Researching psychotherapy integration: A heuristic approach

Moustakas argues that questions and methodology in heuristic research flow out of inner awareness, meaning and inspiration. The approach might arguably embrace a combination of qualitative research methods, and constitute a kind of bricolage. This paper describes a heuristic enquiry into psychotherapy integration that used such a combination of methods – an interpretative phenomenological approach, case studies, reflexive action, and writing. It demonstrates how each of these methods contributed to the six phases of heuristic enquiry, from the initial engagement with psychotherapy as a trainee to the creative synthesis of published works and a PhD thesis, together with some reflection on the enquiry's limitations and rigour. Published texts, training, clinical practice and reflexivity constituted the material from which a new organizing framework for understanding psychotherapy integration was formulated. The author reflects on how the research design allowed deep engagement with this material, and changed his perspective of psychotherapy integration. In conclusion, this paper suggests that both psychotherapy integration and heuristic enquiry can only be conducted on an individual and personal basis, and that it is the quality of the relationship, with the client, or the research material, that produces results.     

Trainee psychotherapy effectiveness at a psychodynamic training clinic: a practice-based study

The degree to which clinical experience is a significant factor in predicting positive psychotherapeutic outcomes is an open question. Empirical studies comparing experienced and beginning practitioners on differences in client outcomes have yielded mixed results. While multiple sources have indicated that trainees are generally effective therapists, few of these studies have examined the effectiveness of graduate-level therapists in a psychodynamic training program. In this study, conducted in the United States, we use a practice-based research approach to examine the outcomes of clients working with trainees at a community mental health clinic in the northeast United States. The theoretical orientation identified by the clinic and training program is psychodynamic with an interpersonal and/or relational emphasis. Results indicated that clients working with trainees at this clinic demonstrated improvement across several indicators of symptoms and psychosocial functioning over the time they received treatment. Implications for training and service reimbursement are discussed.     

Private psychotherapy training in Italy: A systematic analysis

This paper examines the results of a systematic analysis, organised by the Italian Ministry of Education, University and Research, of private psychotherapy training in Italy. Since 1989, training in psychotherapy in Italy has been governed by a national law which recognises both public and private institutions. While the public system usually comprises approximately 150 students, the private system has grown significantly over time, registering thousands of students in hundreds of schools (for example, 19,123 students in 212 schools in 2011). Systematic analysis variables included geographical distribution, theoretical approaches, training methods, student and teacher characteristics, student’s personal psychotherapy, supervision and apprenticeships. Data were obtained from 92% of the schools. The primary issues discussed in this paper are as follows: the uneven geographical distribution of the schools; the disorderly amalgamation of traditional scientific paradigms; programmes which concentrate on theory and fail to meet international guidelines. One key issue is the excess supply with regard to demand, meaning that recently graduated psychotherapists (especially women) risk underemployment and financial hardship. Student enrolment is also increasingly problematic. This is the first paper to present an in-depth analysis of one European country’s situation in this field. The authors believe it will foster comparison and discussion internationally.     

An advanced specialist-level training programme in psychodynamic individual psychotherapy of psychotic and borderline patients: the Finnish approach

Most training programmes in individual psychotherapy, including psychoanalytic training are, in practice, restricted to the treatmentof lessdisturbed patients than those who have succumbed to psychotic or severely borderline-level disorders. This has had a delaying effect on the development of psychotherapy with such patients. Psychotherapy of severely disturbed patients is usually regarded as a difficult domain and is often practised only by psychoanalysts or other psychotherapists specially dedicated to working with patients of this kind. Between 1994 and 1997, an advanced multi-professional training programme in psychodynamic individual therapy with an emphasis on borderline and psychotic-level disorders was organized through the Centre for Extension Studies of the University of Turku, Finland, to close the gap in systematic training for the treatment of the most serious psychic disorders, and also to integrate some of the special requirements of public and private psychiatric health care. Here we briefly describe the main elements of our training programme as well as some of our training experiences. It is important to emphasize that the training was not meant to replace psychoanalytic training. It is a question of a separate multi-professional programme based on psychoanalytic premises but with particular objectives of its own.     

Action research,emancipation and design thinking

This article evaluates the notion and practice of action research, as defined by contributors to the recent special issue ‘Action Research and Emancipation’ in this journal. The author argues that, although action research implicitly has a design orientation, it largely draws on the humanities and sciences as its main role models. As a result, action researchers nowadays do not see themselves as design professionals. Idealized design methods serve to illustrate how design research can help realize the emancipatory intentions of action researchers. Copyright © 2004 John Wiley & Sons, Ltd.     

Reflexive action research: Developing knowledge through practice

This paper gives an overview of different ways of conducting counselling and psychotherapy research. An approach to research is described which overcomes the research‐practice gap: reflexive action research. It is argued that this approach to research is particularly appropriate and relevant for practitioners since it draws upon skills and awareness necessary for clinical work, and can complement positivist methods of research which are already well established in the profession. The wider use of systematic clinical case studies is suggested as a means of promoting the reflexive action research approach. Further consideration of issues of validity and reliability is required on the part of those intending to apply this approach within the field of therapy research.     

Perceptions of psychotherapy trainees of psychotherapy research

Aims: The research‐practice gap and lack of engagement with research by trainees and qualified therapists is a widely discussed issue amongst psychotherapy researchers. The present study investigates the perceptions of psychotherapy trainees of psychotherapy research and explores what would encourage them to participate in research. Method: Two focus groups of 16 trainees in total were conducted at two separate psychotherapy training institutes to explore trainees’ attitudes and perceptions. Data was analysed using Braun and Clarke's (2006) thematic analysis. Results: Three superordinate themes emerged: negative perception of research; recognition of the importance of research; and what would be needed to facilitate engagement in research. Discussion: The results suggest that interest in and willingness to participate in research exists, however it is necessary for negative perceptions about research to be addressed and for researchers to design projects which are supportive of participants.     

Starting from scratch: Developing clinical psychology training and services in Bangladesh

Abstract

This paper outlines the author's personal experience of contributing to the development of the first ever training in clinical psychology in Bangladesh. This was part of a link project between University College London and Dhaka University. It examines the challenges posed by such an enterprise through the author's experience of teaching and assessing patients in the local psychiatric wards. It questions the validity of exporting Western models of psychotherapy – psychoanalysis in particular – to a non-Western culture.     

Emotion-regulation skills as a treatment target in psychotherapy

Background

Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders.

Aim

To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions.

Method

Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial.

Results

Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health.

Conclusion

Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions.     

Culturally educated questioning: Toward a skills-based approach in multicultural counselor training

Increased resources are being committed to the multicultural training of counselors. Despite these gains, training continues to focus almost exclusively on the acquisition of cultural awareness and culture-specific knowledge. Valuable though they are, awareness and knowledge, the authors argue, do not necessarily result in effective multicultural counseling skill. Therefore, it is recommended that current training models be modified to include techniques through which cultural knowledge can be synthesized into effective counseling interventions. Specifically, it is suggested that programs stress the need to conduct cultural assessments of clients using what the authors term “culturally educated questioning”: empirically rooted inquiry designed to elicit from clients clinically relevant cultural data. The benefits of culturally educated questioning, including its safeguards against cultural stereotyping, are discussed.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

Developing therapist self‐understanding through research

This paper explores the application of reflexive action research in practice by examining a piece of the author's previously published work. A process of inquiry is described that involves reflexively engaging with original formulations in order to further continuing professional development. Guidelines for conducting this kind of research are described.     

Ethical considerations in psychotherapy effectiveness research: choosing the comparison group

The primary purpose behind effectiveness research is to determine whether a treatment with demonstrated efficacy has utility when administered to the general population. The main questions these studies are meant to answer are these: Can the typical patient respond to treatment? Is the treatment acceptable to the typical patient? Can the treatment be administered safely and in its entirety in the typical treatment setting? Is the treatment under study significantly better than the community standard of care both from and a cost and outcome perspective? Answering these questions is meant to provide sufficient information to providers and policymakers so that effective interventions can be adopted and become the new community standard. For this research to make a meaningful impact on a provider and policymaker's decision to change the status quo, study interventions should be compared to the existing community standard of treatment, often referred to as treatment as usual (TAU). From an ethical perspective, this decision may not always be the safest choice. In some populations, TAU may mean no treatment at all, and in others TAU may be worse than withholding treatment. The effectiveness researcher is then caught between the pull to do no harm and the need for research to have an impact on change. The purpose of this article is to highlight certain conditions when TAU is ethically acceptable and to discuss alternatives when TAU may be an unethical treatment condition. For purposes of precision, we focus exclusively on psychotherapy effectiveness research rather than system-intervention research or medication-intervention research.     

Interpersonal process in psychotherapy through the lens of the structural analysis of social behavior

As psychotherapy research focuses more and more on mechanisms of therapeutic change, increased attention has naturally been directed at therapy process. Over the past several decades, a variety of researchers have successfully applied Benjamin's 1974 Structural Analysis of Social Behavior (SASB) to the study of in-session psychotherapy events. This system for conceptualizing and analyzing interpersonal and intrapsychic processes has been shown to provide theoretically rigorous and empirically tractable instantiations of both helpful and hindering therapeutic exchanges. In this article the therapeutic alliance is conceived in terms of interpersonal processes as demarcated according to the SASB. This article also provides a review of SASB's wide-ranging applications to observing and studying the therapeutic relationship, therapy process, and client outcome. Also discussed are several data analytic and methodological considerations related to the SASB model and several new ancillary measures based on the SASB. Finally, the applied and clinical utility of the SASB system is discussed in light of a variety of contemporary empirical findings.     

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.