Some unresolved issues in philosophy and psychology: their implications for therapy

This paper is divided into two interrelated sections: the first section examines the scientific status of mainstream Western psychology. It will also consider the major arguments concerning the relationship of mainstream Western psychology to philosophy—in particular to metaphysics and the philosophy of science. It will be argued that psychology has turned away from its past philosophical heritage and has thus, short-changed itself by avoiding the very issues, which form an integral part of one's subjective and existential world and of the therapeutic process. The second section argues that, to a large measure the contemporary approaches to counselling and psychotherapy have moved away from the scientific ideologies, which guide research within mainstream Western psychology. Over the last 30 years or more, counselling and psychotherapy as ‘disciplines’ have proliferated into several sub-disciplines. This has made it difficult, if not impossible, to determine their pedigree and parentage. Although a great deal of ingenuity has gone into the construction of such new therapies, very little effort has gone into testing their validity. Unless serious attempts are made to bring about a rapprochement, it is likely to lead to a state of ‘epistemological anarchy’, or, anything goes.     

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

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 relationship between integrative and Islamic counselling

Integrative counselling is a valuable tool. However, it only considers the client within a social and natural framework. Islamic counselling on the other hand, utilizes the major tenets of integrative counselling, but adds to them an added dimension. This is the relationship between the client and his/her creator. In this paper I aim to draw out areas of commonality between integrative and Islamic counselling and highlight the main difference between these two therapeutic approaches.     

Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches

Thematic analysis methods, including the reflexive approach we have developed, are widely used in counselling and psychotherapy research, as are other approaches that seek to develop ‘patterns’ (themes, categories) across cases. Without a thorough grounding in the conceptual foundations of a wide variety of across‐case analytic approaches, and qualitative research more broadly—something rarely offered in counselling training—it can be difficult to understand how these differ, where they overlap, and which might be appropriate for a particular research project. Our aim in this paper is to support researchers in counselling and psychotherapy to select an appropriate across‐case approach for their research, and to justify their choice, by discussing conceptual and procedural differences and similarities between reflexive thematic analysis (TA) and four other across‐case approaches. Three of these are also widely used in counselling and psychotherapy research—qualitative content analysis, interpretative phenomenological analysis and grounded theory. The fourth—discourse analysis—is less widely used but importantly exemplifies the critical qualitative research tradition. We contextualise our comparative approach by highlighting the diversity within TA. TA is best thought of as a spectrum of methods—from types that prioritise coding accuracy and reliability to reflexive approaches like ours that emphasise the inescapable subjectivity of data interpretation. Although reflexive TA provides the point of comparison for our discussion of other across‐case approaches, our aim is not to promote reflexive TA as ‘best’. Rather, we encourage the knowing selection and use of analytic methods and methodologies in counselling and psychotherapy research.     

Psychotherapy integration: An idea whose time has come

Growing numbers of clinicians and researchers from the major therapeutic orientations have begun to demonstrate an open attitude toward potential contributions of other approaches. Efforts at rapprochement and integration sharply contrast with the acrimonious debates that prevailed in the field a few decades ago. These efforts represent much needed attempts to better understand psychotherapy and to improve its effectiveness. In this article, the factors that have contributed to the emergence and development of psychotherapy integration are described, including the inadequacies of predominant models, limited effectiveness of existing treatments, and external pressures for the accountability of psychotherapy. Also reviewed are core issues within the integration movement itself, such as the search for theoretical integration, elaboration of eclectic therapies, identification of conceptual convergence and common factors, development of integrative approaches for particular clinical problems, and improvement in major orientations as a result of transtheoretical dialogue. Finally, several unresolved issues and unanswered questions facing psychotherapy integration are described, as they suggest future directions for the development of this movement.     

Counselling in the United Kingdom: past, present and future

We chart the development of counselling in Britain since the Second World War through to the present and speculate about possible directions counselling may take in the future. Our major, but not exclusive, focus is on counselling as a developing profession and the particular role that the British Association for Counselling has played in this development. To this end, we consider some of the professional issues that have preoccupied practitioners in the field and those that may do so in the future. Thus, amongst others, we consider the relationship between counselling and psychotherapy, the costs and benefits of counselling's increasing visibility in British society, the role that supervision has come to play in the maintenance of professional standards, the debate that has surrounded the issue of counsellor accreditation/registration, the development of standards and ethics and the tension that exists between the relational and technical aspects of counselling. Counselling does not exist in a vacuum, and this is seen most strikingly in the speculations that we make about future developments of counselling. Thus, for example, we argue that counselling will have to grapple with the increasing emphasis that society places on the accountability of human services and with the inexorable progress occurring in the area of technological development. We note that counselling's response to these significant trends will have to be made against the backdrop of the continuing dissolution of barriers between previously distinct areas of human knowledge .     

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

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.     

The emerging narrative approach to counselling and psychotherapy

An important recent development within counselling and psychotherapy has been the emergence of narrative perspectives on theory and practice. The task of the counsellor is viewed as that of assisting the client to 're-author' parts of their life-story. The origins of this approach within psychology and social science are discussed, and the central elements of a narrative approach to counselling and psychotherapy are identified. A brief case-study illustrates some of these themes.     

A four dimensional,integrative, categorial model of psychotherapy

Integration of psychotherapeutic approaches has been notoriously difficult because of incompatibility of technical procedures and theoretical concepts. A categorial analysis from a higher level of abstraction might be able to overcome these difficulties. A model is proposed with four dimensions: personal regard, a relationship component; structure, a planning component; consciousness, a cognitive component; and process, an individual component. It is maintained that these four dimensions span out the space within which psychotherapy of any lineage moves along. Problems with incompatibility of systems and techniques might stem from the fact that different schools of psychotherapy emphasize different aspects of this framework, while using the other aspects only implicitly. It might also be that clients with different problems and pathologies, and at different stages in therapy, need different approaches reflected in different weights of the four dimensions. The model could be used to arrive at a broader understanding of what psychotherapy does. Should it prove helpful, it could also be used as a means of understanding successful and unsuccessful therapies and as a prognostic tool.     

Examining the role and functions of self-development in healthcare therapy trainings: A review of the literature with a modest proposal for the use of learning agreements

Many healthcare trainings with a psychodynamic orientation encourage or require students to commit to a process of personal development, such as provided through attending individual psychotherapy and/or an experiential ‘as if therapy’ group. This paper reviews recent literature about training in psychodynamically oriented practices within counselling psychotherapy, psychiatry, the creative arts therapies and clinical psychology. The results indicate that the mandatory personal development dimension of therapy training needs urgent reassessment. Results of studies consistently call for further research about the direct benefits of personal development on students’ development of skills for therapy practice. There is minimal evidence to indicate what self-development through individual psychotherapy can specifically deliver in terms of eventual professional competence. To address some aspects of the current lacuna, this paper summarises the recommendations for training programmes available from the current research, and makes a modest proposal for the use of learning agreements, rather than only mandated hurdle requirements, to ensure that the incremental steps by which the student attains expected requirements is negotiated and agreed within regularised, and widely accepted university course procedures.     

Research on embedded counselling: An emerging topic of potential importance for the future of counselling psychology

A significant proportion of the counselling that people receive takes place within informal, situated encounters between service users and practitioners in fields such as nursing, medicine, teaching and social work. However, almost all of the research that has been carried out into the process and outcomes of counselling consists of studies of formal, contracted counselling and psychotherapy based in therapy clinics and offices. The competent and effective delivery of counselling that is embedded in a primary professional role, such as that of nurse, teacher or social worker, presents considerable challenges for practitioners. Research evidence around the process and outcomes of embedded counselling represents a valuable resource that has the potential to enhance the quality of counselling conversations enacted by practitioners in health, education, social work and other professions. An overview is provided of different types of research that has been carried out into informal and embedded counselling, and of the main themes that have emerged from these studies. Suggestions are made for the further development of this field.     

Microphenomena research,intersubjectivity and client as self-healer

This article describes an approach to counselling and psychotherapy which complements dominant discourse approaches to clinical evaluation based on New Public Management systems which underpin the Improved Access to Psychological Therapies scheme within the field of therapy. It is based on an approach to research and practice development which I will call practitioner microphenomena research. In order to demonstrate the method, I will examine an extract from a single case study of a client with major depressive disorder from the point of view of intersubjective theory and a little-known approach to therapy called anthroposophic psychotherapy based on the work of Rudolf Steiner. I will show how the two clinical methods are well suited to examining the microphenomena of practice and can be integrated into a coherent whole. A central feature of the account will be the anthroposophical view about the central importance of our individuality or ‘I’ which has similarities with the Jungian self but is still distinct from it.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Matrices in black and white: Implications of cultural multiplicity for research in counselling and psychotherapy

There is a lack of resarch into the relationship between culture and ethnicity, and the processes and outcomes of counselling and psychotherapy. This paper explores current and historical approaches to defining ethnicity and cultural identity, and makes suggestions for how these constructs might be more usefully understood.     

New approaches in counselling: Healthy diversity or anti-therapeutic?

Concern is expressed about the proliferation of new or 'innovative' approaches in counselling or psychotherapy. Most of these approaches appear to be regressive in that they ignore what we have learned about the importance of certain conditions for the therapeutic relationship. They place the counsellor or therapist in the position of a charismatic expert controlling and directing the lives of his clients. The potential dangers of these methods are noted. Yet there seems to be no good way to protect clients either from well-intentioned but misguided professionals or from the untrained non-professional. If professionals are not successful in policing the field, injured consumers and an aroused public may succeed in imposing unnecessarily rigid restrictions on all practice of counselling and psychotherapy.     

Qualitative approaches to research in counselling and psychotherapy: Issues and challenges

There has been a significant growth in interest in qualitative approaches to research in counselling and psychotherapy. Qualitative researchers in this field have begun to apply methods originally developed in disciplines such as sociology, anthropology and cultural studies. There are, however, a number of distinctive dilemmas and challenges associated with qualitative approaches to inquiry into the processes and outcomes of counselling. A set of key issues are discussed: relationships with research participants, ethics, reflexivity, methodological choice, communicability, perspective and obviousness. Some suggestions are made regarding the link between qualitative research and counselling practice.     

‘Pluralistic accountability’ for the psychological therapies? Holding the tension between diversity's virtues and the need for accountability

ABSTRACT

This paper argues that the field of counselling and psychotherapy needs to find values-congruent ways of managing, and creatively engaging with, the challenging tension between accountability and diversity in therapy work. The authors strongly support the preservation of pluralism and diversity in therapy practice, in the face of the increasingly urgent, anxiety-driven demands for audit, regulation and accountability typifying Late Modernity. It is argued that if accountability itself is to be ‘evidence-based’, then incorporating a relational dimension is essential; for if relationship factors are central to successful therapy, then accountability frameworks must themselves be founded on/in ‘relationship’. The arguments against formal institutional regulation of the psychological therapies in relation to the ineffectiveness of systems are rehearsed, and alternative, more values-congruent approaches considered. In making a case for ‘pluralistic accountability’, a detailed case-study of Bristol's developing local directory of therapists is offered, illustrating how local initiative can deliver good-enough accountability, avoiding the many negative side-effects of more didactic, centralised systems. The paper concludes that innovation and diversity in the field are more likely to be preserved if approaches can be found that hold and embrace the tensions between accountability and diversity, rather than seeking ‘solutions’ that prematurely and inappropriately resolve them.     

Can counselling/psychotherapy be helpful in reducing barriers to learning for the person with specific learning difficulties?

This paper explores the relative helpfulness of counselling/psychotherapy to individuals experiencing specific learning difficulties, as a means of reducing barriers to learning by allowing the individual to return to learning from experience. Highlighting earlier studies which indicate the positive impact of psychological therapy on educational attainment and inhibiting factors such as stress, this research investigates the experience of counselling from the perspective of the person with specific learning disabilities. Using Empirical Phenomenological Research, the study explores their understandings of the circumstances and factors by which therapy is found to be helpful or unhelpful, seeking to contribute to debate on whether psychological interventions that are ‘specialist’ in orientation are potentially more helpful than ‘generalist’ therapeutic approaches. The findings point both to the potential value of psychological therapies for persons with special educational needs as a complement to other interventions and also to the importance of considering the experiences of the client in addition to diagnostic assessments.     

Gossip and counselling: The tendency to gossip and its relation to vocational interests

In this study we attempted to treat gossip as a psychological disposition related to vocational interests, using a newly developed instrument, the Tendency to Gossip Questionnaire (TGQ). One hundred and twenty Israeli students (58 females, 62 males) at the Haifa Technion and the University of Haifa were administered the TGQ together with the Social Desirability Scale and the Ramak-Vocational Interests Questionnaire. We found that: (a) women tended to report that they gossiped more than men did, but this difference was confined to one specific content area of gossip only; and (b) interest in people-oriented professions was related to the tendency to gossip even when social desirability and gender were controlled for statistically. The last finding supports the ‘spillover’ hypothesis (Staines, 1980) on the relationship between vocational and avocational interests. The positive relationship between the tendency to gossip and an interest in people-oriented professions might mean that both derive from the same basic needs. We suggest that counselling and psychotherapy can be regarded as sublimated forms of gossip. It is our hope that the TGQ may be of help in expanding our knowledge about the relationship between the tendency to gossip and other psychological dispositions.

This paper attempts to examine the relationship between Existential thought & Client Centred approach to counselling. This task is undertaken by means of an examination of both the similarities and differences between the two fields, as well as relevant research. The paper draws upon thinking of major writers in the fields under consideration, and in doing so looks at such themes as meaning and existence, such concepts as philosophy and technique in psychotherapy and counselling and characteristics of the therapist and the counselling process.     

Everything you always wanted to know about therapy (but were afraid to ask): Social,political, economic and clinical fragments of a critical psychotherapy

Three seemingly consensual propositions concerning psychotherapy and counselling are examined critically. All turn out to be unreliable, tendentious and even damaging: (i) Psychotherapy and counselling can be free and independent professions provided therapists, acting together, fight for them to be that way. (ii) Psychotherapy and counselling are private and personal activities, operating in the realms of feelings and emotions – the psyche, the unconscious, affects rooted in the body. Above all other factors, the single most important thing is the therapy relationship between two people. (iii) Psychotherapy and counselling, and psychotherapy are vocations, not jobs. Therapists are not only motivated by money. In developing his critiques of these propositions, the author utilizes social, political and economic perspectives. The author reviews new clinical thinking on the active role of the client in therapeutic process and suggests that a turn to the legendary figure of the Trickster might be of benefit to the field. The author locates his arguments in his experience of the politics and practices of psychotherapy and counselling, and engages in self-criticism.