UNDERSTANDING GRADUATE WOMEN'S REENTRY EXPERIENCES

This multiple case study describes the experiences of reentry women in psychology doctoral programs at a major Midwestern research university and illustrates the usefulness of the qualitative case-study method in exploring women's experiences. Semistructured interviews were conducted with four women who were purposefully selected as information-rich participants. Observations and informal interviews were also conducted over a period of up to 2½ years. Eight themes emerged from the data and have been labeled: the decision to return, expectations versus reality, measuring up, frustrations and difficulties, changing family relationships, the necessity of organization, "do it and get on with life," and rewards. This article illustrates that case-study research can be a powerful tool for feminist researchers to document women's experiences.     

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.     

Object elicitation: A compassionate and culturally informed method for psychotherapy research

This study provides an innovative, compassionate and culturally informed method for psychotherapy research, using object elicitation with 13 participants from vulnerable groups. It examines the positive impact it has on building the research alliance, enhanced depth of sharing within qualitative research interviews and emic ways of knowing through the engagement with a culturally relevant, tangible, internalised or transitional object brought by vulnerable participants from diverse cultural contexts of origin. Results showcase how a creative and compassionate research method can promote a culturally informed research alliance with vulnerable participants, helping to build trust, rapport and relational depth; encourage elicitation of experiences; and empower emic and subjugated voices. The implications of this study make the case for the inclusion of object elicitation as a creative and compassionate method in qualitative research with traumatised and vulnerable individuals, which should be used as part of a culturally informed approach to psychotherapy research.     

Psychotherapy,complementary and alternative medicine and social dysfunction

This article investigates a bio-psycho-social approach to psychotherapy which works, where possible, with interdisciplinary complementary and alternative medicine teams. The model, called anthroposophic psychotherapy, sees body, soul and spirit as interconnected and the study discusses the bio-psycho-social aspects of the model by linking cardiovascular disease, psychological stress, asocial behaviour and social dysfunction utilizing single case study methodology. The limitations of this method are acknowledged and discussed, but it is also argued that the study has a valuable part to play in a research programme which may also later include efficacy and effectiveness research. The methodology incorporates the principle of data synthesis, as well as data analysis, in accordance with the holistic nature of the clinical model, since it takes the view that all of the elements in the research field are connected. The anxieties presented by the client were linked to arteriosclerotic symptoms and social problems. All of these elements had their roots in childhood and needed to be treated with a number of interventions, including anthroposophic psychotherapy and medicine, which incorporates the homeopathic principle of ‘like cures like’.     

Persuasion criteria in research and practice: Gathering more meaningful psychotherapy data

Psychotherapy research should ultimately benefit the psychotherapy client. Unfortunately, traditional psychotherapy research continues to have little influence on practicing clinicians and, therefore, does not benefit psychotherapy clients. As behavior analysts begin to show interest in this area of research, they may be in a position to improve its quality. We argue that traditional psychotherapy researchers have become prematurely wedded to a methodology that does not address the concerns of clinical audiences. Furthermore, we make a case for defining and evaluating psychotherapy data in terms of its capacity to influence both researchers and clinicians. We also suggest several alternative methods for gathering psychotherapy data based on the case formulation approach. We argue that this approach may be one of the most promising methods for gathering useful psychotherapy data.     

Adapting Strauss and Corbin's grounded theory in clinical case study research in the field of counselling

Case study can be adopted when aiming to understand an individual's lived experience. Such experience produces rich and complex qualitative data for analysis, conducive to counselling and psychotherapy research. Furthermore, grounded theory (GT) can be adopted to produce a theory from qualitative data, fitting well with case study research that explores complex experiences regarding social, psychological and phenomenological processes. This paper aims to guide the counselling researcher to incorporate Strauss and Corbin's model into the main arena of qualitative counselling research. In addition, this paper draws on a multiple case study that adopted Strauss and Corbin's method and identified various phases in the GT process. The aim is to inform the reader how to put the iterative process and pragmatic theoretical sampling into practice to produce a robust theory from clinical case study data.     

Theory‐building case studies of counselling and psychotherapy

In addition to their potential for healing, psychotherapy and counselling offer extraordinary opportunities to observe human experience and behaviour. I suggest practitioners have expertise in and daily access to the phenomena that theories of counselling and psychotherapy seek to explain. Practitioners’ clinical experience can be accumulated and shared through theory-building case study research. This article summarizes the logic of theory‐building case studies and offers practical suggestions for conducting case study research.     

A Cross-Contextual Construction of Clients' Therapeutic Practice

This study demonstrates how gathering data from a different context can significantly change how an object of study may be viewed. Data from a qualitative diary study of psychotherapeutic practice were used to construct a cross-contextual view of psychotherapy. Data about clients’ everyday lives as well as psychotherapy sessions were analyzed. Examples of how extra-therapeutic factors are significant to client change are presented. Six types of extra-therapeutic information sources that clients use to develop their personal stances while in therapy were identified. The case of one client's abundant use of extra-therapeutic sources of information offers a different construction of how psychotherapy works, emphasizing client activities outside sessions. The implications of the study for psychotherapy research are addressed.     

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 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.     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.     

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.     

Studying psychotherapy change in narrative terms: The innovative moments method

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format.     

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.     

Empirically Documenting Clinically Significant Change in Rational Emotive Behavior Therapy

The purpose of the present article is to outline the conceptual foundation and practical methodology of the Jacobson-Truax Clinically Significant Change index, derived from psychotherapy outcome research. This way of considering what constitutes clinically significant change in psychotherapy puts a premium on social validation. It empowers clinicians to evaluate the meaningfulness of their client's progress and to communicate that progress to third parties such as other clinicians, researchers, and insurers. Application of the method is demonstrated in the case of a client treated with Rational Emotive Behavior Therapy (REBT). The discussion focuses on the advantages of this procedure for satisfying the intellectual interest of the practitioner-scientist and for furthering informed discussion of the value in various applications of REBT to clinical problems.     

Psychotherapy outcome studies do not accurately represent current models of psychotherapy. A proposed remedy

It is argued that the design of contemporary psychotherapy outcome studies is conceptually incompatible with the models of psychotherapy evaluated in those studies. Contemporary outcome studies are incompatible with psychotherapy models because the outcome studies treat patients with standardized treatments that are assigned on the basis of psychiatric diagnosis rather than with individualized treatments based on a theory-driven psychological assessment of the individual's difficulties. One possible remedy, idiographic outcome studies using a case formulation model of assessment and treatment, is proposed here. It is suggested that this research strategy may narrow the scientist-practitioner gap and make it easier to demonstrate differential outcomes of different treatments.     

The validity of psychotherapy 1

How good is psychotherapy as a tool of research into human nature? There is an orthodox defence of it as a research tool, which relies on showing that interpretations are true of the patient when they satisfy certain criteria. This defence is examined and rejected. The reply is considered that an interpretation which ‘keeps things moving’ is true, or an approximation to the truth. This reply is rejected by comparing and contrasting an interpretation in psychotherapy with one from brainwashing sessions. Two suppositions about psychotherapy (which weaken its discovery powers) are deliberately adopted — the suppositions that the material produced is ‘perspective’ and ‘method’ dependent. An unorthodox defence of psychotherapy is then offered — by means of a watery sense of ‘discover’. This enables us to outline a weak sense in which psychotherapy is a valid enterprise, but one which is still strong enough for research purposes.