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19^th June 2017

Research Diaries Blog

It's been a while since we started work on putting together a group of people who are interested in the future of counselling and psychotherapy in Scotland. People who are interested in research as a way of making sense in a complex world that we don't always understand. People who are passionate about dialogue, keeping channels of communication open and are active in ensuring that our clients are offered the best counselling that we can.

We had an event to explore what help Voluntary Sector Counselling organisations need to become more 'research ready' in Glasgow in October 2016 and we're now starting to hold regional network meetings. The first of these will be in Elgin on Monday 5th June 2017. So please contact us if you'd like to know more.

This month also sees the beginning of a regular feature offering insight into how some people who have been active in research in Scotland first became interested in counselling and psychotherapy research. Perhaps you'd like to join them in finding out about something that you believe can make a difference?

Jo Hilton, COSCA Counselling Research Practice Network Coordinator

Research Diaries: Susan Stephen on discovering how data can contribute to knowledge

Becoming a researcher was not on my horizon when I completed my counselling training in 2004. At that time, I wanted to consolidate my learning and develop my practice. I had no inkling that over the next few years my passion for the person-centred approach and the opportunities that arose as a result would lead me to become a researcher and current PhD candidate at the University of Strathclyde. This is my story. 

On completing my counselling training, I became an active member of PCT Scotland, the association for person-centred therapists in Scotland (www.pctscotland.co.uk). This focused my interest on the issue of how we promote and represent the approach and led directly to the survey of the Person-Centred Approach in Scotland carried out ahead of the 20^th anniversary of PCT Scotland in 2007.

This was my first attempt at carrying out any kind of research and I was lucky to work with a fellow member who had some previous experience of number crunching. This adventure also became my first experience of writing for publication (Cornforth & Lambers, 2010). 

Around this time, Robert Elliott arrived at the University of Strathclyde and began to create his research clinic. I read a notice posted on the PCT Scotland website inviting experienced counsellors to become involved in a project that he was developing to investigate the process and outcome of person-centred therapy with people experiencing social anxiety difficulties. I was tempted by this unexpected opportunity to find out how counselling research was carried out. I joined the group and participated during the developmental phase of the project but had to leave before the first clients arrived because of a change in my work commitments. It seemed as if my brief foray into research had ended. 

I continued in practice and as an active member of PCT Scotland. We embarked on campaign work in 2008 in response to several public policy decisions (e.g. SIGN guidelines on depression; the development of the ‘Matrix’) that highlighted the growing marginalisation of person-centred therapy (and other therapeutic approaches) within the NHS in Scotland. We were told that our research evidence did not meet the standards required. It was this experience which led me to reconsider the contribution that I could make within this apparent impasse: I turned my attention to research. I decided to return to the research clinic to take part as a therapist-participant, learn how to be a researcher and to complete a systematic case study using data from the clinic archive in order to gain an MSc in Counselling (Stephen, Elliott & MacLeod, 2011). 

At that point I was determined to take my research activities further but life had other plans for me. In 2012 I was able to return to the clinic as a volunteer and, in the following year, took over from Brian Rodgers as the Clinic Coordinator. In this role I supervise and train the volunteers who work as counsellors and researchers in the clinic, coordinate the running of the clinic, and organise the growing data archive.  

Alongside this experience I have had the opportunity to work as a research supervisor with MSc students. The first two of my supervisees completed their studies in 2016; other students are in the midst of the process. It has been a privilege to support each of them in their own research journeys.  

Other projects have given me the chance to build on previous experiences. For example, I was invited to edit a special issue on Case Studies for Person-Centered & Experiential Psychotherapies, the peer-reviewed journal of the World Association for Person-Centered & Experiential Psychotherapies & Counseling (Stephen, 2014) and, in 2015, I carried out a second survey of the person-centred approach in Scotland on behalf of PCT Scotland (Stephen & Cowie, 2016). 

Finally, in January 2016 I embarked on my own PhD studies. My area of investigation is driven by both passion and pragmatism. I want to make a substantial contribution to our understanding of the impact of person-centred therapy and to make comprehensive use of the data collected within the research clinic archive.

As a result, I am using data collected on the Strathclyde Inventory (a self-report questionnaire developed by Beth Freire based on Rogers’ description of the Fully Functioning Person) to measure patterns of change in congruence for clients participating in person-centred therapy. I have completed my first study – investigating the reliability and validity of the measure (Stephen & Elliott, 2017) - and am now ready to move forward to find out:

• How does client congruence change throughout counselling?

• What is the relationship that exists between congruence and (a) symptoms of distress and (b) the client’s perception of the therapeutic relationship?

• What similarities or differences exist in the therapeutic experiences of clients who significantly develop their capacity for congruence and those who do not? 

This feels like a huge undertaking. I am studying on a part-time basis alongside my teaching, research and practice commitments. One of my biggest challenges is to find enough balance within my life to make this range of commitments sustainable. However, the excitement that I feel about discovering answers to my questions keeps me moving forward. 

References

Cornforth, S. & Lambers, E. (2010). The Person-Centered Approach in Scotland: A Report. Person-Centered & Experiential Psychotherapies, 9, 25-36

Stephen, S. (Ed). (2014). Case Studies [Special Issue]. Person-Centered & Experiential Psychotherapies, 13(2)

Stephen, S. & Cowie, C. (2016). The person-centred approach in Scotland: Has it grown? Paper presented at the 2^nd PCE Europe Symposium, Lausanne, Switzerland.

Stephen, S. & Elliott, R. (2017). The Strathclyde Inventory: Measuring congruence as an outcome of therapy. Paper presented at the BACP Research Conference, Chester, UK.

Stephen, S., Elliott, R., & Macleod, R. (2011). Person-centred therapy with a client experiencing social anxiety difficulties: A hermeneutic single case efficacy design. Counselling & Psychotherapy Research, 11:1, 55-66

Research Diaries: Brian Rodgers on wanting to know more about how counselling and psychotherapy makes a difference

 My initial interest in researching the client’s perspective of the outcomes of therapy started as a result of my counselling training. As a trainee person-centred therapist, I was very interested in Rogers’ (1957) statement of the necessary and sufficient conditions of therapeutic change. Though my training focused largely on the three ‘core’ conditions of empathy, congruence and unconditional positive regard, I was struck by the inclusion of the 6th therapeutic condition – that “The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.” (p. 96). I read into this statement the importance of acknowledging the necessity for the client to perceive all the ‘core’ conditions of the therapist before therapeutic change can happen – that the therapist can be as embodying of the therapeutic principles as is possible, but unless the client perceives this, then it is a waste of time.

For my own research, I wanted to take this further and discover more about how clients perceived their therapy - what was important for them and what really made a difference in practice rather than just in theory. 

This led me to undertake an MSc in Counselling Studies at the University of Abertay,  Dundee to investigate the client’s experience of therapy using in-depth qualitative interviews (Rodgers, 2002). The study involved post therapeutic interviews with clients from the Tom Allan centre. Clients were interviewed between three and four months following therapy and asked to relate what they perceived had changed from before to after counselling, what part therapy had played in these changes, and what was most important or significant in their therapy. The aim here was not to assume that therapy was the central change ingredient, or to make a direct causal link between therapy and outcome, but to find out more from the client’s own perspective about their experience of therapy and the changes in their life. From this study, it was readily apparent that clients experienced therapy in a large variety of ways, some hindering, some unhelpful, and some very helpful. Further, it was clear that clients themselves were the key ‘active ingredient’ in the changes experienced over the duration of therapy (Bohart & Tallman, 1999). 

One of the main results of the study was the finding that the process of ‘restructuring’ seemed to be a key outcome for clients. This was reported as “coming to see things from a different perspective, of things ‘fitting’ better and feeling more integrated, of being able to let go of things and of being more in control and content. It was as if things become restructured for the person such that problems and issues were resolved in one way or another.” (Rodgers, 2002 p. 190). It was this aspect of change that initially sparked the idea for my PhD. I wanted to see if this dimension of change could be explored more fully, not in terms of discrete components, but more holistically. Here I was interested in seeing if this ‘restructuring’ outcome could actually be captured in a way that made sense to participants, of finding a way that allowed participants to reflect on change from a more holistic, integrated perspective. What also interested me was that participants who reported this ‘restructuring’ had difficulty in fully remembering how things were before their therapy, as therapy seemed to quite fundamentally alter their perception of their life. This led to the idea of asking clients to create a ‘snap shot’ or ‘picture’ of their life before therapy began, so as to ‘capture’ this pre-therapy perception. 

This initially simple idea expanded into the development of the Life Space Map (LSM). The basic concept of taking a ‘snap shot’ remained, but the LSM incorporated a shift in emphasis away from the individual in isolation, towards seeing the individual as intimately connected and situated in a complex social world. Concepts from social and ecological psychology played a key role in this development, leading me to question counselling and psychotherapy’s apparent over emphasis on individualism, individual power, and responsibility. I became aware of the potential paradox of therapy, that in the process of working towards empowering individuals in their predicaments, we can slip into putting the responsibility of these predicaments on the individual. In the process of helping people to overcome their difficulties, we are also saying that it is their responsibility. This potentially misses the question of whether the apparent growth in the number of people struggling to cope is a function of an unhealthy society rather than unhealthy people.

Further, I feel there is a tendency to over emphasise the role of therapy in people’s change process, especially in traditional approaches to research. Rather than seeing therapy as the central or key ‘variable’ in change, it feels more realistic to frame counselling and psychotherapy as one of many resources that people can use. The development of the LSM can be seen as an attempt to construct a research instrument which parallels this view, of refocusing the outcomes of therapy in terms of the ‘life space’ of the client, and to ‘position’ counselling within this as one ‘thing’ among many. 

An integral part of undertaking my initial study was my apprenticeship into qualitative research methods. Having studied physics, mathematics and computer science in my first degree, I was initially set on employing a quantitative approach in order to obtain ‘hard facts’. However, I was eventually persuaded by my supervisor that in order to answer the questions I was posing, I would need to adopt a richer, more ‘client near’ approach. So started my long journey of discovery into the realm of qualitative research, in particular to the ideas of Glaser and Strauss (1967) and their insistence that any ‘theory’ generated must be grounded in the data obtained. Glaser’s writing especially attracted me in his more holistic approach to the coding of data and the generation of results. In addition, more contemporary authors such as Pidgeon and Henwood (Pidgeon & Henwood, 1996) and in particular Rennie (1996; 1998; 2000b) pointed me in the direction of how such an approach to research could be applied to the study of psychology and psychotherapy. 

This led me deeper into the philosophical considerations of qualitative research as I attempted to locate myself in the heady world of post-modern research approaches. My initial attraction to extreme relativism, with its insistence that there is no ‘truth’ other than that perceived by the ‘subject’ seemed a natural fit with my research topic. However, as I explored this further, I began to get lost in the seemingly endless philosophical debates around the nature of perception, experiencing and even of ‘being’. From initial attempts to read and comprehend Heidegger, Foucault and others, I soon realised that I was out of my depth, and turned to other contemporary researchers in the field to construct a framework of understanding. In particular, the more pragmatic approach by McLeod (2001c) of the researcher as ‘bricoleur’ seemed to resonate.  

Here the researcher is not so much an expert artisan, but more “someone who works with his hands and uses devious means compared to those of the craftsman” where “the bricoleur is practical and gets the job done”(Weinstein and Weinstein, 1991 as cited in McLeod, 2001c p.119). 

Along with this academic and professional journey, my PhD study was also deeply integrated into my personal ‘life journey’. The main theme that comes to mind when I recall this journey is around my struggle to ‘stand up and be seen’. I really struggled writing up this study, in particular the literature review where I felt I had to ‘arm myself’ with the words of others before I could dare to ‘put my head above the parapet’. This feeling ran deeply and was paralysing at times, resulting in the write-up stage being drawn out over 3 years! This felt a long time to be ‘stuck’, such that at times I felt close to giving up. Indeed, sometimes I have thought that if I were ‘stronger’, I would have stopped and learnt to stand tall without the need to prop up my self-confidence with the letters ‘PhD’.

On better days though, I can see this journey as a coming face to face with my fears and anxieties about being seen, and of learning to trust my own ‘knowing’ rather than constantly deferring to others. 

Finally, I have also come to the realisation that this piece of research will never be ‘complete’, and will definitely not be ‘perfect’. More questions than answers have arisen from the study, along with the realisation that the field of researching the outcomes of counselling and psychotherapy is so complex and multifaceted that definitive answers are unlikely.  This, then, feels like a further step in my learning - to become more comfortable with ‘not knowing’ and to realise just how little we actually know about the impact of counselling and psychotherapy on people’s lived everyday lives. 

References

Bohart A C and Tallman K. 1999. How clients make therapy work: The process of active self-healing. Washington, DC: American Psychological Association.

Glaser, G. G. and Strauss, A. L. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research, New York: Aldine de Gruyter.

McLeod, J. 2001. Qualitative Research in Counselling and Psychotherapy, London: Sage.

Pidgeon, N. and Henwood, K. 1996. “Grounded theory: practical implementation”. In Handbook of Qualitative Research Methods for Psychology and the Social Sciences, Edited by: Richardson, J. T. Leicester. UK: BPS Books. 

Rennie D L (1998) Person-Centred Counselling: An experiential approach. London: Sage.

Rennie, D. L. 2001. Clients as self-aware agents. Counselling and Psychotherapy Research, 1: 82–89. 

Rodgers, B. J. 2002. An investigation into the client at the heart of therapy. Counselling and Psychotherapy Research, 2: 185–193.

Rogers, C. R. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. 

Weinstein Deena and Michael A. Weinstein. 1991. "Georg Simmel: Sociological Flanom Bricoleur." Theory, Culture & Society 8: 151-68. (yours has cited in McLeod )