This essay will provide an evidence based discussion surrounding some methodological issues and dilemmas that psychotherapy researchers encounter. The writer will begin by giving an overview of process research followed with a discussion surrounding two specific process issues. These issues will be correlated with two journal articles and will determine how the researcher either conceded or did not mitigate the research according to the process issues. It should be noted that when conducting research, both process and outcomes studies should be overlapped but due to the limited word count for this paper process studies will be focused on
Overview of Process Research
Similarly to qualitative and quantitative methods, outcomes and process studies aim to provide information. They differ due to the focus on the effectiveness of counselling and psychotherapy and the process of the interior of therapy. McLeod describes process research as “The processes within therapy that are associated with good client progress” (McLeod, 2003, p. 145).
In order for process research to commence two methodological issues need to be present. First, the unit of analysis such as the individual or group being studied has to be selected and secondly there needs to be an observer such as the researcher (McLeod, 2011).
Process research is vast, complex and difficult to measure and involves detailed interactions that occur between the client and the therapist (McLeod, 2011). The earliest attempts to evaluate counselling begin in the United States in the 1930’s (McLeod, 2003). Denker (as cited in McLeod, 2011) discovered that almost half of those who had recovered from a psychiatric ward had received psychoanalysis within the facility. This discovery inspired interest for therapists to focus on spontaneous recovery as well as more rigorous and objective studies in the effectiveness of counselling (McLeod, 2011).
Carl Rogers was a significant key figure who began publishing books of his case studies with relevance to the effectiveness of counselling in 1942 (Sollod, 1978). Thereafter, he began to code and analyse transcripts of his therapy sessions which revolutionized theory in a systematic manner. This then led to his client centered approach including process and outcomes studies (Crisp, 2011). According to Holzman and Forman (1966) the focus around the study of schizophrenics and adaptations of new methods then unfolded. Process research continued by Rogers and others but fizzled out in the 1980’s (McLeod, 2011). Resurgence of process and outcomes began again in 2002 with an interest in the use of various methodologies (McLeod, 2011).
Rogers’s publication of the ‘Client Centered Psychotherapy’ approach remains and in fact continues to contribute to process research today (Sollod, 1978). One way it does this is by making us acknowledge that questionnaires and interview must be client focused and not personally biased from the therapist or researcher (Crisp, 2011). His non-directive approach demonstrated that in order for the client to improve they must feel in control (O’Neill, 2001).
It is recognizable that problems can be identified with obtaining such intricate information, such as how the client feels within the therapy hour. Noticeably, bias and validation from the therapist is a continual struggle (McLeod, 2011). It could be implied that Rogers may not have had a dilemma with obtaining research whilst letting the therapeutic work flow due to his expertise (O’Neill, 2001). However, a researcher obtaining data for process studies without proper counselling training would be undoubtedly problematic (McLeod, 2003).
Issues such as confidentiality and informed consent are topics that perhaps were not considered in the earlier part of the century but are very much a large part of the ethics within process studies today (Robinson & Gross, 1986).
Discussion – Methodological issues in process research.
Process issues can include the therapeutic alliance, therapist errors, things not said and the use of language which are all very difficult to collate and analyse (McLeod, 2011). Some more powerful ideas about therapy processes such as the psychodynamic perspective of transference, countertransference, interpretation, free association and resistance presents even further methodological issues for researchers (McLeod, 2011). Firstly, they must have had many years of psychodynamic training in psychotherapy in order to understand the phenomena (Shapiro, 1986).
The reason for choosing the two following process issues begins with my interest in the subjects. In my experience, the therapeutic alliance is always debated with CBT theorists. Generally speaking, they believe strategies are more important than the therapeutic alliance. This may explain why CBT therapists are inclined to use the care plan method from GP’s which give 10 free sessions per year. I come from a psychodynamic background and firmly believe that the therapeutic alliance and transference is vital and unavoidable within therapy.
In an article by Bachelor (1995), clients were researched in order to view their perception of the therapeutic alliance. Due to the interest surrounding the phenomenology of such an alliance, there purpose was to elucidate the therapeutic alliance from the point of view of the client using a qualitative phenomenological methodology (Bachelor, 1995). The study involved 23 trainee psychology students based within a university consultation service, interviewing 34 clients (26 females and 8 males).
The therapeutic alliance has been described as the working relationship between a client and a helping professional (Ana & Mary Elizabeth, 2011). Parallel to this, process research has been viewed as a positive therapy outcome (McLeod, 2003).
Within this paper, the researchers measured the therapeutic alliance by giving clients an open-ended self-report inquiry format which is generally used in phenomenological research (McLeod, 2011). This proved beneficial as it yielded rich descriptive data as well as authentic data but appeared less helpful when trying to organize the themes and processes. Another limitation of this account gathering technique is clients can easily forget episodes that happened within the therapy session and therefore do not give direct descriptions. The lack of co – construction within the paper resulted in a limited amount of validation.
An additional limitation within the study could perhaps be based around the clients understanding of the term ‘therapeutic alliance’ and all that it encompasses. Clients have shown defensiveness in such studies which could result in making the client an unreliable source (Shapiro, 1986). Therefore, the client should be fully aware of the topic at the beginning of the study to ensure complete validity (McLeod, 2011).
Further restrictions of the study include male clients being underrepresented along with inexperienced therapists. The advantages of the study involved full provisions being paid for the university.
The study had a high amount of units of analysis. 34 subjects is a relatively large scale within process research but to assist with this, a large amount of therapists were recruited. Although the therapists were students in psychology, each of them had access to a moderator in research and ongoing supervision was made available. The therapists used a variant of approaches such as cognitive behavioral therapy, humanistic –existential, analytic and gestalt. All which have shown no difference towards the therapeutic alliance, whereas the relationship itself appears to be more significant (Summers & Barber, 2003).
The interviewers tried to remain unbiased by rotating teams in groups then analysing random selections of the research. They ensured validity and integrity of the study by being aware of their limitations before the study, therefore helping to prevent it (McLeod, 2011). Worth noting is although these techniques minimize problems it certainly does not remove problems within process research (McLeod, 2011).
To assist with the data analysis, two qualified researchers were employed and used to code the research. They used the interpersonal process recall (IPA) technique method to organize the data which assisted in a systematic analysis of the data (McLeod, 2011).
Ethical considerations including confidentiality, informed consent and privacy were mitigated very well in the study. In fact, the study discussed this with great clarity and succinctness that it seemed irrelevant to go into much detail other than stipulate that it was done well.
Future recommendations include expansion of interview methods and have experienced therapists included in the study to compare the therapeutic alliances styles with the trainee therapists.
A study by Gelderman, (1998) titled ‘A study of transference in the male to male counselling relationship’ will now be discussed. The paper’s main aim was to focus on male therapists and how they experienced the transference within the counselling relationship.
Transference has been described as an individual creating patterns from passed experiences from their past or childhood, then projecting their thoughts onto friends, family, therapists and others (Levy & Scala, 2012). Transference is a difficult topic to analyse and requires experienced therapists (Jorge de la, 2005). As stipulated in the psychodynamic research, it is vital that in order to obtain credible research of processes, therapists must perform the research within the therapeutic setting themselves (McLeod, 2003).
The limitations surrounding this study include the fact the experienced therapists must be aware of the here and now and the transferences taking place, whilst trying to maintain a therapeutic alliance (Frederickson & Ebook, 1999). It is a difficult task, and in fact there is little evidence focusing on qualitative data in relation to transference due to its difficulties. Additionally, the limited amount of research is from the 1990’s and before. Notably, this same research focuses predominantly on the therapist’s statement of transference rather than the client’s point of view. The obvious reason for this is that the average client would not understand what transference is and therefore the process of transference has been focused on from the perspective of the therapist.
The approach to this study was a qualitative methodology as a way to explore the phenomenon of transference. This phenomenon enabled the reader to experience the essence of the therapy.
The participants consisted of 8 male clients and 3 male therapists. The focus of the research originated when the primary researcher wanted to understand his own transference with respect to other males. He also wanted to improve his abilities of communication and understanding with other males. Part of the selection criteria was that the therapists interviewing must have had over two years’ experience working with male clients and in addition, an understanding of transference.
The data integrity was maintained by the therapists noting down their feelings next to the transcriptions. They then kept a log diary of these feelings in order to identify the difference between their own feelings and their client’s feelings. Transference is a particularly significant issue where therapists could easily include their own subjectivity on the data (Levy & Scala, 2012). In cases such as the novice researcher, the presumption may be that it’s too difficult to research, however in order to remain unbiased, the methods of the researcher help to avoid this process due to the systematic process (McLeod, 2011).
Collection of the data included eight semi-structured interviews. It involved using open ended questions providing the reader with guided and focused events. Prior to the interview, the therapists were supplied with the interview questions in order to consider their experiences of transference. The interviews were conducting using a relaxed atmosphere to help illicit information from the client.
The interviews took place wherever it suited the clients preferably in a familiar place over a 90 minute period. It was noted that observing the clients within their own working environment allowed for a more ambitious analysis (McLeod, 2011).
Data collection included audio-tape and observation. A transcribed copy was sent to the participants in order to receive feedback that the transference reflected their true experiences. The clients then had the choice via transcription or telephone to change their reflections. Interestingly, little changes were made by the clients and in fact half of the clients experienced surprise as their transference was described succinctly.
In addition to the researchers, a transcriber was hired whilst upholding confidentiality. The transcription was checked with the audio tapes in order to ensure validity. Arguable, it would be almost impossible to observe transference whilst maintaining the therapist role along with transcribing the observations. Therefore, employing a transcriber appeared logical and appropriate.
Ethical considerations were maintained by the therapist ensuring informed consent was completed and that names had been given an alias. The clients had also been informed that the research material would be destroyed after 1 year.
One of the researchers’s described his disempowerment when interviewing a client who was more experienced than him. In this particular case, the interview technique hampered his ability to remain on topic. Shortly afterwards, one of the other therapists had to redo the session. Significantly, qualitative research discusses the importance of inequality between the clients and the researcher (McLeod, 2011). In consideration of this, perhaps the client chosen in the pre-selection should have less experience than the interviewers enabling a better collection of data.
The above papers focused on the therapeutic alliance and transference. Both papers appear to have been researched well and a high level of validity was apparent. The writer of this paper is a trainee therapist and has gained knowledge around these topics significantly in regards to the research methodologies of these topics.
My recommendation for further advancement in process issues would be to have non-government organizations participate in research. The majority of these organizations compete on a yearly basis for funding. If the research budget was to incorporate researchers into this funding then perhaps there would be an advancement of current process research. A further consideration could be to encourage therapists to partake in regular research enabling data collection from a variety of agencies such as drug and alcohol, gambling and bereavement. This could better their services and enable therapists to become more involved in data collection, data analysis and data dissemination within the workplace.