Is research in psychotherapy and counselling a waste of time?

The following is a conversation between the Editors, Del Loewenthal and Evrinomy Avdi, of this double special issue on what is now our biannual exploration of developments in research in psychotherapy and counselling. It is based on the sixth Qualitative Research in Mental Health conference held in Chania, Crete, Greece in May 2016 and the Universities’ Psychotherapy and Counselling Association conference ‘What future long-term and open-ended psychotherapy and counselling?’. This editorial is in no way intended as a reflection on these conferences, but it is a comment on what for many years has come to be regarded as research in psychotherapy and counselling.

Del

Some time ago I was asked by a publication to name what research has been most helpful to me as a psychotherapist. It was then that I had to face my growing realisation that there was nothing currently regarded as research that influenced how I work as a practitioner. Not only positivistic quantitative research but, since then, qualitative research continues to go down in my estimation. I can see that my students gain what might be a useful personal discipline; but, this is of little use to anyone else as well as providing little opportunity for comparative research, etc.

Can I square all this up with being: the founding chair of two national psychotherapeutic research bodies, responsible for two books on research, one of the first journal editors-in-chief to establish a research section and continuing to co-edit this and other special issues of the European Journal of Psychotherapy and Counselling on research?

I have for a long time been interested in phenomenology but I’ve always been concerned that ‘phenomenological research’ is a misnomer – surely ‘phenomenology’ is research? When I became the first chair of the United Kingdom Council for Psychotherapy (UKCP) research committee I was aware of many psychotherapists writing about theoretical considerations but then, as in other areas of enquiry, the culture changed and the name ‘research’ changed to only mean ‘empirical research’. Furthermore, UK universities, for one, endorsed this with an ever increasing bias in National Research Assessment Exercises for empirical research with in an increasing number of disciplines anything else being labelled ‘scholarship’! This has developed to the extent that several years later when as a member of that UKCP committee I asked how something was defined I got a response ‘but that is philosophy!’ Also, on another occasion when asking a similar question at an Economic and Social Research Council meeting I got the reply ‘We don’t know how to define it Del, but we think we know how to measure it!’.

I have consequently come to see research, as with counselling and psychotherapy, as cultural practices (2016). I still with my Master’s and Doctoral students suggest that they carry out whatever is currently regarded as (usually qualitative) research so they can come alongside current research cultural practices and critique them. However, though I am still very much interested in questions of methodology as well as recent developments in research methods (as in this special issue), I am increasingly concerned that most research, along with the training for it, are for the most part a waste of time and can better be seen as attempts at professional legitimising rituals.

Evrinomy

I found myself struggling to respond to Del’s position of critique and, reflecting upon why this might be the case, I realised that one important reason for this is that very different versions of research came to mind when I was trying to respond to his arguments. It is almost impossible to discuss ‘research’, or even ‘qualitative research’ in counselling and psychotherapy as a unitary entity, given that the context of where research is carried out, by whom, for what reason(s), from what position, with what aims, and in what manner are some of the, many, factors that affect its quality – and usefulness.

I agree with Del’s position that research as well as psychotherapy and counselling are cultural practices – that occupy different positions of validity and legitimisation in different European countries and local contexts. Moreover, as a social and cultural practice psychotherapy research is entangled with power, and as such not all research is seen to have the same validity. For example, although there is more than ample evidence from outcome studies that so called ‘common factors’ are key to the outcome of therapy, the majority of outcome research is still engaged in defining the ‘best’ therapy approach for specific ‘conditions’ – with significant implications for the public funding, training and legitimisation of psychotherapy.

Given this diversity, ‘research’ in counselling and psychotherapy can include a vast range of activities and cultural productions, which are borne from different needs, rely on different theories, follow different ideologies, and serve different functions. Given this, I will outline some of the conditions which I have found in my own experience help make research, at its best, useful.

I agree with Del that engaging in research can be extremely useful and enriching for clinicians and I would argue that this is potentially the case at all stages in our professional development, despite the fact that we often only engage in research during training. I believe that at its best, engaging in research can enhance our reflexivity, promote rigour, foster an open and questioning attitude towards our assumptions, and can work towards creating a culture of inquiry in our services and local contexts. In my own attempts to carry out research on psychotherapy, I have found that working closely with clinicians at all stages of the research endeavour – from formulating the questions, to discussing issues of design and ethics, to the collection, analysis and interpretation of the research material – enriching, stimulating and productive, if not always a smooth process. For example, in a recent project I have been involved in, we spent several hours watching and discussing videos of couple therapy sessions with the therapists in the service; in addition to better understanding the processes of engagement we were interested in, these dialogues produced changes in both the service itself and in the ways we are conducting our research. Moreover, engaging in research might improve practice in unexpected ways – for example in the project mentioned, there were noticeably less drop-outs in couples participating in the project than in the service, in general – arguably an indication of improved practice?

Similarly, research carried out with clients or by users of services is, in my mind, another very fruitful avenue towards useful research. There is a wide range of studies adopting such a framework, including studies focusing on and highlighting clients’ views and experiences of helpful and unhelpful aspects of therapy, to research exploring how clients make use of therapy in the context of their everyday life, to studies that interview clients and therapists together about their work, to name but a few.

In brief, I think that one condition that can help make research useful is when it is designed and conducted collaboratively – including co-researchers from different positions.

Del: In my latest book, Loewenthal (2017), I label a section as ‘Thoughtful Practice and Research’ and perhaps it should have been titled ‘Thoughtful Practice or Research’ as they seem to be increasingly mutually exclusive! Though, as mentioned, this depends on what is meant by ‘research’.

Evrinomy, I hesitate writing this but wasn't it the Greeks who enabled us to see that the phusis/physis, which is the root of our psychology and psychotherapy, is the natural what comes out of itself? Furthermore, as in our Greek notions of democracy, shouldn't evaluation criteria emerge from the particular situation? Thus any attempt to actually impose external evaluation criteria will always induce some form of violence. Indeed, as a case in point, recently a student who said she thought it was wrong to carry out an evaluation after each counselling session was told by her agency, who had introduced the policy in an attempt to secure funding, that she had to stop working there and then with all her clients!

However, with regard to your point of working collaboratively with clients and service users, this is a cultural practice that I would wish to consider, whether it be within a consulting room or more generally within our communities. However, can we measure the effect of clients being involved in working with their therapists empirically – perhaps we can measure their satisfaction at a moment in time but surely not their experiences of for example intimacy or love?

Evrinomy

For me, research is one way of knowing; as such it can, at best, answer only some questions and from a specific perspective, and I firmly believe that it should not be treated as representing truth with regards to psychotherapy – or any other aspect of human life. From this perspective, the primacy given in more and more European countries to research as the most legitimate and valid source of knowledge about psychotherapy is very problematic – and I agree with Del that it is an act of violence.

In my view research, of any type, can at its best illuminate only part of the complex picture of human suffering and psychotherapy. At the same time, I do think that it has a useful – yet perhaps overestimated – contribution to make to our understanding and practice.

So what have the papers in this double special issue provided to contribute to this debate?

The first paper in this first half of our double special issue is entitled ‘Therapeutic Community for Children With Diagnosis of Psychosis: What Place for Parents? The Relation Between Subject and the Institutional “Other”’ by Katia Romelli and Giuseppe Pozzi. This paper concerns parents’ perspectives on, and relationship to, the institutions involved in moving their child to a therapeutic community. Here the authors describe an interesting way of working with parents in order to make their relationship with such residential services less problematic, and providing an original theoretical conceptualisation of the dynamics characterising this relationship from a Lacanian perspective. It makes an important contribution both in terms of clinical work with parents in the context of therapeutic communities and methodologically, in terms of the authors’ creative use of Lacanian theory in analysing discourse.

Our second paper, ‘Hurting and healing in therapeutic environments: How can we understand the role of the relational context?’, summarises the findings of three studies using different methodologies that indicate key factors in the relational context of therapeutic environments. With methods including narrative ethnography, grounded theory and a novel auto-ethnographic methodology, Simon Clarke, Jenelle Clark, Ruth Brown and Hugh Middleton identify the expression and containment of affect in a congruent environment, belonging and hope, and fluid hierarchies of relational structures as key aspects of the relational context informing change.

‘Mental health care and educational actions: from institutional exclusion to subjective development’ by Daniel Goulart and Fernando Gonzàlez Rey is our third paper, and proposes the idea that subjective development from a cultural-historical standpoint can help address dichotomised notions such as social/individual. This can then inform institutions for mental health care and how they may move away from manualised care and an adherence to diagnostic categories, and instead see mental health as a living process. This paper provides a cogent articulation of a theoretical model for conceptualising subjectivity and mental distress that relies on the dialectical interplay of social context and subjective experience. It draws upon the authors’ experience of mental health care in Brazil and discusses some of the implications of the model in relation to a case study. The paper is interesting as it pulls together in a coherent way Rubinstein and Vygotsky’s views on mental life and proposes a theoretical approach to subjectivity, with reference to literature from post-structuralism and the anti-psychiatry movement.

The fourth paper, ‘Displaying Agency Problems at the Outset of Psychotherapy’ by Jarl Wahlström and Minna-Lena Seilonen, deconstructs how psychotherapy clients construct themselves discursively in terms of agency. They uniquely seek to describe a noted difference in subject construction between clients in voluntary vs. semi-voluntary therapy, with an illustration of the presence of aspects such as relationality, causal attribution, intentionality, historicity and reflexivity in psychotherapy.

Rafidah Bahari, Alwi Mohamad, Najib Muhammad, Nasrin Jahan, Muhammad Radhi Ahmad and Ismail Mohd Saiboon provide our fifth paper, ‘How do people cope with post traumatic distress after an accident? The role of psychological, social and spiritual coping in Malaysian Muslim patients’. This paper reports on their interesting qualitative study of coping with distress following road traffic accidents in a Malay Muslim population. It is particularly topical in view of recent findings by Brewin et al. that people in less affluent countries are less likely to suffer from post-traumatic stress disorder (PTSD).

Our two published respondents for the above papers are by David Harper and John McCleod. In ‘The diversity of international qualitative research in mental health’ David Harper helpfully discusses common themes in, and differences between, the papers speaking directly to the authors whilst exploring how all our work could easily be criticised. John McCleod, in ‘Everyday life, manifesto-writing and the texture of human agency’ provides some thought-provoking reflections on the papers from the perspectives of a focus on everyday life, the tension between theorising and description in qualitative research, and the nature of human agency.

For both published respondents, it would appear that they consider that research in psychotherapy and counselling presented in this issue is far from a waste of time. For David Harper, ‘Reading the articles, it is clear that there is theoretically and rich research being conducted internationally, on a range of important social topics in mental health and psychotherapy’. For John McLeod, ‘The articles in this issue of the journal confirm the rigour and relevance of qualitative research in counselling, psychotherapy and related disciplines’. Whatever your thoughts on what is currently regarded as research we both strongly recommend not only specific papers according to your interests but our published respondents analyses of all the papers for anyone carrying out psychotherapeutic and counselling research.

Del Loewenthal
[Editor in chief
European Journal of Psychotherapy and Counselling
Director of the Research Centre for Therapeutic Education
Department of Psychology, University of Roehampton, London, UK
[email protected]]
Evrinomy Avdi
[Associate Professor
Clinical Psychology, Aristotle University of Thessaloniki
[email protected]]