The many meanings of theory and practice

What constitutes ‘theory’ in professional work, and what constitutes ‘practice’? These two terms are frequently used in professional education but rarely accompanied by a thorough analysis of the range of meanings they can carry. Indeed, a failure to deconstruct or clarify these terms creates a cloud of obfuscation over much of our work. How do professionals think about, evaluate and justify what they do? What kinds of evidence do they seek and for what purpose? How do they conceive the connection between actions, contexts and outcomes? What do we mean by a ‘good’ theory, how is the construct of ‘good practice’ created and for what reasons is this accolade given? The most useful starting points for exploring the nature of theory are its sources and its uses. Tracing origins, rather than sources, presents a different kind of problem, as theories found in one source may sometimes be traced back to another. However, that need not concern us here. Four types of source are usefully distinguished: academic publications; community discourse among practitioners; community discourse among the general public (sometimes referred to as ‘lay theories’); and personal theories, which may be either explicit or tacit. When theories are used, their meanings are shaped both by the context(s) in which they are acquired and by the context(s) in which they are used. Academic writing for publication is one particular context of use, characterized by the way in which the use of a theory has to be tailored to the norms and expectations of the anticipated readers or editors, and situated within the discussion of a particular paragraph or longer section of writing. Within an academic context, hegemony in matters of theory is normally accorded to the disciplines of scientific and social science. However, while jealous of their status and identity, disciplines are still divided into specialisms and, especially in social science, into factions with different epistemological assumptions and methodologies. In some fields the factions are so diverse that a paper published in one reputable journal might be rejected by another. Whatever one's epistemological position on the various types of academic theory, there is strong evidence, now well published by the media, that many theories are highly contested and that personal allegiances and rivalries play an important role in such disputes. So also do national or local policy agendas. It is also helpful to see groups of allied theories as being situated within a particular paradigm characterized by particular sets of assumptions about core theories and methodologies. These paradigms may rise, fall or reinvent themselves over quite long periods of time. For professional departments within the academy, the situation is more complicated. Knowledge from several disciplines may be of potential relevance to their profession. Sometimes this is recognized by appointing people trained in these disciplines to positions in the department, who then have the task of resituating the relevant theories from their discipline in the contexts of the profession(s) for whom they now work. Whereas those without such training in the discipline may seek to appropriate its theories for their own professional purpose, with rather less concern for their meaning in the discipline of their creation. The extent to which such intellectual ‘raiding parties’ are justified will depend on the nature of the theory concerned. If the theory is treated as an intellectual resource that aids one's understanding of a context or an issue, such transfers are unlikely to be problematic; but if the theory is regarded as a direct guide to action, based on experimental evidence, then the availability of confirming evidence in the new professional context will be the critical factor. A profession is better understood as an applied field rather than a discipline, because its rationale derives from its social purpose and not from any distinctive form of knowledge. Typically, it uses theories from a range of formal disciplines, appropriating and resituating them in its own professional contexts; and this process is justified only in as far as it advances the social purpose of the profession. Professions, however, are not wholly dependent on imported theories; they also create their own theories, both in the academy and in their professional practices. These theories may be based on empirical research and conceptual frameworks peculiar to the applied field, the elaboration of practitioner maxims and practical principles, or what can best be described as a preferred view or ideology of the profession, i.e. a theoretical justification of its purposes and practices in terms of moral principles, views of society and occupational beliefs about the effectiveness of various practices. This last type of theory plays an important part in sustaining professional identity and will usually derive partly from ethical principles articulated by philosophers and partly from the cultural assumptions about the role of that profession which prevail (or used to prevail) in that particular society. This raises the question of how all these different types of published theory are evaluated. From a practitioner perspective the key criteria are utility, effectiveness and alignment with their own perceived goals. However, the problem is not as simple as it appears. First, there are many complex problems for which several theories from different sources are all considered relevant; hence, assessing the contribution of just one of those theories may be difficult. Their utility may be confirmed, but not their effectiveness. Second, a theory's utility may depend on whether the professionals concerned have learned how to use it – and this aspect of professional learning is often a weak element in programmes of professional formation. Finally, theories are often embedded in practices that may be learned without understanding their theoretical foundation. So, in what sense can an embedded theory be said to be ‘in use’; and does it matter if practitioners are unaware of its significance? The problem is that when the context or conditions change, or integration with other types of theory is required, a more explicit consideration of embedded theories becomes necessary. That is why professions advocate critical thinking and reflection to keep personal practice under critical control, even when it cannot easily be articulated. Theories based on practitioner maxims may be published in ‘how to do it’ books and are based on the cultural knowledge of practices. Key questions concern the extent to which the advice is as effective as claimed, and the conditions under which such claims cease to be valid. These questions are no different from those asked of other types of theory, but the more embedded they are in the cultural practices of the profession, the more difficult they will be to change if the evidence fails to support them. On the other hand, if the evidence is positive, they will be incorporated into more academic publications and the relevant evidence will be cited, i.e. they will be relocated in the category of academic theories created within the applied field. Theories, however, are not only derived from empirical evidence. Their other role is to help practitioners to explain, understand, and critique occupational practices and the arguments used to justify them; and to appreciate new thinking about the role of the profession and proposed new forms of practice. Theories related to the ideology of the profession are particularly important in discussions of its goals and purposes, especially in occupations based on personal interaction with clients. However, there may also be a strong tendency to construct theories of practice which are ideologically attractive but almost impossible to implement. The main problem is that the professionals concerned are urged to adopt practices that involve much greater levels of time and effort than service users and/or the public purse can possibly finance. Hence, there is a significant gap between the theories of practice taught by former practitioners, based on how they would have liked to have practised, and the activities performed by current practitioners. This contrasts with a common workplace stance, in which current practice is uncritically accepted as an inevitable reality, and any impetus towards improving the service provided by an occupation is lost. Neither provides an adequate basis for a professional career. Whatever their source, and whether or not they are explicitly acknowledged, theories have a strong influence on how we interpret and understand the world around us. Indeed, both the way in which we conceptualize our environment, and our assumptions about what causes what or what will happen if we do X, can be characterized as personal theories. Such theories are pervasive and unavoidable, but what is their status as knowledge? Several possibilities come to mind, all of which might be considered to be true in certain circumstances. One possibility is that a personal theory is a personalized version of a published theory, tuned to the context by the personal experience of its ‘owner’. The need for empirical verification of theories found in practitioner community discourse has already been discussed, and this also applies to so-called ‘lay theories’. However, lay theories have an important significance for professionals because they suggest how their clients might be thinking and this is an important guide to how they might interact with them. Practitioners’ implicit theories differ greatly from theories found in academic publications. These are seldom stated by the knower but are inferred by others to explain observed regularities in their behaviour. Thus, those observed are said to behave as if they were using the implicit theory imputed to them. If knowers are informed about their own implicit theories, they often recognize them but also sometimes deny them. Recognition is extremely important, because it helps to bring actions based on personal theory under the critical control of the actor. Being unaware of the theories informing one's actions is tantamount to not being responsible for the effects of those actions. Such implicit theories can be developed by the unconscious aggregation of experiences of similar situations or by participation in a community of practice for whom certain implicit theories form part of their taken-for-granted world. The denial response, often only temporary, is usually because the implicit theory conflicts with the knowers’ self-image or with the theories they use to justify their actions. Argyris & Schön made a very useful distinction between espoused theories, often ideologically correct and acquired during professional education, and theories in use, which determine what people actually do; then go on to discuss how mid-career professionals and managers can be helped to reconcile them. Between these two extremes lie a wide range of situations in which some explicit use is made of theory in professional/vocational contexts. Theories in use may be explicitly derived from personal experience – informally acquired from colleagues, or learned from private study or formal education and training. Unless the use of theory is repetitious, it will have to be re-interpreted or transformed to fit each new situation; and this will require varying amounts of further learning, depending on how much the new situation differs from those previously encountered. Thus, a person's theoretical capability will depend not only on the range of theories which they ‘know and understand’, or even on the range of theories they have used, but also on the range of contexts in which they have used them – and their accumulated expertise in, and disposition towards – further use of those theoretical resources. This brings us back to the nature of practice, another term with several meanings in common use. First, there is a holistic meaning: the practice of medicine, for example, embraces everything a doctor does in his role as a doctor. To this must be added a set of activity-based meanings, e.g. the practice of physical examination, history-taking or the interpretation of X-rays; and a set of condition-based meanings, e.g. the practice of diagnosing and treating asthma. The ‘practice’ in evidence-based practice is normally condition-based, and its use depends on the condition being appropriately diagnosed. Insofar as it is translated into guidelines, it implicitly defines a practice as ‘an explicit set or sequence of actions that can be replicated by any practitioner with the requisite competence’. This is an abstraction from a holistic definition because, first, it focuses on what are assumed to be the key set of investigations, decisions and actions in a particular type of case, and second, it assumes that this description of a ‘good practice’ applies to all cases of that type. At a meta level, evidence-based practice can be considered as an approach to practice or even as a theory of practice. There is a danger that such abstracted accounts of practice focus exclusively on what is observable and only on those aspects of what is observable that might be described as associated with clinical decision making. Other aspects of practice, such as caring, may be totally neglected. It also takes for granted that practitioners will have developed the competence needed to perform the practice, and that the requisite competence is somehow specified within the description of the practice. These assumptions are far from being valid because competent performance depends not only on following guidelines but also on situational understanding, skilful action, ongoing monitoring and contingent responses to changes in a patient's condition, as well as ongoing care. Not all of these aspects of performance are, or even could be, explicitly described. Therefore, I would argue that in most situations there are two types of practice rather than one: the observable, socially constructed and approved, practice (possibly evidence based); and the only partly observable, only partly describable experience-based practice of the performer. Consequently, practitioners need both the capability to obtain and interpret research-based evidence in general, and the competence to perform the particular practices judged appropriate for each particular case. The notion of shared tacit practices is strongly embedded in the concept of ‘communities of practice’, but how much is really shared among the members of such a putative community? This should be an empirical question that yields different answers in different contexts, not a theoretical assumption. It is easier to imagine a relatively stable community developing a significant portion of implicit shared practices; but even that might be jeopardised by micropolitics, factionalism or practitioners who zealously guard their personal autonomy. When members of a community are coming and going quite frequently, the contributions to their practice of knowledge acquired from their diverse previous contexts of work and formal training are bound to have a significant effect. The problem is how best to use that diversity for the benefit of their clients. To complicate matters still further, it is not unusual to find groups of practitioners who offer similar descriptions of their practice but behave very differently; or groups who behave in a similar way but describe their practice very differently! This raises the important issue of the extent to which practitioner descriptions of their practices are reliable indicators of what an appropriately experienced researcher might observe. From a learning viewpoint, the critical question is what a practitioner would have to learn in order to competently perform a new practice. For them the focus has to shift from practice as an observable performance to practice as the overt result of experientially acquired understandings and capabilities that remain largely tacit. Therefore, we have two representation problems rather than one: How do we define and represent practice? How do we represent the understandings and capabilities practitioners require to perform that practice? Such learning goals may be broken down into knowledge resources, understandings and dispositions, skilled actions and interactions, decision making, etc. However, in most types of practice all these ‘requirements for performance’ are used in a highly integrated manner; and many combinations of them may be observed on a single shift. Representations of such rapidly changing complexities can at best be only partial, and one has to choose those that best fit one's purpose at the time. Theories of practice have a useful role to play in generating representations of observed or reported practices, provided that one tests the extent to which they add to our common understandings of those practices. Another much neglected dimension of practice that needs careful consideration relates to the practices of teams, groups, departments or even whole organizations. Many professionals’ practices are dependent on those of other people; and they would not be able to practice competently in many situations unless those others were also performing competently. Furthermore, the effectiveness of a team is highly dependent on the interactions embedded in the performances of its members, which cannot be judged in isolation from each other. Team practices are even more difficult to describe because no single member will be aware of everything that goes on. Then, at a higher level still are the organizational practices essential for creating and sustaining the conditions, including workloads, that make it possible (or impossible) for its constituent individuals and teams to practice effectively. Finally, let me stress the importance of attending to user practices that either affect or are affected by their health. Those practices deemed to cause damage or put one's health at risk, need to be understood in the user's life context before they can be appropriately addressed. Helping users with chronic conditions or disabilities requires understanding both their physical and their social environment and discussing how it might best support those practices of daily living which are most valued by the user. Priorities differ greatly, and knowledge of how best to support certain practices may be difficult to find. User practices can also be subdivided, like professional practices, into observable activities and the experience-based practices which users need to learn and for which support may be needed at the beginning.