Medium 9781855753013

What is Psychotherapeutic Research?

Views: 1094
Ratings: (0)

This book marks an important watershed in the development of psychotherapy. It provides examples of how psychotherapeutic research and the abilities to carry it out can help the practising psychotherapist. A lack of relative knowledge of research in psychotherapy, a history of apparent defensiveness is being evaluated, and a reluctance to work with universities has developed in psychotherapy. The papers represent a cross-section of current research thinking from within the UKCP, North America and Continental Europe. It will prove useful for students and practitioners of psychotherapy, as well as those more traditionally engaged in psychotherapeutic research.The book has been divided into five sections: Section One outlines what is meant by psychotherapeutic research and gives an overview of the features of different research methods. Section Two describes how to get started in the use of qualitative and quantitative methods. Section Three focuses on research into the process of psychotherapy. Section Four concentrates on research into the outcomes of psychotherapy. Section Five investigates researching the therapist and the therapeutic context.It is hoped that they will inspire current and trainee practitioners to develop themselves and their practice through research.The United Kingdon Council for Psychotherapy (UKCP), established in 1993, promotes the art and science of psychotherapy through research and education, and maintains high standards of training and practice in psychotherapy and the wider provision of psychotherapy for public benfit.

List price: $31.99

Your Price: $25.59

You Save: 20%

Remix
Remove
 

23 Chapters

Format Buy Remix

CHAPTER ONE: Psychotherapy research: nature, quality and relationship to clinical practice

ePub

Mark Aveline

Introduction

Every therapist has a keen interest in practising effectively and efficiently. The practitioner wants to know that what she does is at least as helpful in addressing the patient’s problems as other forms of help on offer and preferably is better! Although patient motivation can be complex and contradictory overall the patient has the same interest as do employers, health purchasers and planners, and practice regulators.

But how can the practitioner know that he or she is practising effectively and efficiently?

The time-honoured way is through experience. Therapists learn to be therapists through practice. Each therapy is a form of research. Before I consider this proposition further, consider Jerome Frank’s formulation of common therapeutic factors in all effective psychotherapies (Frank, 1973). At the heart of the work is an imaginative encounter between patient and therapist.1 With the assistance of the therapist, the patient identifies feelings, thoughts, relationships, situations, actions, and dilemmas that are problematic. The patient confides emotionally and intensely. The therapist, often in the role of trusted healthcare professional within that society, engages the patient in addressing the problems and, through the exercise of theory, expert intuition, explanation, interpretation, and interaction, provides a way of understanding the significance of the problems and their origin. A plausible rationale helps the patient feel more hopeful about their situation and counters the demoralization that typifies those seeking help. Finally, therapy can provide success experiences, both inside the consulting room and outside in everyday life, as the patient’s problems are grappled with and overcome. These experiences enhance the patient’s sense of mastery.

 

CHAPTER TWO: Case study revisited

ePub

Talal Al Rubaie

This brief article is written in the light of the recent establishment of the Research Committee (RC) within the UKCP and the continuing discussion about what constitutes (scientific) evidence in respect of psychotherapy and its effectiveness. Also, one aim is to stimulate further, relevant discussion. The views expressed here are my own and not necessarily shared by other members of the RC. Owing to different philosophical and political reasons, there are several strands of research philosophy that challenge the traditional, quantitative (“positive” “scientific”, “hypothetico-deductive”, or “modern”) approach that psychology/ psychotherapy developed largely under the influence of advances in “hard sciences”, particularly classical physics. The challenges come from some qualitative researchers known collectively as “new paradigm” or “postmodern”.

Quantitative data commonly use statistics and the research results are analysed and evaluated in terms of statistical significance. Qualitative data are generally content analysed and evaluated subjectively, often in terms of themes, categories, or new concepts. This article focuses mainly on case study as a special form of qualitative research.

 

CHAPTER THREE: Avoiding the fate of the Dodo bird: the challenge of evidence-based practice

ePub

David Winter

Aquarter of a century ago, Luborsky, Singer, and Luborsky (1975), reviewing comparative outcome studies of different therapies, concluded with the verdict of the dodo bird from Alice in Wonderland that “everybody has won and all must have prizes”. However, despite the fact that more recent metaanalyses (Grissom, 1996) have generally supported this conclusion, it is unlikely that in the new millennium our judges will be as benign and generous as was the dodo bird, and even if they were it is unlikely that there would be sufficient prizes to share between the burgeoning number of different forms of psychotherapy. At the last count the literature contained references to nearly 500 of these (Karasu, 1986), and the number is growing, with philosophers recently getting in on the act with the growth of philosophical consultancy (Boele, 1999).

A specific demand with which we are increasingly faced, particularly by commissioners and purchasers of health care, is for clinical practice to be “evidence-based” (National Health Service Executive, 1996), or “empirically validated”, to use the terminology of the American Psychological Association (Task Force on Promotion and Dissemination of Psychological Procedures, 1995). We are confronted with the spectre, already apparent in the USA and likely to gain ground elsewhere, of managed health care systems requiring evidence of the efficacy of particular treatment approaches before agreeing to fund them, and of insurance companies prescribing what form, and how many sessions, of therapy a client should receive. Indeed, arguably health insurance companies are becoming more in touch with the therapy outcome literature than are many clinicians.

 

CHAPTER FOUR: Questioning psychotherapeutic “evidence” (and research)

ePub

Del Loewenthal

Heaton (2001) argues that much that is important to psychotherapy (tradition, custom, intuition, and love) is ignored in evidence-based medicine. He concludes, “evidence-based medicine has little relevance to psychotherapy and counselling”. While sympathetic to this argument I do not entirely agree with the conclusion, regarding it important for practitioners to be at least familiar with current fashions in research methods in a similar way to those such as Freud and Rogers, who put their case using the dominant recent methods of their day. However, the ability to use such approaches as CORE (Mellor-Clark, Connell, Barkham, & Cummins, 2001), which many practitioners appear to have found useful in legitimizing their work, does not mean that we should just replace thoughtfulness by such tools, otherwise the measurement system determines the approach rather than what is natural to, the phusus, of psychotherapy.

In contrast to Heaton, Baker and Firth-Cozens (1998) argue that psychologists should take advantage of this trend as “The increasing emphasis on evidence-based care is world-wide and represents a huge shift in the ways we deliver services, make decisions, involve patients and manage outcomes”. American notions of evidence-based approaches to psychotherapy would indeed appear to be having a radical effect on the provision of publicly funded health service psychotherapy services in Europe as well as on the training of therapists. For example, the Review of Strategic Policy of Psychotherapy Services in England (Parry 1996) states:

 

CHAPTER FIVE: Towards a collaborative approach to clinical psychotherapy research

ePub

Georgia Lepper and Tirril Harris

In the Spring 2001 issue of The Psychotherapist, our UKCP Research Committee colleague David Winter put a compelling case for therapists to meet the challenge of evidence-based practice and become involved in empirical validation of their work. In echoing his call we would like to suggest that psychotherapy research, far from being the dehumanizing and difficult toil that has sometimes been suggested, can help clinicians to humanize their practice by collecting and responding to evidence.

Previous articles in this series have argued the case for the merits of one or other of the different research approaches available to us, as if, for example, by undertaking quantitative analyses with samples of many patients we would automatically prevent ourselves from using the insights that can be obtained from qualitative analysis such as emerges in the single case history. In this article, we hope to make the case for a pluralistic approach to research that would increase understanding along several fronts simultaneously.

 

CHAPTER SIX: Evidence-based practice: issues for psychotherapy

ePub

Martin Milton

Summary

This paper attempts to review both the frequently discussed “objective” factors in evidence-based practice as well as the more subjective factors facing psychotherapists engaged in this debate. The contention is that greater familiarity with the issues will allow us to inform and structure this debate in a more appropriate manner than if we allow those from other disciplines to structure it for us.

Introduction

Readers of this journal will be familiar with the attention that is currently being paid to the concept of evidence-based practice (EBP). Readers are also likely to have views on the strengths and limitations of this approach and on what constitutes evidence”. These positions are also evident in the literature (Owen, 2001; Roth & Fonagy, 1996,)

While the concept of EBP addresses some of the desires that psychotherapists have for their patients’ best interests, it is also one that requires thorough consideration, as the notion of “evidence” is not a straightforward, unambiguous, clear notion (Newnes, 2001; Spinelli, 2001). This dimension of the evidence-based debate therefore often fosters a level of anxiety, confusion, and ambivalence that is not well attended to in the literature or in health service policy.

 

CHAPTER SEVEN: Quantitative approaches to psychotherapy research: using single case evidence in routine psychotherapy practice

ePub

Andrew Gumley

Introduction

Psychotherapy has benefited from a range of research methodologies that are based on quantitative approaches. For example, randomized controlled trial methodology has enabled the development of a robust evidence base for a number of psychotherapeutic approaches to alleviating emotional distress (Roth & Fonagy 1996). In addition, experimental approaches to psychopathology have enabled researchers and psychotherapists to test, evaluate, revise and update clinical theory and practice. Furthermore, quantitative approaches are necessary to develop of reliable and valid measures used by researchers and psychotherapists alike. To cover the breadth and depth of this approach to research methodology is impossible in a single chapter. Therefore, this chapter aims to help readers to incorporate aspects of quantitative approaches to psychotherapy research into their day-to-day clinical practice. In particular this chapter emphasizes the value of using single case methodology as a rigorous procedure to evaluate outcomes in routine care and as a means of elucidating important processes involved in the process of psychotherapy.

 

CHAPTER EIGHT: The use of discourse analysis as a way of psychotherapists thinking about their practice

ePub

Maureen Taylor, Jayne Redmond, and Del Loewenthal

Introduction

This chapter reviews elements of two studies utilizing differing approaches to discourse analysis when researching young people’s perceptions, preconceptions, and experiences of therapy. In study A, none of the participants had experienced therapy; whereas all participants in study B were in therapy at the time. Similarities found in these studies support findings reported by other studies in the literature. Some considerations of using this and some other approaches will be offered.

Discourse analysis

Discourse analysis comes closest to a postmodern approach to research in that it challenges and critiques traditional research methodology, where proof and certainty are sought (Taylor & Loewenthal, 2001). It offers a radical approach to research that is likely to be of interest to therapists who are interested in words and what they allude to. Evolving from linguistics, cognitive psychology, sociolinguistics, and poststructuralism, it has been widely used to enhance understanding of human experience and how this is described through language.

 

CHAPTER NINE: An exploration of case study method through an examination of psychotherapy with a person with dementia

ePub

Dennis Greenwood and Del Loewenthal

Introduction

This paper starts by exploring some of the literature on case study (Bromley 1986; Hamel, 1993; Hammersley & Gomm, 2000; Kazdin, 1982; Merriam, 1998; Meyer, 2001; Platt, 1988; Stake, 1995; Yin, 1984) in order to provide a basis for conceptualizing it as a method for psychotherapeutic research. A great deal of the literature focuses on describing the basic principles of a case study approach, with the specifics associated with defining a research method being assimilated in the presentation of the research findings. Yin (1984) outlines a broad method for designing case study research, which can be applied to qualitative and quantitative studies. A small qualitative case study of psychotherapy is presented that was structured by interpreting Yin’s (1984) approach. The findings of this study are presented and effectiveness of the approach is discussed.

What is case study?

The term case study originates from that of a case history (Hamel, 1993, p. 1) and so has a tradition in the clinical setting of medicine and psychology. Kazdin (1982, pp. 3-6) states that research using a few subjects has a tradition in experimental psychology, e.g., Wundt, Pavlov, Thorndike and Ebbinghhaus, particularly at the beginning of the 1900s through to the 1920s and 1930s.

 

CHAPTER TEN: Exploring the unknown in psychotherapy through phenomenological research

ePub

Julia Cayne and Del Loewenthal

Introduction

This chapter examines how a particular phenomenological method was developed and utilized in: “describing individuals’ lived experience of feeling ready to call themselves psychotherapists.” The study began with a rather vague idea about how psychotherapists find their own place as a psychotherapist and was concerned more with how people speak of their own sense of feeling ready compared with validation through professional bodies. The researcher’s own experience suggested that there is a gradual awareness, an evolutionary process, rather than a sudden arrival at a predestined place. It seemed likely that many factors would contribute to this awareness, not least the therapist’s personal development. For example, Strupp (1989) emphasizes the importance of personal process alongside “skilful execution of professional craft” and Gilbert, Hughes, & Dryden (1989) point to the dangers of relying on technique, which they argue occurs as a result of insecurities in the therapist, rather than “being in a psychotherapy relationship”.

 

CHAPTER ELEVEN: Heuristic research

ePub

Theresa Rose and Del Loewenthal

Introduction

The aim of this chapter is to explore heuristic research as a method for researching psychotherapy. Initially the heuristic approach to research is discussed, followed by the process of conducting a heuristic inquiry; an eight-step approach is described. A discussion is provided on the application of heuristics for psychotherapeutic research, followed by a discussion on the potential merits and limitations of heuristic research. An overview of what is required in the research report concludes the chapter. Heuristics is considered here to be a relational research method that facilitates exploration of the lived experience of psychotherapy.

Definition

Heuristic research is a method located within phenomenological research and is premised on how an individual interprets their experiences (Moustakas, 1994; Patton, 1990). Heuristic “comes from the Greek word heuristkein, meaning to discover or to find” [original italics] (Moustakas, 1990, p. 9). He goes on to state: “A heuristic inquiry is a process that begins with a question or problem that the researcher seeks to illuminate” (Moustakas, 1990, p. 15), whereas Patton (1990, p. 71) states that this method “brings to the fore the personal experience and insights of the researcher”. Thus, a distinction of heuristics from other research methods is the explicit nature of the researchers’ involvement with the phenomenon that is being investigated. The research question emanates from the researchers’ lived experience; the subject is of interest to them in their own lives and they wish to know more about the subject, and to elicit “what is other people’s experience of this phenomenon?” The process of elic-itation is underpinned by the concept of tacit knowing; Moustakas (1990, p. 22) states “the tacit dimension underlies and precedes intuition and guides the researcher into untapped directions and sources of meaning”.

 

CHAPTER TWELVE: The use of postmodern feminist methodology to examine the influences of therapists’ sexuality

ePub

Julie Ryden and Del Loewenthal

The purpose of this chapter is to describe experiential analysis and briefly outline what happened when this discourse analytic perspective was used as part of a method involving triangulation of interview, literature analysis, and reflective diary methods. The actual study explored the influence of therapists’sexuality upon lesbian experiences of therapy and particularly the influence of marginal and dominant discourses within the process.

This research, arising from an MSc in Psychotherapy by one of the authors (Ryden, 1999), employed this postmodern feminist methodology, specifically the approach termed “experiential analysis”. Experiential analysis was originated by the feminist researcher Shulamit Reinharz in 1983, and later developed by Bungay and Keddy in 1996 to reflect a more postmodern influence.

Experiential analysis seeks to explain the relationship between the knowledge produced or accepted in a particular society at any time, and the other dimensions of that society (Bungay & Keddy 1996). Its focus is upon:

 

CHAPTER THIRTEEN: Researching sensitive and distressing topics

ePub

Thaddeus Birchard

As part of a doctoral research programme jointly sponsored by the Metanoia Institute and Middlesex University I am developing a modular training unit to teach psychotherapists and counsellors to assess and work with the problems of sexual addiction and compulsivity. This module could stand alone or within a programme of continuing professional education, or it could be integrated into an existing counselling curriculum. It is constructed in such a way as to recognize the growing role of Internet pornography in addictive compulsive patterning. This is a professional studies academic programme with an expectation of a product-orientated outcome rather than the preparation of a traditional dissertation destined for the library and not the workplace.

I had intended, before the current project, to research the relationship between religious behaviour, sexual behaviour, and sexual offending. After four months of indecision and distress, I set this to one side to develop this other work, the teaching and training programme on sexual and romantic addiction. This is of more interest to me and, I believe, of wider benefit to the community. The other research was leading professionally away from my main areas of clinical interest. I also made that decision because I found the other research distressing and disturbing.

 

CHAPTER FOURTEEN: A heuristic-dialogical model for reflective psychotherapy practice

ePub

Christine Stevens

This is an account of how I went about developing a research method that was compatible with my day-to-day practice of Gestalt psychotherapy how I applied it in a small scale study of my work, and the impact it has had on my professional development.

My aim in writing this account is to elicit critical responses to the methodology as a contribution to the debate about ways of doing psychotherapy research. In the space available I have chosen therefore to focus on the research process rather than simply report on my research findings.

During the research period, my work was based in a GP surgery, and was funded by the local Health Authority. I was working with brief client contracts of 6-8 weekly sessions of fifty minutes of therapy. Through my training I had come to appreciate the involvement of the therapist’s active, authentic self as an intrinsic part of Gestalt therapy, rather than the sophisticated application of appropriate techniques. My training, however, presented a model of psychotherapy that was normatively long term and open-ended. Furthermore, my exploration of the literature showed Gestalt therapy was barely represented at all in studies of brief work in primary care. What I wanted to look at was how I used my self as a therapist in the work I was doing—was it possible to work dialogically within a brief therapy contract?

 

CHAPTER FIFTEEN: Psychotherapy research in a postmodern world: discourse analysis and psychoanalysis

ePub

Colleen Heenan

Introduction

In this paper I broaden out the focus of psychotherapy and psychotherapy research in order to contextualize it within postmodern debates. I take two ideas from postmodern and post-structuralist thinking—the idea of the self as socially constructed and the idea of knowledge as discursive—and use Foucault’s concept of “discourse analysis” to deconstruct a piece of therapeutic text in order to demonstrate how psychotherapy constructs meaning. My aim is to make clear that discourse analysis is not simply a positivistic research tool but a perspective that challenges taken-for-granted ways of understanding psychotherapy. However, this challenge can be beneficial to practitioners, patients and researchers.

First, I outline some key ideas that inform discourse analysis. Next, I give a discourse analytic reading of clinical material and outline the usefulness of a discourse analytic perspective in relation to psychotherapy theory, research, and practice. However, I also indicate some of the tensions that arise in attempting to amalgamate ideas from discourse analysis and psychoanalytic theory, particularly in relation to issues of agency. My intention is to encourage both psychotherapists and psychotherapy researchers to think more critically about their practices.

 

CHAPTER SIXTEEN: Identifying cohesion in group psychotherapy process

ePub

Georgia Lepper

Introduction

One of the problems in researching the psychotherapy process is how to identify clinically significant events and link them to theory. Many of our clinical concepts were derived from experience in the consulting room and then used to develop theory. Where clinical concepts are drawn from other kinds of theory—systems theory or cognitive theory for example—the same problem arises: how can we link clinical events in the practice of psychotherapy reliably to the clinical concepts that shape our understanding of the process and our interventions? First, the researcher must seek ways to identify clinically significant elements or moments in the process; and then, if the research is to be of use to clinical practice, seek to understand what it was about those moments that was significant.

One such clinical concept that informs practice, but is little understood, is the concept of “group cohesion”. It was Yalom (1975), in his original study of patient responses to the group process, who first studied the clinical concept of “cohesion”. In doing so, he employed the subjective report. He compared his concept to that of the “therapeutic alliance”. Like the concept of “therapeutic alliance”, “group cohesion” is a heuristic concept, a combination of some research findings and the experience of clinicians and group members. In their 1994 review of the research literature on cohesion, however, Bednar and Kaul conclude that “there is no consensus about the definition or composition of the cohesion construct” (p. 651). Some of the research into cohesion which has been undertaken to date (Kivlighan, Multon, & Brossart, 1996; Marcus & Kashy, 1995; Silbergeld, Koening, Manderscheid, Meeder, & Hornung, 1975) has attempted to bring empirical methods of study to bear on these clinical concepts. They use subjective reports of the therapist and patients and the ratings of observers to measure the phenomenon. This strategy has, however, left us with an unanswered question: is there any way to identify what is happening in the interaction when, as participant observers, we have the experience of cohesion? Do therapists’ clinical interventions promote it? Or do they hinder it?

 

CHAPTER SEVENTEEN: “The vehicle of success”: theoretical and empirical perspectives on the therapeutic alliance in psychotherapy

ePub

Jocelyn Catty

“Transference of friendly or affectionate feelings... which is admissible to consciousness and unobjectionable … is the vehicle of success in psychoanalysis exactly as it is in other methods of treatment” (Freud, 1912)

The importance of the “therapeutic alliance”, “therapeutic relationship” or “working alliance” in psychotherapy has long been recognized, first in clinical practice and theory and latterly in a wealth of quantitative research. It has been shown in empirical studies to be one of the most powerful predictors of outcome in psychotherapy (Horvath & Symonds, 1991; Orlinsky, Grawe, & Parks, 1994), and is often seen as encompassing the common factors of the different schools of psychotherapy. This image of the alliance as common ground, however, may obscure crucial differences in definition and operation.

Despite the increasing interest in the alliance, I argue that two key questions remain unanswered. First, how successfully can a concept such as the alliance be transposed, either from one setting to another or from a clinical concept into a research instrument, and is its meaning irrevocably distorted in the process? Thus, what are the implications of using research measures based on the alliance in empirical studies and how do we interpret the findings of such studies? Second, how is it that the major proponents of the alliance have defined it as a means by which interventions are delivered and not curative in itself, while quantitative research increasingly links it to outcome?

 

CHAPTER EIGHTEEN: Outcome measurement

ePub

Richard Evans

The therapist as researcher

Most therapists in ordinary day-to-day clinical practice already routinely build up narrative case notes and supervision discussion notes about each client. And most therapists fairly frequently use those notes to ask themselves pertinent questions.

This process of reflecting on practice (sometimes referred to as “reflective research”) was first recognized by Donald Schon (1983) as playing a crucial role in individual professional development (see also Argyris & Schon, 1992; Ghave & Ghave, 1998) in all professional fields. Therapists are possibly better versed in this process of reflective research than professionals in many other fields because of the nature of their training.

Unfortunately this form of reflective research is often overlooked in discussions concerning “research” in the psychological therapies field, which focus instead on formal psychological therapy research studies carried out by full-time, academic researchers. Reflective research is different in a number of important ways to the research carried out by academic researchers but it is complementary to it and of equal importance.

 

Load more


Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000020536
Isbn
9781780495323
File size
1.73 MB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata