Showing papers in "Counselling and Psychotherapy Research in 2001"

Beyond grounded theory: The use of a heuristic approach to qualitative research

Abstract: The grounded theory approach has become established as the qualitative methodology of choice for many counselling and psychotherapy researchers. It is now becoming apparent to many researchers that there are significant difficulties associated with defining what the grounded theory method actually is, and how is should be implemented. In addition, its popularity has tended to keep other qualitative approaches under-explored and under-utilised. This paper explores some of the methodological issues raised by the grounded theory approach, before presenting and then contrasting heuristic inquiry as a very different but equally useful form of qualitative methodology. Finally, the notion of researcher as bricoleur will be considered in the light of the need to develop pluralistic approaches to qualitative research in counselling and psychotherapy.

Client perceptions of hindering experiences in counselling

Abstract: The purpose of this study was to increase understanding of what clients perceive as hindering experiences in counselling. In-depth interviews combined with concept mapping were used to gather, organize, and understand clients' perceptions of hindering aspects of therapy. In the initial data gathering stage, 8 adult client participants, aged 18 or older (average of 14.1 sessions) were asked to respond to the following open-ended questions: (a)What was unhelpful or hindering about counselling? (b)What would have made counselling more helpful? In the second phase of the data gathering, a sample of 20 participants (7 male, 13 female) were asked to participate in the sorting and rating task utilizing statements derived from the interviews. The analysis produced a thematic structure that identified three core aspects of counselling that clients found hindering: (1) counsellor behaviours, (2) external and structural barriers and (3) client variables. Implications for practitioners are included in the discussion.

Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why Counselling and Psychotherapy Research is necessary

Abstract: Despite the general acknowledgement that it is important for counselling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary. It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner-oriented inquiry in the field of counselling and psychotherapy. Some of the ways in which Counselling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities. Readers are invited to participate in this endeavour.

The client as a self-aware agent in counselling and psychotherapy

Abstract: Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self-awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over-arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non-directive and directive counsellor performances alike. Vignettes selected from the participants' r...

Moments of empowerment: A qualitative analysis of positively experienced episodes in brief person-centred counselling

Abstract: 38 positively experienced episodes in brief person-centred counselling with six clients were analysed. The Interpersonal Process Recall (IPR) method was used as the prime research tool. Clients were asked to identify positively experienced moments in the counselling session during a post-session review interview. Clients and counsellors were invited to report on the feelings, perceptions and intentions they recalled experiencing during these moments. Three analyses were used to categorise the meaning and feeling quality of these moments, and a taxonomy of types of positively experienced episodes was also created. The most frequently reported positive client experiences were associated with empowerment, safety and insight. Other significant themes emerging from the analysis included: freedom in the relationship, shortcomings of the relationship, assurance of the relationship, unfolding of the client's personal meaning, and the importance of the counsellor's presence. Taxonomy of episodes revealed nine cate...

Writing qualitative research — A gathering of selves

Abstract: This paper is a reflection and discussion on the integration and personal development that may occur when we use ourselves in heuristic research, particularly in the process of writing. It focuses on my writing about a study I undertook with two of my ex-clients who are brothers, and their journey towards healing, and on their experience of our counselling relationship as part of that journey. As their counsellor, and the main researcher, my story inevitably intermingles and overlaps with theirs. My ‘selves’ as woman, survivor, client, counsellor, researcher (and numerous other selves) and their selves as survivor, man, client and researcher (and many others) are impacted by the collaborative, experiential nature of the work. Issues faced in the writing of a book about the research (Etherington, 2000), such as self-disclosure and reclaiming my voice, parallel many of my own issues as a client and my clients' issues.

An administratively created reality: Some problems with the use of self-report questionnaire measures of adjustment in counselling/psychotherapy outcome research

Abstract: Outcome research in counselling and psychotherapy has come to rely heavily on the use of self-report questionnaire measures of anxiety, depression and general symptomatology. The validity of these measures in the context of psychotherapy research has, in general, been taken for granted. This paper proposes that, despite the success of self-report questionnaires in personality research and personnel selection, there are significant problems involved in the use of these methods in research into therapeutic change. Specifically, three areas of difficulty are reviewed. First, questionnaires are completed in a social setting that itself changes as a result of therapy. Second, the experience of psychotherapy changes the way that clients make sense of questionnaire items (the ‘response shift’ phenomenon). Third, the conceptualisation of the person implicit in questionnaire design is not compatible with the conceptualisation of persons espoused by most contemporary therapeutic approaches. It is argued that the co...

Counsellors' experiences of working with suicidal clients: An exploratory study

Abstract: Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi-structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self-doubts about their professional competence. In addition, they identified the threat of litigation for negligent p...

Reflexive action research: Developing knowledge through practice

Abstract: This paper gives an overview of different ways of conducting counselling and psychotherapy research. An approach to research is described which overcomes the research-practice gap: reflexive action research. It is argued that this approach to research is particularly appropriate and relevant for practitioners since it draws upon skills and awareness necessary for clinical work, and can complement positivist methods of research which are already well established in the profession. The wider use of systematic clinical case studies is suggested as a means of promoting the reflexive action research approach. Further consideration of issues of validity and reliability is required on the part of those intending to apply this approach within the field of therapy research.

Paradoxes of qualitative research

Abstract: In qualitative research paradoxes abound in research design, sampling, generalisation, ethics and the behaviour of the researcher. The ultimate paradox is that qualitative inquiry is impossible — both conceptually and practically — yet it still goes on. It must do so if the professions of counselling and psychotherapy are to advance.

Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists' views

Abstract: Findings are reported from six semi-structured interviews with experienced psychotherapists, focusing on the reasons for using touch and the sort of touch used. They suggest that there is a distinction being made by therapists between ‘social space’ and ‘therapeutic space’, and a different view of touch taken if it is judged by the therapist to be ‘out of the therapeutic environment’. Whether or not touch was initiated by the therapist or the client would also appear to influence its further discussion by the therapist, either in processing it with the client or in supervision. What also emerged from the interviews was the finding that an exploration of touch in supervision was unusual. The implications for practice, supervision and training are discussed as areas for further exploration in the main survey, which will be conducted in the second year of the research.

How effective is workplace counselling? A review of the research literature

Abstract: The provision of counselling for work-related problems has expanded in recent years, as organisations have recognised the value of this approach to staff support. However, there has been relatively little research into the outcomes of workplace counselling, and no systematic reviews have been conducted into the effectiveness of counselling in this setting. This paper presents the results of a preliminary review of evidence in this area. 34 studies of the effectiveness of workplace counselling were identified, of which 16 were sufficiently well designed to be considered as comprising reliable findings. The results of these studies suggest that, in general, workplace counselling is effective for clients for a wide variety of type and severity of presenting problems, employed across a range of different organisational contexts. The paper includes discussion of methodological issues associated with this research, recommendations for further research, and implications for practice.

Psychotherapy for lesbians: The influence of therapist sexuality

Abstract: This study explored the influence of therapist sexuality upon lesbian experiences of therapy, and particularly the influence of marginal and dominant discourses within the process. It is argued that explorations of discourses of sexuality should be a necessary feature of a psychotherapist's training. A postmodern feminist methodology — Bungay and Keddy's adaptation of Reinharz's experiential analysis — was used in the study. This method involved triangulation of interview, literature analysis and reflective diary methods, with analysis drawing upon a discourse analytic perspective. Two sites of contradiction were explored, indicating the possible emergence of resistant lesbian discourses against the dominant patriarchal, heterosexist and homophobic discourses. The study illustrates the discursive and contextual nature of psychotherapy with lesbians.

Counsellors' experiences of changing their practice: learning the psychodynamic-interpersonal model of therapy

Abstract: Seven counsellors were interviewed about their experiences of learning and applying a new approach to therapy: the psychodynamic-interpersonal model. These interviews were analysed using grounded theory — a qualitative approach. Under the core category of ‘changing counselling practice: applying the PI model of therapy’, the material was organised into 10 major categories: difficult feelings; new awareness; therapeutic identity; identifying reasons for choosing how to work; experiencing difficulties in adherence; attributing causes of difficulties; ways through the difficulties; understanding how change in practice occurs; changing interventions; and specific other inputs. Examples from the interviews are used to cast light on the difficulties experienced by counsellors in the process of changing their practice.

Evidence-based practice: Accounting for the importance of the therapeutic relationship in UK National Health Service therapy provision

Abstract: It is argued that different models of therapy result in broadly similar outcomes and that the therapeutic relationship is the most important factor in relation to outcome. This paper presents some of the main findings from over 30 years of psychotherapy research. We discuss these findings in relation to current provision of therapy within the UK National Health Service (NHS) and express our fears that despite a culture of evidence-based practice, this evidence is in danger of being ignored. We conclude by discussing some of the implications and challenges that this evidence presents to therapy researchers, policy makers, trainers and practitioners.

Introduction: Research into the client's experience of therapy

Abstract: (2001). Introduction: Research into the client's experience of therapy. Counselling and Psychotherapy Research: Vol. 1, No. 1, pp. 41-41.

(Re)Searching for a client in two different worlds: Mind the research-practice gap

Abstract: A criticism voiced by counsellors and psychotherapists is that research does not truly reflect the complexities of therapy. Researchers, on the other hand, accuse practitioners of not attending to research findings and suggest that as a result they engage in an ill-informed process. This polarised understanding can give rise to the situation where the client is missed, falling into the research-practice gap. In reality the research-practice gap gets smaller and smaller every time a practitioner employs — which is often the case — a complex and sophisticated construct system in search of a client's psychological distress. The metaphor of the ‘search’ seems to become a point of connection between the practitioner's search and the researcher's (re)search. As a way of exploring this issue, the paper briefly considers the research-practice gap and the critique of current research. It argues that counsellors and psychotherapists are themselves engaging in research when they practise therapy since every counsell...

Introduction: Critical issues in the methodology of qualitative research

Abstract: (2001). Introduction: Critical issues in the methodology of qualitative research. Counselling and Psychotherapy Research: Vol. 1, No. 2, pp. 114-117.

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Abstract: Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource-impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co-constructing meanings for ambiguous but significant experiences in therapy are discu...

The significance of psycho‐peristalsis and tears within the therapeutic relationship

Abstract: This paper represents a heuristic study of the significance of involuntary, intuitive gut responses (psycho-peristalsis) and tears within the therapeutic relationship. Autobiographical material and qualitative data were gathered from case-notes and semi-structured interviews with four client/co-participants. Data on occurrences of psycho-peristalsis and tears were collected from 92 clients seen within a six-year period. Eleven elements of a ‘general constitutional structure of experience’ were identified. A central finding of the study concerns the gut's apparent ability to ‘pick up’, at an unconscious level, significant material that might otherwise have been overlooked. The research suggests some possible clues to the process of unconscious communication and healing, and adds an interesting psychological dimension to recent findings in the fields of neuroscience and cell biology which amount to the discovery of a ‘second brain’ in the walls of the small intestine. These phenomena are examined in the lig...

The rhetorical organisation of dream-telling

Abstract: An appreciation of the ways in which clients and patients tell stories in psychotherapy is essential to an understanding of the therapeutic process. This paper reports findings arising from a programme of research into the analysis of patient narratives in psychotherapy sessions and diagnostic interviews. The focus of the current paper is on the analysis of the use of language in patient-therapist interaction during the recounting in therapy of dream narratives. Dream-telling follows certain rules of presentation that can be described as a set of specific rhetorical practices. The rhetoric of the dream-teller reporting a dream is one of emotional distance, reflecting a narrative sequence which lacks a motivational framework. The report needs to be put into context by establishing a dialogue with the listener. The sharing of the dream with another, especially in the psychotherapeutic context, represents the dream-teller's attempt to reproduce the dream experience. This attempt is made with reference to a r...

‘The threat of the Other’: Using mixed quantitative and qualitative methods to elucidate racial and cultural dynamics in the counselling process

Abstract: This paper examines the use of mixed quantitative and qualitative methods in the study of racial and cultural dynamics in the counselling process. The approach is illustrated by the author's own research which combined quantitative survey instruments with a blend of qualitative methods. Emphasis is given to complex racial and cultural phenomena arising from the qualitative methods of data collection and data analysis, particularly the pervasive experience of ‘threat of the Other’. These phenomena were seen to permeate the counselling interactions both explicitly and implicitly. The emerging racial dynamics are discussed with reference to theoretical concepts which stress the interrelationship between intrapsychic development and sociopolitical issues. The effectiveness of employing pluralistic methods in this field of enquiry is also evaluated.

Culture: The song beyond words

Abstract: The paperarises from Pakeha attem pts to dealwith bicultural responsiveness in Aotearoa, New Zealand, and represents the application of a social constructionist conceptual framework to practical issues faced by counsel brsworking around cultural difference. It seeks to de-construct some of the assumptions made in discourses around difference through expbration of the language through, and by which, we make cross-cultural connections. Readers are invited to consider the relationship of text to ethos, and the relationship of the words we use to the space between the words. It is suggested that the power of this in-between space, this chora (Kristeva, 1980), is related to the expression of culture. The paper aims to present a challenge to those who at times wonder about the ethics and efficacy of their counselling profession in relation to their desire to create a betterworld — in particular in redressing the inequities which invariably exist between different cultures. It is proposed that counselling as a d...

Introduction: Discourse and the social construction of meaning in therapy

Abstract: (2001). Introduction: Discourse and the social construction of meaning in therapy. Counselling and Psychotherapy Research: Vol. 1, No. 3, pp. 191-193.

Debriefing and research

Abstract: This paper argues that some recent research, which claims to have shown that psychological or critical incident debriefing (CID) is ineffective or can make people worse, does not provide an adequate evaluation of the effectiveness of this type of intervention. Despite the limitations of this research, it appears to have influenced some authorities and organisations to such an extent that many have now abandoned, or been advised to abandon, CID as a response to traumatic events. This paper also argues that there are certain criteria vital to the context, content and conduct of the use of CID which must be reflected in research into its effectiveness. Unless we get these criteria right, CID will continue to be misunderstood, misrepresented and misused. CID is not a panacea for all traumatic ills and it might not prevent the development of post-traumatic stress disorder (PTSD), as was perhaps once believed, but it is one response, amongst many, which could be used and offered when traumatic incidents occur.

Evaluating the effectiveness of counselling in primary care: Taking a fresh look

Abstract: One criticism voiced by counsellors and psychotherapists is that research does not reflect either the culture or values of therapy. Researchers, on the other hand, accuse practitioners of not attending to their findings, and the implication is made that the latter engage in treatment processes that are ill-informed. These polarised understandings give rise to the situation where the client — and his or her development — fall into the practice-research gap. In more recent studies of counselling in primary care, an attempt has been made to offer new perspectives for interpreting and understanding findings, and the relative value — and limitations — of different research questions and methods. They provide just a few examples of how practitioner-researchers in the future may ask more precise questions, yet reflect on their findings from a broader set of viewpoints.

It takes two to tango: Research and practice as an amazing dance

Abstract: This paper offers an appreciative critique of Kim Etherington's recent book, Narrative Approaches to Working with Adult Male Survivors of Male Child Sexual Abuse. I discuss the issues raised in the book with reference to one of my current clients. Etherington does not produce new substantive theory: the power of this work is in the narrative. Her important contribution lies in the reflexivity with which she encounters her material. The use of critical reflexivity challenges the subject/object dichotomy inherent in much positivistic research, and presents a much-needed approach to process that is congruent with the lived experience of counselling. I would suggest that research is more likely to succeed in informing practice if the material is open to personal interpretation by the reader/therapist. Further, I would claim that the activity of using research creatively is itself a heuristic process: useful learning is most likely to occur if the dialogic relationship with the client and therapist is mirrored in the relationship between the therapist and the research text.