자연주의적 탐구조사(Naturalistic Inquiry)

With the increased popularity of qualitative research, researchers in counseling psychology are expanding their methodologies to include mixed methods designs. These designs involve the collection, analysis, and integration of quantitative and qualitative data in a single or multiphase study. This article presents an overview of mixed methods research designs. It defines mixed methods research, discusses its origins and philosophical basis, advances steps and procedures used in these designs, and identifies 6 different types of designs. Important design features are illustrated using studies published in the counseling literature. Finally, the article ends with recommendations for designing, implementing, and reporting mixed methods studies in the literature and for discussing their viability and continued usefulness in the field of counseling psychology.

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Mixed Methods Research Designs in Counseling Psychology.

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This study examined the relationships among African American clients’ perceptions of their White counselors with respect to (a) perceived racial microaggressions in cross-racial counseling relationships, (b) the counseling working alliance, (c) their counselors’ general and multicultural counseling competence, and (d) their counseling satisfaction. Findings revealed that greater perceived racial microaggressions by African American clients were predictive of a weaker therapeutic alliance with White therapists, which, in turn, predicted lower ratings of general and multicultural counseling competence. Greater perceived racial microaggressions also were predictive of lower counseling satisfaction ratings. In addition, African American clients’ perceptions of racial microaggressions had a significant indirect effect on these clients’ ratings of White counselors’ general and multicultural counseling competence through the therapeutic working alliance.

Racial Microaggressions Against African American Clients in Cross-Racial Counseling Relationships

Quality and rigor of the concept mapping methodology: A pooled study analysis

Research on resilience in adolescence has burgeoned over the past 2 decades as attention has turned toward the constructive behaviors and life-enhancing competencies of youth in navigating through significant stressors and adversity. With its focus on the strengths and adaptive processes of adolescents, the study of resilience offers a positive alternative to research concerned with developmental deficits and psychopathology. As Richardson, Neiger, Jensen, and Kumpfer (1990) stated, a resilience-based approach implies that "the processes of coping with mild to severe disruptions are opportunities for growth, development, and skill building" (p. 34). The study of how teenagers survive and thrive in the face of life difficulties has much to contribute to the greater understanding of adolescent development and to the generation of mental health interventions that build on adolescents' strengths (Fraser & Richman, 2001; Luthar, Cicchetti, & Becker, 2000; Olsson, Bond, Burns, Vella-Brodrick, & Sawyer, 2003). One of the most serious difficulties facing many adolescents is the issue of suicidality. Suicide rates have risen dramatically in several industrialized countries in the past few decades. In Canada, the sharpest rise has occurred in adolescents between the ages of 15 and 19 years, with the rate of completed suicides quadrupling since the 1950s (Breton et al., 2002). Suicide is now the second leading cause of death among Canadian youth, next only to motor vehicle accidents (Langlois & Morrison, 2002). In the United States, suicide is the third leading cause of death among youth, and an estimated 8% of American adolescents attempt suicide each year (Stanton, Spirito, Donaldson, & Boergers, 2003). Yet, despite the severity and magnitude of the problem, little is currently known about the subjective experience of adolescents who have overcome suicidal behaviors. The inclusion of the participant perspective is a critical addition to theoretical and clinical perspectives on suicide and resilience. The purpose of the present study was to develop an understanding of how adolescents overcome suicidality from the subjective perspective of previously suicidal female participants. A resilience framework was used to conceptualize this process, based on the view of individuals as active agents who adaptively avail themselves of strengths and resources to rebound from adversity. Definition of Resilience The term resilience has often been used to describe a stable personality trait or ability that protects individuals from the negative effects of risk and adversity (see Hollister-Wagner, Foshee, & Jackson, 2001; Howard & Johnson, 2000; Walsh, 2002). Resilience has also been conceptualized as a positive outcome, the criteria for which commonly include positive mental health or absence of psychopathology, social competence, positive self-concept and self-esteem, academic achievement, and success at age-appropriate developmental tasks despite exposure to risk (Hauser, 1999; Masten et al., 1999). Increasingly, researchers have come to regard resilience not as a fixed attribute or specific outcome but more as a dynamic process that evolves over time (Luthar et al., 2000; Olsson et al., 2003; Richardson et al., 1990; Richman & Fraser, 2001; Rutter, 1987, 2001). Rather than being an invariant trait that a person either has or does not have, resilience can more accurately be viewed as a normal part of healthy development that can be enhanced throughout the life cycle (Baldwin et al., 1993; Drummond, Kysela, Alexander, McDonald, & Query, 1997; Jackson, Born, & Jacob, 1997). In defining resilience, a multidimensional perspective is important, along with a consideration of the context in which resilience occurs (Carbonell, Reinherz, & Giaconia, 1998; Fraser & Richman, 1999; Luthar et al., 2000). As Luthar et al. stated, some youth manifest resilience in some situations and areas of functioning but not in others. …

Creating a Future: A Study of Resilience in Suicidal Female Adolescents

The question of what clients experience as helpful in counseling was examined via concept mapping, a methodological approach combining qualitative and quantitative strategies. The purpose of the study was to clarify the scope and interrelations among elements of the retrospective experience of helpfulness among 36 clients who had completed counseling after an average of 11 sessions. Five thematic clusters consistent with previous research were identified: Counselor Facilitative Interpersonal Style, Counselor Interventions, Generating Client Resources, New Perspectives, and Client Self-Disclosure. Four new thematic clusters were also identified: Emotional Relief, Gaining Knowledge, Accessibility, and Client Resolutions. The structure of the concept map generated by the participants in this study was found to be consistent with an integrative, pantheoretical model of the counseling process.

Clients' perceptions of helpful experiences in counseling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.

The client as expert: Researching hindering experiences in counselling.

This paper presents a conceptualisation of the therapeutic alliance from the adolescent perspective and discusses implications for practitioners. The main aim of the study was to focus on the factors that participants identified as important in relationship formation and maintenance. Eighteen individuals were interviewed using a semi-structured format. Three major themes were identified: therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics. Participants identified both positive and negative aspects of the therapeutic relationship. A strong alliance was found to be necessary in that the perception of the therapist as accepting, supportive and trustworthy influenced the adolescent's evaluation of the appropriateness of therapeutic tasks and goals. Participants stressed the importance of the supportive nature of the relationship in their willingness to collaborate in therapeutic interventions.

The therapeutic alliance: Adolescent perspectives

Despite comprehensive prevention and awareness programs, suicide continues to be the 11th leading cause of death among Americans (McIntosh, 1991, 1999) and 5th leading cause of death among Canadians (Health and Welfare Canada, 1994). Of even greater concern is the drastic increase in the rate of suicide for youths over the past 20 years (Health and Welfare Canada, 1994; Sakinofsky & Leenaars, 1997). Due to the prevalence of attempted and completed suicides, it is not surprising that suicide is the most frequent crisis situation encountered by mental health professionals (Bongar, 1992). Because suicidal individuals often communicate their thoughts to someone, the therapeutic approach taken by a counselor is of tremendous importance. To be effective in reducing suicidal behavior and ideation, an extensive understanding of the dynamics of the therapeutic process is necessary. As a result of the strong substantiating research that supports the efficacy of all psychotherapy approaches (Bergin & Garfield, 1994; Lambert, 1992), the question arises as to what constitutes effective treatment components. Among the factors contributing to therapeutic efficacy with clients, in general, that have been identified by researchers thus far are the therapeutic relationship (alliance), client motivation, client distress, and in-session emotional intensity (Beutler, 1999; Greenberg & Watson, 1998; Lambert & Bergin, 1994). Although these findings apply to clients, in general, much remains to be done to specify what works best with specific client populations (e.g., clients who pose a suicide risk). Although, typically, it has been the counselor's or investigator's point of view that has informed our understanding of this therapeutic process, the client's perspective is increasingly being recognized as essential in understanding the therapeutic process and efficacy of treatment (Heppner, Rosenberg, & Hedgespeth, 1992; Lietaer, 1992; Wilcox-Matthew, Ottens, & Minor, 1997). In addition, numerous researchers (Bachelor, 1991; Elliott & James, 1989; Gershefski, Arnkoff, Glass, & Elkin, 1996; Orlinsky, Grawe, & Parks, 1994) have recognized the importance of understanding the client's perception of the treatment process because it often differs from the counselor's perception. This expanding body of research provides a compelling argument for a more collaborative client-counselor relationship that respects and understands the client's frame of reference. Despite the growing evidence that suggests a need to incorporate the client perspective as a key element in the therapeutic process, the majority of the research literature on suicidal individuals has been focused on risk assessment, prediction, and crisis management strategies (Bongar, 1992; Firestone, 1997; Maltsberger & Goldblatt, 1996; Maris, Berman, Silverman, & Bongar, 2000). Although some research suggests that cognitive-behavioral strategies are helpful in altering patterns of thinking in suicidal individuals (Freeman & Reinecke, 1993; Hughes & Neimeyer, 1990), increasingly the relational aspects of counseling are being considered key components in treating suicidality (Eddins & Jobes, 1994; Jobes, 2000; Lineham, 1997). ERRORS OF TREATMENT The literature notes certain errors in treatment, which include failure to develop an understanding of the individual (Kreiger, 1978), therapist anxiety about death (Birtchnell, 1983; Hendin, 1981), and therapist difficulty in dealing with anger and hostility (Pope & Tabachnick, 1993). A critical and potentially dangerous error of treatment reported in the literature is the failure to assess the clients' access to emotional support (Maltsberger & Buie, 1989). Treatment errors, either by omission or commission, can provide counselors with an additional understanding of counseling suicidal individuals. Firestone (1997) identified the failure to prevent suicide as occurring in the absence of adequate risk assessment and preventive measures when events could have been foreseen. …

Barbara L. Paulson

Papers

Creating a Future: A Study of Resilience in Suicidal Female Adolescents

Clients' perceptions of helpful experiences in counseling

The client as expert: Researching hindering experiences in counselling.

The therapeutic alliance: Adolescent perspectives

Counseling for Suicide: Client Perspectives