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REVIEWarticle: Corralling Psychotherapy Research

Practise based image Ethics image Two new books focusing on the researcher as a person and which deftly explore ethical issues

 

Reviewer Peter Jenkins

Psychotherapy research has seen rapid, exponential research in the last decade, accompanied by an explosion of books geared to this new market for supporting students needing to complete research at Master’s or Doctorate level. Generally, this is seen as a positive development for counselling and psychotherapy as emerging professions. Credible research will, the argument goes, help to place the latter on a more equal footing with other established professional groupings. Still, for many practitioners, the doubts persist. Doing research is all very well in the greater scheme of things, but will completing a Masters actually help me to get (or even keep) a job, or to secure promotion? Or would I be better off putting my energy into seeking accreditation, or paying for that specialist CPD course I have really set my heart on?

Two recent books – Doing Practice-Based Research: A Reflexive Approach (Bager-Charlson, 2014) and Research Ethics for Counsellors, Nurses and Social Workers (Danchev and Ross, 2014) – are very much geared to the developing market for entry-level texts for postgraduate researchers. In the past, research texts were often written for a generic readership and needed somewhat careful translation to fit the specific therapeutic and relational paradigms of psychotherapy. In contrast, these texts are squarely addressed to a therapeutic readership, directly in the case of Doing Practice-Based Research, and, slightly more ambiguously, in the case of Research Ethics for Counsellors, Nurses and Social Workers.

Research into practice:
The first book, Practice-Based Research, is written by Sofie Bager-Charlson, academic adviser for the Doctorate in Psychotherapy run by Metanoia and Middlesex University. This reads like a distillation of practice, drawn from the experience of tutors and students, in grappling with the practical and theoretical issues involved in undertaking research. It includes chapters on the supposedly more ‘technical’ side of research, which includes discussion of evidence-based research, formulating your research question and doing a literature review. It is infused with a broadly humanistic approach, where the personality and perspectives of the therapist as researcher occupy the centre-ground. It includes material on the researcher as a person, personal development and reflexivity, with a welcome chapter on epistemology (or, in other words, how we know what we know).

The real strength of the book lies in its evident grounding in ongoing and current research practice, frequently quoting from, or giving live examples of, students’ work, such as the personal impact of going through a professional complaint or evaluating a voluntary sector agency providing school-based therapy. Hence the chapter on formulating a research question, often the key struggle for beginning researchers, gives a range of real-life examples which will be valuable to most readers. While the book is clearly a useful resource, its style could perhaps have been improved with further editing, in that it is often overly densely referenced, making it hard at times to catch the author’s own distinctive voice as a therapist-researcher. The outline of quantitative methods, often an Achilles heel for psychotherapy research texts, here relies heavily on quotation and is presented with rather less enthusiasm than for mixed methods or qualitative approaches.

Ethics of doing research:
The experience of one contributor, Beverly Costa, points to an enduring problem in undertaking research, namely the issues involved in getting ethical approval. She writes that, in her experience, “processes for gaining ethical clearance for medical research with patients and clients are so arduous that it is off-putting for researchers” (p.31). The issues around research ethics provide the focus for the second book in this review article, Research Ethics for Counsellors, Nurses and Social Workers by Dee Danchev and Alistair Ross. One initial observation is that the title perhaps suggests the triumph of marketing optimism over academic content as the bulk of the illustrative material relates mainly to counsellors, partly to nurses and only rarely to social workers. Still, this is an interesting and very readable book by two experienced researchers and research supervisors. For many novice researchers it is often unclear where to situate ethics within their research process other than as a late after-thought. Common questions asked for example are ‘Are ethics just a subsection of my methodology chapter? Or should they really be a chapter on their own? For Danchev and Ross, their central argument is that “the entire research process is freighted with ethical decisions” (p.2).

Again, their starting point, unlike standard research texts, lies in focusing on the person of the researcher, with an outline of more recent post-modernist and relational approaches to ethics. Each chapter is solidly referenced, so that there is a real grounding of expertise available to readers in unpicking the ethical issues and helping them to clarify and set out their own ethically-informed stance. There is a wealth of boxed examples, which are, curiously, often left anonymised – some level of identification of the source would have been useful, if only in satisfying this reader’s curiosity.

The real strength of the book is its conscientious unpicking of the research process via an ethically-informed lens. Addressing ethical issues is very much seen and presented as a process, as, for example, in obtaining informed consent, leading up to the a very useful discussion about the ethics involved in getting your research findings out into the real world. This stage is often missing from many student research proposals in my experience. While the focus on process is valid and helpful at a pragmatic level, I found the section on getting ethical approval disappointing in failing to address the wider contextual issues. While the chapter does look in some detail at the process of applying for and achieving ethical approval, either through the NHS system, or via university research ethics committees, it does not flag up, in my mind, the real level of threat that this system now poses for the future development of psychotherapy research. The authors do acknowledge that the establishment of research ethics committees “caused ethics to be seen as a bureaucratic process” (p.104), but with some positive benefits, as in highlighting common issues and standardising application processes.

Research ethics and hegemony
However, another reading of the shift to the emerging role of research ethics committees is much less benign (Jenkins, 2013). The authors refer to the standard rationale for relying on research committees as to minimise the risk of litigation, but with no evidence to support it. There is, in fact, little track record of successful litigation against universities for damage caused by incompetent or unethical research. In reality, the NHS fear of litigation for medical negligence has been transposed to universities, but without any credible justification. In the process, research into the experience of clients has been effectively proscribed. Instead, therapists are encouraged, or advised, by supervisors to go out and interview other therapists in a somewhat lopsided, partial and potentially discriminatory research discourse. The authors give several examples of research projects aiming to interview children and young people where the research has been delayed, or even blocked, by committees insisting on parental consent, which is quite unnecessary under English law post-Gillick.

To be fair, the problem is recognised by Danchev and Ross at a practical level, if not situated in any over-arching analysis. For psychotherapy to gain professional recognition, it needs evidence of professional status. This, in turn, includes acquiring attributes such as a clear evidence base. However, the authorisation of this crucial research is now set firmly under medical hegemony, initially set up via the NHS, and now extended to university settings. The research agenda for psychotherapy is largely determined by a non-therapeutic medical model, with psychotherapy joining nursing, social work and teaching as subordinated semi-professions. For psychotherapy, funding for approved quantitative approaches such as sizeable randomised controlled trials is practically unobtainable. Research into clients and patients, particularly with young people, or other ‘marginalised’ groups, is deemed to be far too ‘risky’. Practice-based evidence and ethically informed research are clearly valid and necessary activities, but the current institutionally-based research ethics system is effectively ‘corralling’ psychotherapy and blocking its development as a profession.

Peter Jenkins is a Senior Lecturer in Counselling at the University of Manchester.

 

References
Bager-Charlson, Sofie (2014) Doing Practice-Based Research: A Reflexive Approach. London: Sage.
Danchev, Dee and Ross, Alistair (2014) Research Ethics for Counsellors, Nurses and Social Workers. London: Sage
Jenkins, P. (2013) “The only way is ethics? University ethics committees and the future of psychotherapy research”, Contemporary Psychotherapy, 5:2 http://www.contemporarypsychotherapy.org/volume-6-no-2-winter-2013/