|
|
Post by Maddie 1 on Oct 6, 2015 19:28:01 GMT
Hello, Here are my current thoughts on the challenges of primary research in psychotherapy: The main challenges of primary research within psychotherapy that I am aware of are as follows: 1. Researcher bias. Arguably it is impossible for any researcher to be completely objective. All human beings have their own assumptions and biases and these are a challenge to primary research in psychotherapy because they may influence the findings and/or the way results are presented. As Cooper (2012) asserts: ’… limitation of research findings is that they will inevitably be influenced by the researchers' own assumptions and agendas.’ (4)
This research bias can occur either consciously or unconsciously. For example, a therapist from a particular school of thought may be keen to demonstrate the superiority of his approach over other approaches and this may result in a distortion of the results. Cooper (2012) writes about this in relation to research into Cognitive Behavioural Therapy (CBT) and psychodynamic therapy: ‘[…] researchers who were allied to behavioural rather than psychodynamic approaches to therapy (as defined by themselves, their colleagues, or as indicated in their papers) tended to find that behavioural approaches were more effective than psychodynamic ones, while researchers allied with the psychodynamic approaches tended to find the opposite. Indeed, on the basis of Luborsky et al’s data, Westen and colleagues (2004) calculate that, in more than nine out of ten instances, the results of a comparative trial can be predicted by knowing the researchers’ allegiances alone.’ (47)
If ninety percent of research studies back up the psychotherapeutic orientation of the researcher, then arguably, overcoming this researcher bias is clearly a big challenge when conducting primary research in psychotherapy. In part, this is an ethical issue and I will look at this in a little more detail below.
2. Analysis methods.
According to Cooper (2012), ‘Researchers can even come up with radically different conclusions with the same set of data if they use different tools of analysis.’ (4)
The challenge is therefore for researchers to be aware of the different tools of analysis and to utilise different approaches with their findings. As with researcher bias, there is an ethical dimension to this because researchers need to have the integrity to highlight contradictions in their research or ways in which it might underline their psychotherapeutic modality. I will look at this in a little more detail below.
3. Cost of primary research.
The cost of undertaking primary research into psychotherapy can be regarded as a challenge because as McLeod (2013) attests:
'Unlike fields such as cancer care, consumer electronics or the defence industries, there are no multi-million dollar research institutes devoted to the advancement of knowledge about counselling and psychotherapy.’ (1)
Obviously, without funding, it is much more difficult for practitioners to devote time to research. It is also less likely that research that has been undertaken will be re-tested by other researchers in order for results to be challenged/verified.
The cost issue may also make it more challenging for research into longer term psychotherapy to be undertaken and more likely that the primary research which exists will be skewed in favour of brief therapies: ‘[…] it could be argued that there is so much more evidence for CBT because, as a brief structured therapy, it lends itself much more easily to testing […]’ (Cooper, 2012, 47)
4. Ethical considerations.
In order to undertake primary research within psychotherapy, the ethics of the research must be carefully considered. This can be challenging for many reasons, in large part because research within our field involves working with real people and as such there is always the potential that harm could be caused. Every aspect of primary research within psychotherapy must therefore be carefully considered and tailored as necessary to ensure participants are protected. By necessity, this limits what can be studied and is therefore a challenge to primary research in psychotherapy. Professor Tim Bond, has written at length about ethics within psychotherapy and he points out that ‘There has been a long history of researchers being so committed to investigating a particular topic, as rigorously as possible, and with a strong belief they will benefit society, that they have lost sight of the consequences for their research participants.’ (2015, 104)
Fortunately, most research into psychotherapy now needs to be approved by an ethics committee (Bond, 2015) and participants will therefore receive protection.
The use of randomised control groups in primary research is also challenging in the field of psychotherapy. In order for a treatment method to be proven efficacious, a control group needs to be part of a study. So, for example, in order to prove that hypo-psychotherapy is an effective treatment method for people who overeat, a study would need to include two groups of participants. One group would receive treatment and the other group, the ‘control’ group, would not. If the group receiving treatment improved measurably more than the control group, then the research would have demonstrated the efficacy of hypno-psyschotherapy as a treatment method for this issue. The control group is essential because without this, it could be argued that improvements seen in individuals were the result of factors outside of the therapeutic intervention. The ethical challenge of this is well explained by Bond (2015):
‘The control group might receive no treatment, perhaps by being kept on a waiting list as a point of comparison with those receiving treatment, in order to make an accurate measure of the impact of receiving the intervention. This meets the ethical requirement of being academically rigorous but, given that the waitlist condition entails waiting to access treatment, raises new ethical issues about what to do if the treatment proves to be particularly effective. Should the people in the control group be taken off the waitlist and offered the new treatment? This is an ethical question, which requires consideration against other ethical principles, particularly what would be respectful or trustworthy?’ (104)
In relation to the issues of researcher bias and analysis methods raised above, it is an ethical challenge for the researcher to reflect findings accurately regardless of their psychotherapeutic orientation. Bond (2015) states that the researcher must ‘[…] have integrity [… which] means undertaking the research in a genuine spirit of inquiry by being open to finding the unexpected and the puzzling […]’ (103).
My references:
Bond, T (2015) in ‘The Counselling and Psychotherapy Research Handbook’ Sage, London [Edited by Vossler, A and Moller, N: 2015]
Cooper, M (2012) ‘Essential Research Findings in Counselling and Psychotherapy; The Facts are Friendly’ Sage, London
McLeod, J (2013) ’An Introduction to Research in Counselling and Psychotherapy’ Sage, London
|
|
|
|
Post by clarem on Oct 7, 2015 12:10:49 GMT
The Challenges of Primary research-
I agree with all what Maddie has written and my answer to the question is on similar lines, hence a bit of repetition for readers.
The challenges of primary research within psychotherapy field is the huge cost and time that gathering and processing the primary information will take.
Initially, the primary research needs to be decided and whether it is relevant and beneficial to the profession.
This commences with agreement from relevant ethical committee, gathering suitable clients, producing questionnaires, approved protocol and the execution. Also, gathering a suitable pool of similar clients needed to enable accurate findings will be immense; therefore it is easier and simpler to gather a small sample of clients.
There is another challenge with research into psychotherapy, it is the ease at which findings can be repeated to obtain the same conclusion.
In the physical sciences, a scientist can reproduce the same experiment by using the same procedures and materials under identical conditions and then produce comparable results to confirm or advance previous experiments ( I have conducted these experiments many times during my pharmacology degree course work!). However, this is merely impossible in psychotherapy!
This approach to research is rarely performed in psychotherapy for many reasons including;
‘The uniqueness of a particular dyadic relationship between client and therapist…. cannot be easily duplicated.’ (Meltszoff A. 2007. p37)
The therapeutic alliance adapts and changes with each new client or even in each session, this would need to be scrutinised by the researcher.
Another great challenge is the possibility of the researcher bias which needs to be fully investigated and reported within the published literature.
‘It takes little talent to bias research…..many different bias can be introduced from conception of the research to reception of the completed report. They include bias of the investigators, sampling, patients, therapists, criteria, criteria measures, interviewers, testers and judges, data analysis and interpretation, and publication and reader bias’ (Meltszoff J. 2007. p28)
There is no magic formula to control bias, but it is the responsibility of the researcher to be fully aware of the pitfalls addressing these accordingly.
Once the research is completed there is another challenge of peer review:
‘The peer view process must be handled efficiently and effectively. It maintains standards and ensures reporting is as truthful and accurate as possible. It helps the layperson or non expert to believe and what to view with scepticism.’ (Wiley.2008 p2)
Publishing in a highly regarded journal is essential.
Hanes I.( 2008). Peer Review and Manuscript Management in Scientific Journals: Guidelines for Good Practice. Blackwell Publishing. Oxford
Moeltzoff J. (2007). Research in Psychotherapy. Transaction Publishers. London
|
|
|
|
Post by Maddie1 on Oct 7, 2015 17:10:17 GMT
Your post is very interesting Clare. You've highlighted a major challenge to research within psychotherapy that I didn't highlight and that's the complexity of the therapeutic alliance. As you point out, the many dimensions of the therapeutic relationship are difficult to measure and therefore difficult to replicate. Mearns, Thorne and McLeod (2013) also make this argument in relation to research into person-centred counselling:
'[...] from a research perspective, the study of the process of therapy presents a number of significant challenges. A major area of challenge is associated with the complexity of the therapy process: the interaction between client and counsellor involves multiple levels of cognitive, emotional and behavioural interaction. Some of these dimensions of process are accessible to the conscious awareness of the client or counsellor, while other facets of the process are outside awareness.' (p192)
This complexity can also make it challenging to choose an appropriate research methodology: ‘There exists a variety of different ways in which the effectiveness of counselling can be evaluated. […] Each of these methodologies has its own distinct advantages and disadvantages.’ (ibid pp187-8)
Mearns, Thorne and McLeod (2013) go as far as to assert that:
‘On balance, it is probably reasonable to conclude that the core conditions hypothesis, taken as a whole, is too complex to be properly tested through the research methodologies that are currently available.’ (p183)
Mearns, D, Thorne, B and McLeod, J (2013) 'Person-Centred Counselling in Action' Sage, London [ed. Dryden, W]
|
|
|
|
Post by clarem on Oct 8, 2015 10:54:43 GMT
Hi Maddie,
Thank you for your reply.
There has been over 30 years of research into the therapeutic alliance and outcome but all with limitations, it is indeed complex and challenging.
'The study of the therapeutic alliance in modern fashion requires a maintaining a balanced focus on theoretical, empirical, and clinical issues and the balance of using sophisticated statistical analysis and to perform research that can inform clinicians in their clinical practise'(Omar 2014. p325)
This is an important point made, to compete with other interventions there is need for significant statistical data to highlighting significant differences which can be presented and accepted by NICE. The complexity of the therapeutic alliance combined with psychotherapy combined with Hypnosis? How would all this be statistically measured accurately?
Omar G et al. 2014. Psychotherapy Research: Foundations, Process and Outcome. Springer. London
|
|
|
|
Post by ashman on Oct 14, 2015 10:33:16 GMT
As Clare said in her post above this answer to some extent is an iteration of what both Maddie and Clare have said already. Some of the common research challenges that are encountered in primary research are the following: Research bias is a challenge in primary research, the researcher of course brings their own bias to the study which can be in how they ask questions, how they take notes and how the data is interpreted. Reported and actual behaviour sometimes differ. The research participants may actually give feedback that is bias, they may say what they think is more socially acceptable or expected of them which obviously skews the accuracy of the research findings. Overgeneralisation of results leading to failures to recognise generalisations in the primary research as patterns or trends that may change. Confusing correlation with causation. Interpreting and understanding a pattern in the research as being the cause of another, and example would be eating chocolate on Monday and having acne on weds, it would be easy to say the cause of the acne on weds was the chocolate on Monday however the participants elevated stress levels throughout Monday and Tuesday were not taken into account and so stress as a factor was not even considered in the study. References: study.com/academy/lesson/primary-secondary-research-definition-differences-methods.html www.slideshare.net/mobile/Mfaume/primary-and-secondary-datawww.knowthis.com/data-collection-primary-research-methods/primary-researchdisadvantages |
|
|
|
Post by Maddie1 on Oct 15, 2015 2:00:50 GMT
Hi Ashman,
You make a very interesting point about the bias that might occur from research participants giving feedback that they feel is expected of them. I will go away and try to find out about how researchers attempt to prevent this bias.
I also like your point about confusing correlation with causation. I think that is why it is important for as much research as possible to be undertaken in the field of psychotherapy. A different team of researchers undertaking research into the same subject might utilise a different research method which would yield different results to challenge the first set of a results. Using your example of the cause of acne, if a second research study is undertaken into this utilising a qualitative interview based approach where participants are encouraged to provide detailed accounts of what occurred in their lives between Monday and Wednesday, it is possible that the stress factor that was missed in the first research study may be highlighted in the second research study. I think this also points to the idea that generalisations or firm conclusions ideally are not be made from one research study alone.
|
|
|
|
Post by Maddie1 on Oct 15, 2015 2:14:55 GMT
I've been reading a little more about research methods in psychotherapy and I have uncovered a couple of other challenges related to conducting primary research which I think it is worth raising. These are challenges that need to be considered when psychotherapeutic research is conducted using case studies. The first of these is about confidentiality. McLeod, Thurston & McLeod (2015) point out that '[...] in a case report, even if the age, occupation and gender of the client are altered, the basic life story remains. It is usually possible to anonymise case studies so that general readers will not be able to identify the subject of a case, but it is virtually impossible to write up a case in a way that will prevent friends and family members from realising who is being described.' (202-3). The second of these is made by the same authors who state that 'As well as the issue of confidentiality, it is possible that a client may be disturbed by reading what a researcher, or their therapist, has written about them, even when they have given their consent for their case to be analysed.' (ibid, 203). Given that case studies are one of the most straightforward ways in which I, as a 'lone' practitioner, may be able to conduct research, I feel that these particular challenges are very relevant and need careful consideration.
Reference:
McLeod, Thurston & McLeod (2015) in Vossler, A and Moller, N (2015) ‘The Counselling and Psychotherapy Research Handbook’ Sage, London
|
|
|
|
Post by Maddie1 on Oct 15, 2015 20:18:04 GMT
Just following up again on Ashman's point about the potential issue of research participants providing the feedback that they feel is expected of them rather than their genuine feedback, I have just read a really interesting case study called 'Transactional Analysis Psychotherapy for a Case of Mixed Anxiety & Depression: A Pragmatic Adjudicated Case Study – ‘Alastair’' (conducted by Widdowson, 2014) which highlighted one way of attempting to ensure this bias does not alter research results. That is the use of 'Elliott’s (2002) non-therapy explanations for change' (Widdowson, 2014, 73). Elliott (2002) set out eight criteria for consideration when evaluating and critiquing psychotherapy research. Number three is relevant here: '3. Relational artefacts: apparent changes are superficial attempts to please the researcher or therapist.' (McLeod, 2010, 144) In Widdowson's research, an adjudicated case study method was used whereby a judge and a team of analysts assessed whether they believed this bias to have existed or not. In that particular case, they concluded that number three of Elliott's non-therapy explanations for change was not relevant and the changes made by the client were genuine. It's interesting to see how this potential bias has been recognised in Elliott's theory and then guarded against in practice in a real example of psychotherapeutic research. McLeod, J (2010) 'Case Study Research in Counselling and Psychotherapy' Sage, Los Angeles, London, New Dehli, Singapore, Washington DC Widdowson, M (2014) 'Transactional Analysis Psychotherapy for a Case of Mixed Anxiety & Depression: A Pragmatic Adjudicated Case Study – ‘Alastair’' in International Journal of Transactional Analysis Research Vol 5 No 2, July 2014 [accessed at usir.salford.ac.uk/32036/1/IJTAR_5_2_Widdowson._Alastair._pdf.pdf on 15/10/15] |
|
