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Is Psychotherapy getting rid of itself?

Werner Kierski argues that our profession is under threat from a lack of research into the emotional experiences of our clients.  Here he considers some of the obstacles and anxieties that are getting in the way.

Werner Kierski

Counselling and psychotherapy, like any other profession, is heavily reliant on maintaining an innovative and creative edge to ensure its future success. One of the yardsticks for measuring this success is the number of counsellors and psychotherapists finding meaningful employment in conjunction with the respect the public offers their profession.

But there are serious risks that can threaten the inventive and creative edge of any profession. To see how risks ravage a profession we don’t have to look far. Journalism and the newspaper market are reflecting the decline of a once established and successful profession. The recent cessation of the print issue of The Independent and numerous other examples from around the world tell us of radical changes that leave many journalists struggling for employment and to make ends meet.

Below I describe some of the threats our profession faces when trying to offer effective and meaningful services that meet the emotional and mental needs of clients. The threats, I have found, are caused by obstacles preventing research into the emotional and mental experiences of clients. This threatens the future of psychotherapy, a danger that Lees (2016) alerted us to in his recent contribution. Lees eloquently pointed out how deep divisions between schools of therapy stand in the way of engaging in open-minded research. Though his point is important, these divisions are mere symptoms of a problem that lies much deeper and are more influential in inhibiting research into the emotional needs of clients.

The emotional and mental needs of clients are complex. Our profession’s ability to understand these needs requires ongoing critical thinking and inquiry. According to Feltham (2014) there is a dearth of critical thinking amongst the profession, which may explain the wider context of the problems that Lees highlighted.

The consequence of what these authors say is that therapists need to learn to research the deeper, often unknown, emotional mysteries and dimensions and, for that, they need to be trained in research.  Indeed recent years have seen research classes being introduced to many courses. In addition, more courses have become university accredited as Masters degrees and as such require graduates to complete a research project. Most Doctoral level courses are largely based on research already.

This is all promising. Yet it appears to work on paper only. In practice, many problems have occurred in research.

Currently, innovative and original research that can illuminate further the deep and complex dynamics of working with clients is being stifled or blocked entirely. Instead, budding researchers are forced to contend with what appear to be futile bureaucratic exercises that do not help our work.

The causes for this situation comprise of two problem areas, which I will explore in detail:

    1. Distortion of research ethics that  often mistakes litigation with ethical issues. The worst element of this is that it creates unethical situations particularly when patronizing research participants.
    2. An explosion of research for MA and Doctoral studies focused entirely  on therapist experiences and, as such, fails to contribute to the understanding of client experiences.

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Distortion of research ethics

Some years back,when teaching the final year of a counselling degree course at a top university, I was tasked with setting up a small research project that would be the basis for their thesis. A few weeks into the course, the senior administrator told the class that the application process for research ethics approval had changed retrospectively. As a consequence, students, to their dismay, had to re-submit a renewed complicated ethics application form. In that meeting the senior administrator openly admitted that the reason for the exercise was really just about litigation. Calling it research ethics was a disguise to protect the university from any unwanted attention that might be linked to student conduct. Later, several of the students had pseudo ethical comments written into their application form that were not of an ethical nature; for example, asking if the students could find enough research participants and pointing out spelling mistakes. One member of the ethics committee who I asked to explain the comments did not know that the issues raised were not of an ethical nature. At another training organisation, the new head of training suddenly prevented students putting up invitations for research participation on the organisation’s notice board, claiming this was unethical.

The list of chicane created by ethics committees includes many examples, such as the student researcher whose training organisation refused ethical clearance as the researcher mentioned the BACP membership breakdown by gender. To cite this was branded sexist. This organisation also published a declaration saying that all research is per se unethical.

Another  student who wanted to interview ex-military personnel about their transition into civilian life was forced to classify each and every participant,  without their knowledge, as highly vulnerable people. When I inquired of the ethics committee why this was the case, I was told by the head of the committee that a soldier in his wider family had been on tours of duty in Afghanistan and everyone was nervous and concerned about it. Therefore all soldiers must be declared to be fragile, at risk individuals. Jenkins’ (2016) seminal article on research ethics as a stifling factor in the development of psychotherapy research lists a number of other examples of how counter-productive current research ethics has become. Jenkins goes as far as saying:

“There is rich and promising material here for a comic novel in the style of Malcolm Bradbury set on campus, perhaps entitled The Ethics Man, or even a new reality TV show.”

Ex-barrister David Gladwell (2015), who turned psychotherapy trainee, gives a disturbing account of how his sound Doctoral research project was rejected by an ill-informed, opaque and prejudiced ethics committee.

In an ideal world the role of research ethics is intended to protect research participants from harm. This principle was borne out of the experiences of trials that can destroy the health or the life of participants in research. Readers may remember the Northwick Park Hospital trial in which six men ended up fighting for their lives (Vince, 2006). Therefore research needs to be governed by ethical principles. I believe that research ethics committees and researchers alike want to do the right thing. This is why they work in the field of helping others.

But why has research ethics in psychotherapy escalated in such extreme ways? Why, despite a positive motivation, is research being stifled so frequently even when this can threaten the future of psychotherapy?

It is likely that in ethics committees, questions of new knowledge may often not even feature as the focus is entirely on the perceived risks of research. Without being aware, ethics committees can then drift into moral vanity. This leads to exaggerating and escalating what risks can occur. Moreover, there may be an unconscious assumption amongst its members that “I am doing good already whereas you as the researcher still need to prove that you are doing good”. In their critique of distortions by ethics committees, seasoned researchers Della Sala and Cubelli (2016) state that the interaction between ethics committees and researchers too often is non-cooperative.

Members of ethics committees are oftentimes poorly experienced in research. My observation across a number of organisations is that these committees comprise administrators and tutors whose only personal experience of completing empirical research was for their own MA or Doctoral thesis. If one were to use the same level of experience when teaching clinical therapy skills then the only requirement for tutors would be to have only ever worked with one client.

Ethics distortions are likely also a symptom of organizational anxiety. Langdridge (2010), a leading expert in phenomenological psychology, stated that the excesses behind research ethics are a reflection of organizational anxiety rather than of the actual risks for participants. Hammersley (2008) identifies similar organisational problems and therefore questions whether research ethics committees “are capable of making sound judgments”. For him the problem is so severe that he calls it “the evils of ethical regulation” (ibid.). Apart from repressing research, he thinks there are many other disturbing consequences:

“Indeed, it may encourage cynicism about ethical requirements and/or irresponsibility, in the sense of a belief that ethics committees have now taken over the task of determining what is and is not ethically acceptable. Researchers will tend to be preoccupied with what will get through an ethics committee, not with what is and is not ethically justifiable. There also seem likely to be serious negative consequences of ethical regulation for the quality of research: it adds to bureaucratic demands for accountability, squeezing the time available for the reflective practice of research to a point where it becomes much harder to do what is already a difficult task.” (Hammersley, 2008:9)

University and NHS based research particularly borrow ethics principles from medical and pharmaceutical research where participants can be at considerable risk because their physical health is being tampered with. This of course requires strict protection. Psychotherapy research is usually based on interviewing people, giving out questionnaires or observing behavior in experiments. Thus participants maintain autonomy and physical health. Improvements are needed in separating psychotherapy from medical research ethics to allow progressive studies to be carried out.

Consequently in committee practice two things influence decision making: a) identical medical principles are employed for medical and psychotherapeutic research and b) participants in psychotherapy research are being deprived of a sense of autonomy and agency and instea are being declared as individuals who cannot cope with their emotions in an autonomous manner.

The fear of ethics committees to engage in any deeper explorations of human emotions contradicts what research, unhindered by such obstacles, has shown. For example there is the study by medical researchers Takesaka, Crowley and Casarett (2004) about possible risks that might occur when family members are being interviewed about the stressful experience of caring for a dying loved one. The study found that sensitive questions about death and dying are unlikely to cause distress to family members. The researchers report that any slight risk to feeling distressed in the interviews will by far outweigh the benefits family members experience when discussing their experiences. It seems unlikely that many psychotherapy research ethics committee members would have allowed such a study in the first place.

It is evident that all the while these problems are occurring, there is no discussion amongst the profession about what research ethics is supposed to be. Therefore ethics committees are not being challenged, which is compounded by the fear of many researchers that they would appear subversive if they challenged these committees. Enormous anxiety is what many research supervisors need to manage in their supervisees. That’s why ethics committees need to be governed by principles that show maturity, a willingness to help rather than to restrict, and become accountable for their decisions.

Research focused only on therapist experiences

The increased number of studies focusing on the emotional experiences of therapists instead of clients is equally undermining the development of knowledge and is impacting the future success of psychotherapy. It is a daunting trend that Mick Cooper (2011) has challenged by drawing our attention to the urgency for a totally different client-focused research.

Imagine if brain surgeons were to carry out research on the brains of other brain surgeons only, rather than amongst the general patient population. This would be questioned. Yet something similar is increasingly happening amongst trainee therapy researchers.

There is now research on when the therapist is an only child, when the female therapist is not a mother, when the therapist is a non-English speaker, when the therapist dreams about their clients, when the therapist is interested in watching movies, the therapist’s choice of clothing, the therapist’s act of self-disclosure, the therapist’s religious beliefs, but none shed light on the client experience.

There is an added escalation of this trend in that some therapy researchers only research themselves and their own private world. This goes along with jargon such as autobiographical (Chang, 2016), heuristic (Moustakas, 1990) or first person research (Varela and Shear, 1999). Apart from doubting whether these are actually research methods, it can be asked whether this is navel-gazing. And are such trends a mere expression of therapist narcissism, therapists who value themselves over their clients? I do not think so. This trend reflects guidance from tutors who may have little research experience themselves. This, coupled with ethics chicanery, limits research into client experiences.

Ethics committees can be overwhelmed with anxiety when they face research proposals that focus on the emotional experiences of non-therapists. They fear that when people are being interviewed about emotional experiences participants might be traumatised. This is bewildering considering that in therapy people talk about all sorts of emotional experiences and there they are not traumatised. On the contrary, talking about emotional experiences creates relief and healing, which is why our profession exists.

This trend of avoiding emotional experiences of non-therapists is causing the BACP research department (Kierski, 2012) to wonder about a vicious cycle of ethical obstacles and research being stuck with therapists’ experiences, but no action has been suggested to overcome this impasse in psychotherapy research.

When I deal with the many anxious, inexperienced researchers who are mortified that they could distress the participants in their studies just by asking them questions about emotional experiences, I usually ask them to reflect on their clients. When they reflect on their clients they know that questions about emotional experiences, including difficult ones, are useful to the client. What worries me though is seeing that too few research tutors or supervisors tell the student researchers that their anxieties are unfounded.

We therefore need an overhaul of the current research climate; we need to see more experienced tutors guiding novice researchers and ethics committees becoming transparent and fully accountable so that the future of psychotherapy is secured.

Dr. Werner Kierski is a psychotherapist, researcher and lecturer. He has completed a wide range of research projects over a period of 20 years. More information on: www.london-counselling-service.co.uk

Bibliography:
Lees, J. (2016) The future of psychotherapy. Therapy Today. Vol 27, issue 8, pp.20-22.
Feltham, C. (2014) Whatever happened to critical thinking? Therapy Today. Vol 25, issue 3, pp.14-18.
Jenkins, P. (2013) The only way is ethics. Contemporary Psychotherapy. Vol 5, no 2: [insert link here to www.contemporarypsychotherapy.org/volume-5-no-2-winter-2013/the-only-way-is-ethics/] (accessed 3.11.2016) First published in The Psychotherapist, Autumn 2011, issue 49, pp.14-16.
Gladwell, D. (2015) Do Ethics Committees Facilitate Research? Contemporary Psychotherapy. Vol 7, no 2: [insert link here to www.contemporarypsychotherapy.org/volume-7-no-2-winter-2015/do-ethics-committess-facilitate-research/] (accessed 3.11.2016)
Vince, G. (2006) UK drug trial disaster – the official report. New Scientist, 25 May 2006: [insert link here to www.newscientist.com/article/dn9226-uk-drug-trial-disaster-the-official-report/] (accessed 9 May 2016)
Della Sala, S., Cubelli, R. (2016) Entangled in an ethical maze. The Psychologist. Vol 29, no 12, pp 930-932.
Langdridge, D. (2010) Power and Politics in Phenomenological Research. Professional Knowledge Seminar. London: Metanoia Institute. 10 June 2010.
Hammersley, M. (2008) Against the ethicists: on the evils of ethical regulation. International Journal of Social Research Methodology. Vol 12, issue 3, pp. 1-14.
Takesaka, J., Crowley, R., Casarett, D. (2004) What is the Risk of Distress in Palliative Care Survey Research? Journal of Pain and Symptom Management. Vol. 28 No. 6, pp. 593-598.
Cooper, M. (2011). ‘Meeting the demand for evidence-based practice’. Therapy Today. Vol 22, issue 4, pp10–16
Chang. H. (2016) Autoethnography as Method. Abingdon, Oxon: Routledge
Moustakas, C. (1990) Heuristic Research: Design, Methodology, and Applications. London: Sage
Varela, F., and Shear, J. (1999) First-person Methodologies: What, Why, How? Journal of Consciousness Studies. Vol 6, no. 2–3, 1999, pp. 1–14.
Kierski, W. (2012) Personal email communication with the BACP research department. November 2012 to January 2013.

Image: Paul Delaroche – The Execution of Lady Jane Grey [1834]