minded workers whose subsequent findings may persuade others that the previously unbelievable technique is worth a closer look. In what follows we try to make explicit the nature of the complex interplay between clinical innovation and controlled evaluation. The importance of attending to the idiographics of individual cases is also explored in a © 1994 AMERICAN PSYCHOLOGICAL ASSOCIATION D12 • 0969-5893/94/$5.00 157