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.     

Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Psychotherapy research: an interplay between inner and outer and a succession of meanings

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual’s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the ‘Centre for research on the psychodynamics of personality’. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re‐authoring one’s life narrative is accepted as part of a productive therapy as well as discovering one’s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.     

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.     

Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

Quantitative and Qualitative Research: Beyond the Debate

Psychology has been a highly quantitative field since its conception as a science. However, a qualitative approach to psychological research has gained increasing importance in the last decades, and an enduring debate between quantitative and qualitative approaches has arisen. The recently developed Mixed Methods Research (MMR) addresses this debate by aiming to integrate quantitative and qualitative approaches. This article outlines and discusses quantitative, qualitative and mixed methods research approaches with specific reference to their (1) philosophical foundations (i.e. basic sets of beliefs that ground inquiry), (2) methodological assumptions (i.e. principles and formal conditions which guide scientific investigation), and (3) research methods (i.e. concrete procedures for data collection, analysis and interpretation). We conclude that MMR may reasonably overcome the limitation of purely quantitative and purely qualitative approaches at each of these levels, providing a fruitful context for a more comprehensive psychological research.

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a client's presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each client's functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Grounded Theory methods in child psychotherapy research

This article considers the place of qualitative research in psychoanalysis and child psychotherapy. It discusses why research methodology for many years occupied so small a place in these fields, and examines the cultural and social developments since the 1960s which have changed this situation, giving formal but also qualitative methods of research much greater significance. It reflects on the different pressures to develop explicit research methods which arise both from outside the psychoanalytic field, as a condition of its continued professional survival, and from within it, where its main aim is the development of fundamental psychoanalytic knowledge. It suggests that the conduct of mainly quantitative research into treatment outcomes is largely a response to these external pressures, whilst the main benefits to be gained from the development of qualitative research methods, such as Grounded Theory, are in facilitating the knowledge-generating capacities and achievements of child psychotherapists themselves. The paper describes Grounded Theory methods, and explains how they can be valuable in the recognition of hitherto unrecognised meanings and patterns as these are made visible in clinical practice. Finally, it briefly describes three examples of completed doctoral studies, all of which have added significantly to the knowledge-base of child psychotherapy, and which demonstrate how much can be accomplished using this method of research.     

The Roles of Metaphor and Imagination in Child Trauma Treatment

ABSTRACT

This article presents developmental theory regarding the emergence and importance of metaphor and imagination to child development. The author then reviews psychotherapy research and clinical literature to identify ways that these two mental processes, as transtheoretical elements of child therapy, can be applied within trauma-specific treatment for expressing and processing difficult experiences, integrating traumatic memories, containing fears, bolstering self-efficacy, and expanding understanding of self and others. Case examples are provided to illustrate clinical applications.     

Researcher and clinician: Role conflict and resolution

Group therapy investigations are often conducted by researchers rather than by experienced clinicians who also possess research expertise. Given the fact that doctorally prepared clinicians must demonstrate research competence in their education programs, it is surprising that there is not more research on group therapy. The literature indicates that research and group psychotherapy practice are considered quite separate entities. However, there is much that both processes have in common. The principal investigator's experience during a group psychotherapy research project suggested that the conflict between the roles of researcher and clinician may not be due to differences in the external processes but rather to difficulties in trying to combine them within one person. The value of the researcher-clinician is elaborated, and recommendations are offered.This paper was supported by a grant from the Group Psychotherapy Foundation.     

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.     

Revisiting a meta-analysis of helpful aspects of therapy in a community counselling service

This small scale mixed methods study examines helpful events in a community counselling setting, categorising impacts of events according to Timulak’s [(2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis. Psychotherapy Research, 17, 305–314] meta-synthesis of significant events research. Comparisons were made between the types of impacts reported as helpful by clients receiving cognitive behavioural therapy (CBT) or relational integrative counselling. Seventy-five clients identified 291 significant events on 216 Helpful Aspects of Therapy (HAT) forms. The findings broadly reflect all nine impacts identified by Timulak (2007). The study also suggests that a potential new category, ‘voicing’ may exist. Differences between the types of impacts reported as helpful by clients in CBT and integrative therapy showed a higher percentage of CBT clients reporting ‘behavioural change/problem solution’, ‘reassurance’ and ‘client involvement’ as helpful. Differences in other categories were not statistically significant.