Research in Psychotherapy and Counselling (eBook)

Introduction

Psychotherapy and counselling research is one of the areas that contributes to the development of psychotherapy and counselling.1 Psychotherapy and counselling research is interesting in that it is not in a laboratory that it is first conducted before it is brought to practice; instead it is practice itself that informs what should be studied (McLeod, 2003). Apart from direct research, psychotherapy and counselling also benefit from basic research in psychology and related areas. Counselling and psychotherapy are also informed by related scientific disciplines, such as philosophy and other human and social sciences and medical, biological and interdisciplinary sciences such as neuroscience (Grawe, 2007). Counselling and psychotherapy are to a great extent also formed by practitioners’ clinical experience of working with clients, as well as by practitioners’ personal development experience and supervision.

Research in psychotherapy and counselling tries to come to an understanding, by the use of rigorous methods, of what is happening in therapy that leads to client changes in the direction of improved mental health. Like every research, psychotherapy and counselling research is extraordinarily complex. Rigorous investigations attempt to employ critical and reflective processes that will enhance our understanding of psychological therapy. However, critical thinking also reveals many limitations of studying psychotherapy. Awareness of the historical and social context that influences research activity is part of this critical process.

When talking about psychotherapy and counselling research, we must not forget that the investigation of human beings is always influenced by the worldview of the investigator. What is relevant to study is up to the investigator. Similarly, the investigator’s view on what constitutes the core of human beings determines the nature of the investigation. The researcher asks only those questions that he or she needs to understand and considers valuable. Researchers’ own perspectives on what constitutes people’s well-being will inform their understanding of the tasks and goals of psychotherapy and counselling. In this, the researchers’ position is not so different from that of practising therapists, who often differ significantly in their views on what the tasks and goals of therapy should be.

The worldview that shapes the delivery and goals of therapy does not preclude therapists from sharing their experiences of and reflections on therapy. The same applies to research. Researchers as well as therapists of different orientations and persuasions can learn from empirical findings that were gathered in the studies of ‘other camps’. However, what they should bear in mind is that this therapy and investigation was conducted in a certain paradigm, which they need to translate to their own. The paradigmatic differences may sometimes preclude openness to the findings from some research studies or therapies. It is a reality that for years has been part of the field of psychotherapy and counselling.

Despite the differences, it is quite likely that therapists and researchers of different orientations ask similar questions and that their conceptualizations of psychotherapy and its goals do not differ dramatically. This is probably more visible in recent years, when integration in psychotherapy and counselling has been quite popular. Furthermore, the empirical nature of research in psychotherapy invites researchers and consumers of research findings to use the findings to enrich their understanding of therapy beyond the ideology they employ.

The positive side of psychotherapy research is that it can inform the understanding of therapy as well as therapeutic practice. The negative side is that it can be misused in ideological battles between different psychotherapy camps. This text hopes to encourage readers to be aware of psychotherapy research and critical of its limitations and potential misuse.

Theoretical Orientation of this Book

This book attempts to look at psychotherapy and counselling as generic curative activity, as proposed by some well-known psychotherapy researchers, such as Klaus Grawe (2004) or David Orlinsky and Kenneth Howard (1986). This conceptualization of psychotherapy cuts through different theoretical approaches, in the best tradition of psychotherapy research, as it attempts to discover universal mechanisms of psychotherapeutic endeavour and change. Understanding psychotherapy as a generic and relatively unified activity fits well with the empirical nature of research in psychotherapy and counselling, as well as with my own persuasion that there are universal principles that can be applied within different therapeutic contexts (which are often shaped by one’s own personal history and professional training and experience).

Despite the fact that I have my own preferences in what I offer to my clients in my work and views on what constitutes human well-being, I have an interest in how, in general, psychotherapy is being researched, and what the findings are. This allows me to adapt and use in my practice findings gathered in contexts that are often different from my own way of conducting therapy. It also allows me to search within an enormous area of psychotherapy research studies for answers to questions that I encounter in my practice. I constantly experience excitement when I conduct research or read research studies that creatively attempt to uncover pure psychological mechanisms and principles of therapeutic change.

Two Reasons for Researching Psychotherapy and Counselling

There exist two main reasons for empirical investigations of psychotherapy. The first is to inform therapeutic practice. Research tries to bring knowledge that either confirms how psychotherapy is practised or points to the need to alter existing therapeutic practice (when alterations become significant, new approaches to therapy can be born). Practitioners may use research as a resource that is quite similar to everyday practice, when one works in an exploratory and collaborative manner with the client, constantly checking whether the chosen strategy works. The main advantage of research, as opposed to everyday practice, is its rigor and the otherwise inaccessible outside perspective it gives. This advantage can be incorporated by the therapist in his or her own reflective process when conducting therapy with a particular client.

Apart from the fact that psychotherapy and counselling research informs everyday practice, research can also serve as a justifier of the therapeutic endeavour. Psychotherapy research rigorously assesses the benefits of psychotherapy for clients as well as broader society. Different stakeholders want to be assured that their resources are not wasted if they are invested in psychotherapy and counselling. From this perspective it is important that psychotherapy research is also conducted (or reviewed) by investigators who represent stakeholders who have a healthy scepticism towards the usefulness of psychotherapy and are open to see not only its usefulness but also its limitations and negative impacts.

Psychotherapy Research and Practice

The main ambition of most psychotherapy researchers is to have an impact on therapeutic practice. This ambition is, however, still not fully realized, though a positive trend of incorporating research studies into mainstream therapeutic practice has certainly been growing in recent years. Klaus Grawe (1997), a prominent psychotherapy researcher, predicted that research-informed psychotherapy will be the future of psychotherapy. Research-informed psychotherapy, according to him, should replace traditional therapeutic orientations: it should be based on the key mechanisms of psychological change regardless of the specific therapeutic approach (school) used in a work. Uncovering those ‘basic therapeutic principles’ should be one of the goals of psychotherapy research, and work based on these principles would be truly generic psychotherapy.

No matter how logical Grawe’s (1997) proposition seems, the reality of the world of psychotherapy is that it exists quite independently from psychotherapy research. Training in psychotherapy and counselling still relies heavily on the accumulated clinical wisdom and personal experience of trainers rather than on research findings. The roots of this detachment probably lie in how research has been taught on undergraduate programmes. I suspect that the search for objectivity sometimes led to minimal validity.

Table 0.1 Critiques of psychotherapy research

Source: C. Morrow-Bradley and R. Elliott, ‘Utilization of psychotheraphy research by practicing psychotherapists’, American Psychologist, 41, 188–197, 1986. Published by American Psychological Association, adapted with permission.

Twenty years ago, Morrow-Bradley and Elliott (1986) investigated the use of psychotherapy research among members of the Division of Psychotherapy of American Psychological Association. They approached 10% (384 members) of this APA division and received answers from 73% of their sample. The results of their study showed that the average therapist had published in his or her entire career to date one research study, and read five psychotherapy research articles each month. Ten per cent of the sample stated that psychotherapy research articles or presentations informed their practice. Thirty-seven per cent read articles and 57% attended research conferences that they found meaningful, while 24 per cent of the respondents stated that a research article had helped them in work with a difficult...