The nature space. A reflexive thematic analysis of therapists' experiences of 1:1 nature-based counselling and psychotherapy with children and young people: Exploring perspectives on the influence of nature within the therapeutic process

Nature-based therapy is an emerging and rapidly developing field within counselling and psychotherapy, yet there is little published empirical research, or integrated models relating to its practice with Children and Young People (CYP). The present study aimed to explore therapists’ experiences of one-to-one nature-based counselling and psychotherapy with CYP, eliciting perspectives on the interaction between nature and the therapeutic process. A reflexive thematic analysis provides preliminary insights into possible mechanisms of action with the potential to inform a longer-term exploration of whether nature-based therapy is effective, for whom and why. The study highlights the need to better explore and understand how nature-based therapy supports relational and intrapsychic change in interaction with developmental processes, to inform construction of coherent and consolidated theory and models for practice.     

Qualitatively driven mixed‐methods approaches to counselling and psychotherapy research

Many researchers and clinicians take an ‘either, or’ position regarding factors responsible for change when conducting research. Qualitatively driven mixed methods privilege the qualitative approach and offer the opportunity to generate multi‐dimensional material, permitting a more holistic insight into experiences that can be understood from a combination of epistemological and ontological stances. A qualitatively driven mixed‐methods approach apply a ‘both, and’ position when exploring the elements that produce change or that are under investigation, which can be of particular value to counselling and psychotherapy research. There are various ways of engaging with qualitatively driven mixed methods. Some designs include both qualitative and quantitative components, where the former is the core element. The secondary component may also be qualitative, known as a multimethod design. Yet, other designs mix different qualitative approaches, through the application of different qualitative analyses to the same data (pluralistic qualitative research). This paper discusses the application and value of qualitatively driven mixed methods in counselling and psychotherapy research through the presentation of two research case studies; one which mixes both qualitative and quantitative components to investigate the experiences of pain alleviation following a CBT pain management programme; and one which applies a pluralistic approach to a counselling psychology doctorate exploring the experiences and meanings attached to self‐harming. Through illustration and discussion of the case studies’ mixed‐methods approaches, this paper demonstrates that qualitatively driven mixed methods produce a more enhanced and holistic understanding into phenomena, and therefore a more balanced perspective to counselling and psychotherapy research.     

Phenomenological research on supervision: Supervisors reflect on ‘being a supervisor’

A study using a phenomenological research method was performed to reveal the meanings of the concept ‘supervision’, from the supervisor's perspective. Eleven supervisors of counselling and psychotherapy from a humanistic/existential framework answered the open question: “What does being a supervisor mean?”. Content analysis and frequency measuring were performed, revealing six groups of statements; six facets describing the experience of supervision: ‘structuring’, ‘teaching’, ‘nurturing’, the ‘supervisor as person’, ‘supervisor as colleague’, and the ‘triangle, client-therapist-supervisor’. Structuring was the largest category, and the first three categories together represented more than 75% of the statements. The results showed that ‘teaching’ and ‘nurturing’ were very similar in their importance, as represented by the number of statements in each. Further research should address the possible relation between supervisors' perception and experience of their role and the theoretical framework of counselling and psychotherapy in which they are based, The phenomenological research method in this study has shown the possibility of doing research on processes without ‘betraying’ the subjective perspective.     

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.     

Working with differences: Issues for research and counselling practice

This paper considers our experience within a group researching domestic violence in minoritised groups and the implications for counselling practice. Issues of race, gender and power were significant within the research team. These issues are intrinsic to minoritised women's experiences of service responses and are also a powerful, yet often unexplored, dynamic in counselling practice. We reflect on issues of ‘outsiders’ and ‘insiders’ in terms of the research process and findings, and the impact and influence of these power roles on counselling practice. We acknowledge that it is only by retrospectively engaging with each other and our differences that we have been able to explore our parallel processes and consider their implications for counselling practice.     

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.     

Theoretical approaches to psychological trauma: Implications for research and practice

In recent years, a range of counselling and psychotherapy interventions have been developed in work with clients and patients suffering from the psychological effects of trauma. This paper outlines various theoretical models of psychological trauma, selected because they can specifically encompass both the external aetiology (i.e. the traumatic event) and also explain (to a greater or lesser extent) the enormous range of reactions to that event. These models are critically discussed in terms of their implications for counselling practice, and as guides to further research. Examples are given of ways in which the author has drawn on different theoretical frameworks to inform her own therapeutic practice in work with people experiencing post‐traumatic stress disorder.     

PSYCHOANALYSIS AND COGNITIVE BEHAVIOUR THERAPY ‐ RIVAL PARADIGMS OR COMMON GROUND?3

The author suggests that contemporary enthusiasm for cognitive‐behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive‐behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to ‘collapse’ into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to ‘integrate’ the two models. Cognitive and ‘integrated’ treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on ‘dynamic’ than ‘cognitive’ elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.     

心理治疗中共同要素理论的历史发展

从共同要素的角度,分理论模式化与研究实证化两条线索,追溯了心理治疗中共同要素理论的思想渊源,并自Saul Rosenzweig开始,综述了Carl Rogers、Jerome Frank、Marvin Goldfried、Michael Lambert、Bruce Wampold等学者的观点,探讨了共同要素理论的历史演进、内涵结构、理论模式及当代研究进展。认为它在不久的未来,将与特殊技术说逐步走向整合,加深对心理治疗过程与改变机制的认识,共同提升心理治疗的效果。     

Interpersonal psychotherapy: A review and multicultural critique

Interpersonal psychotherapy (IPT) is a therapeutic approach focusing on the role of interpersonal dynamics in creating psychological difficulties that may be particularly relevant to the field of counselling psychology. IPT’s development within randomized controlled trials in the 1970s resulted in a strong empirical foundation without a cohesive theory. Regardless, theorists have since created a theoretical framework for IPT, which has received empirical support. Counselling psychologists have contributed to this research base and may have unique expertise to enhance IPT. Specifically, counselling psychologists can help integrate multicultural and diversity perspectives into IPT with the goal of creating a more culturally competent approach. For example, several aspects of IPT can be expanded to reflect these perspectives, such as integrating cultural sensitivity, cultural knowledge, cultural empathy, and cultural guidance. The authors conclude that IPT is a well-researched and effective treatment approach that holds potential for continued development within counselling psychology.     

Research and the organization of knowledge: where do psychotherapy and counselling fit in?

In order to clarify the place of research in psychotherapy and counselling, I look at the interrelationship of two ‘organizations of knowledge’. Organization can represent a process or an institution. My thesis is that there are particular characteristics of psychotherapy and counselling, considered as an intellectual discipline, that mean it organizes knowledge in peculiar ways that are reflected in the difficulty of reconciling them within the organization of the modern university. I shall propose that a different conception of research, based upon a third ‘organization of knowledge’, is necessary to resolve these tensions. Once psychotherapy/counselling finds more cohesion as a discipline, it is more likely to establish an independent niche within the university.     

Constructing and deconstructing psychotherapeutic discourse

This paper reviews recent work on the social construction of the self in counselling and psychotherapy, and argues that we need to attend to the ways in which the therapeutic self is fashioned (a) in relation to the ‘psy-complex' as the network of theories and practices concerned with psychological governance and self-reflection in modern Western culture and (b) in the context of ‘therapeutic domains' outside the clinic and academe, domains of discursive regulation and self-expression which then bear upon the activities of professional and lay counsellors. Therapeutic domains contain repertoires, templates and complexes within which counsellors and clients fabricate varieties of truth and story a core of experience into being. I then turn to describe and assess some of the various ways in which this kind of critical reflection on therapeutic discourse and counselling practice now already underpins the work of social constructionist ‘narrative' therapists. Some attention is given to the different pragmatic and deconstructionist approaches which make the discursive constitution of the problem into the problem, either by dissolving or by externalizing the account the client presents. Here I argue that the activities of social constructionist counsellors can be viewed as forms of deconstruction-in-process (a deconstruction of the discursive frames which have been constructed by the client), but that they should not be viewed as stepping outside the discursive conditions of possibility which ground their work. the psy-complex and therapeutic domains still function as relatively enduring structures which limit the degree to which we may construct and deconstruct psychotherapeutic discourse.     

(Re)Searching for a client in two different worlds: Mind the research‐practice gap

A criticism voiced by counsellors and psychotherapists is that research does not truly reflect the complexities of therapy. Researchers, on the other hand, accuse practitioners of not attending to research findings and suggest that as a result they engage in an ill‐informed process. This polarised understanding can give rise to the situation where the client is missed, falling into the research‐practice gap. In reality the research‐practice gap gets smaller and smaller every time a practitioner employs — which is often the case — a complex and sophisticated construct system in search of a client's psychological distress. The metaphor of the ‘search’ seems to become a point of connection between the practitioner's search and the researcher's (re)search. As a way of exploring this issue, the paper briefly considers the research‐practice gap and the critique of current research. It argues that counsellors and psychotherapists are themselves engaging in research when they practise therapy since every counselling and psychotherapy session is basically a (re)search process.     

Transcultural histories of psychotherapy

Abstract

Both proponents of and critics tend to assume psychotherapy’s origin and status as a ‘Western’ practice. The history of the emergence of psychoanalysis and psychotherapy are far more complex than this picture allows for. Today as we enter a more multipolar era of world history, the easy identification of psychotherapy with ‘the West’ will become increasingly difficult to sustain, as Bangalore and Shanghai are likely to rival Hampstead and Manhattan as centres of influence for the development of therapeutic practice and theory in the coming decades. Adapting to this new world will necessitate a different conception of the role of ‘culture’ than we have been used to in recent discussions in psychotherapy. Rather than simply seeing ‘culture’ as a factor that needs to be added to discussions to counteract the alleged ethnocentrism of ‘Western’ psychotherapy, we will need to begin to pay more careful attention to the work that is done by appeals to the ‘culture concept’ in different contexts. In particular ‘culture’ can be constructed as an object of evaluation that makes it part of the ‘check-list’ of skills that characterise the reconception of psychotherapy in an era of neoliberal instrumental manualised therapy training and practice.     

Why are therapists indifferent to research?

In counselling and psychotherapy there is a serious research—practice gap. Why should research on the therapeutic process have such little impact? Five related factors are considered: (i) epistemology—reliance on experiential/personal knowledge; (ii) preciousness—reliance on nonaxiomatic truths; (iii) lack of theoretical rigour—looseness with which constructs are construed; (iv) non-Popperian logic—tendency to work within a theory and defend it; and (v) personalisation of theory—evaluation seen as criticism. The result is a proliferation of therapies rather than a refinement of therapy.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.     

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

Design: Interviews were conducted with six carers of people with dementia about their experience of receiving counselling/psychotherapy. Interviews were conducted in the carer's own home, and data were analysed thematically using a narrative approach. Findings: Three themes were identified from the data: ‘Still doing the best I can’ (identified as losses and processes of personal growth); ‘Feeling connected and being understood’ (identified as attributes believed to be important within the therapeutic relationship); and ‘Wanting to share information’ (identified as sharing information with someone ‘neutral’). Carers placed emphasis on the age of the therapist and the amount of therapist self‐disclosure. Attending counselling and/or psychotherapy also helped the carer to find a ‘safe space’ to disclose and share concerns. Discussion: Carer loss and personal growth are explored, together with the importance of building therapeutic relationships and, for the therapist, seeking supervision when managing personal self‐disclosure. The theme of therapist self disclosure is explored together with the importance of therapists seeking supervision when managing personal self‐disclosure.     

Getting engaged: A case study and a model of the engagement period as a process of conflict-resolution

This paper addresses the problem of why so many marriages end in divorce. It develops a preventative approach to marital breakdown by proposing pre-marital counselling as a resource to be made widely available to couples. The key psychological issues which a counsellor could use as the backbone of any such counselling or therapeutic work are outlined. It is suggested that these issues are part of the psychological ‘working-through’ period during an engagement, when the couple are preparing for marriage. The psychological difficulties that an individual may be struggling with are illustrated via an account of psychodynamic psychotherapy with a young woman during the year of her engagement.     

The Absence of Multiple Universes of Discourse in the 1936 Tarski Consequence-Definition Paper

This paper discusses the history of the confusion and controversies over whether the definition of consequence presented in the 11-page 1936 Tarski consequence-definition paper is based on a monistic fixed-universe framework—like Begriffsschrift and Principia Mathematica. Monistic fixed-universe frameworks, common in pre-WWII logic, keep the range of the individual variables fixed as ‘the class of all individuals’. The contrary alternative is that the definition is predicated on a pluralistic multiple-universe framework—like the 1931 Gödel incompleteness paper. A pluralistic multiple-universe framework recognizes multiple universes of discourse serving as different ranges of the individual variables in different interpretations—as in post-WWII model theory. In the early 1960s, many logicians—mistakenly, as we show—held the ‘contrary alternative’ that Tarski 1936 had already adopted a Gödel-type, pluralistic, multiple-universe framework. We explain that Tarski had not yet shifted out of the monistic, Frege–Russell, fixed-universe paradigm. We further argue that between his Principia-influenced pre-WWII Warsaw period and his model-theoretic post-WWII Berkeley period, Tarski's philosophy underwent many other radical changes.