On Learning from the Client: Coming to Grips with Research

By Gerry Myers

Communicating With The Outer World

I spent over a decade as a member of a religious order involved in youth-work and education. The order, at that time (and things have changed since), was involved in a type of happy amateurism which would have been more suited to the Victorian era, when some great adventures were undertaken with not much more than enthusiasm. In my time with the order we were hands-on people, whose practice was justified solely on the basis that what we did worked in a moderately effective way. In particular, we never really came out of our ghetto to communicate with others involved in the fields of education and youthwork. I’m not saying that we didn’t do good work at that time, we certainly did! But it was never more than average in its effect­iveness, and it was always very insular. When I moved out of religious life and into the world of psychotherapy I was disappointed to find that things were not much different there! Not unlike religion, therapy has its gurus (“I trained under Prof. Emmy van Deurzen-Smith in London myself”), and ther­apists operate in a frequently esoteric world where one form of therapy develops a different language from the next, and where we have a tendency to give great loyalty to our own “school”. We tend to live in a world where we differentiate ourselves as psychotherapists from counsellors, clinical psychol­ogists, psychiatrists, social workers, educational psychologists etc. Above all we seem to be immersed in a happy amateurism, content to know that we are moderately effective in what we do. If we could be truly happy to leave it at that all would be well. However, we refuse to stay in our box because:

a)  we want to genuinely improve and challenge our practice
b)  we want to be recognised as professionals.

My own journey out of the insular box of psychotherapy was not chosen, it was forced on me. Shortly after I signed up for an MA in Counselling Psychology, it went through a change and became the M.A. in Psycho­therapy, validated by City University in London.

Now City has a strong psychology department and, very sensibly, they insisted that clinical research become a core part of any M.A. or Ph.D. dissertation presented by Regents College trainees. As a consequence, disser­tations acquired a hard-edge and a sharp method, and qualitative research became a much-consulted category in the library. The truth is that psychotherapy seems to need that “outside” pressure in order to motivate us to engage in research. When we do engage in research, it is usually to look at either of two key fields of concern:

“The first has focused on the question regarding the scientific nature of therapy while the second, more common, concern, concentrating on outcome studies, has studied the effects …. of therapeutic interventions” (Spinelli, 1994 : 66).

My own belief is that, left to our own devices, we might not get involved in research at all, either to improve out practice, or to examine our outcomes. Certainly, in my case, the psychologists in City University had a major role to play in my research activity.

First Steps in Research

Out of necessity created by City University’s research bias, I decided to in­clude some qualitative research in my M.A. dissertation. I chose to research the mystical aspect of experience. As I designed the research project, it never occurred to me that I could investigate the mystical experience of my own clients. My own tendency had been to put research, and my own therapeutic practice, into separate boxes. Again it took someone trained in clinical psychology to help me to see that one can do very useful research on her or his own practice. My psychologist friend challenged me to see that, if my research was well constructed, it would be valid and useful to integrate it into my therapy process with clients. In responding to my friend’s challenge I began to look around for a way of doing research, which would allow me to learn directly about my practice with my own clients. Clearly, this ghetto-ised psychotherapist was knocked out of his insular box by the helpful challenges of psychologists.

For my own part I didn’t know the first thing about qualitative research, but I knew enough about quantitative research to know that it wasn’t for me. My training programme in London had not included any formal instruction in research. Apart from some of my trainers advocating it, they did not provide specific guidance as to how to “get-into” it. I would suggest that one of the criticisms which can be levelled at many training programmes is their poor attention to training in research. It would be fair to say that training programmes are often more concerned with passing on their orthodoxy (the understandings and practices of their “school”), than they are in providing their trainees with the attitudes and skills necessary to ask critical questions of psychotherapy itself.

One of the things I hope to see in the future is the inclusion of a research module in all therapy training programmes. One can reasonably expect that the university-based training programmes will increasingly feature a re­search element. However, in Ireland, the vast bulk of training is undertaken in non-academic settings, and the risk is that Irish trainees might be de­prived of research training.

Barkham (1990) talks of two key focuses for research in psychotherapy; he talks of outcome research, but also of “process” research in which psycho-therapy processes are put under the spotlight. I myself would like to suggest a third focus for research, and that is pure research of people’s experience in its various aspects. Rowan (1992) indicates that if we are to engage in pure research of people’s experience a new paradigm of research is needed.

When therapists think of research, they frequently associate it with large-scale sociological surveys, packed with statistics. It must be said that quantita­tively based research can be invaluable in relation to psychotherapy, indeed much outcome research tends to be quantitatively based. However, humanistic and integrative psychotherapy is largely experience-based, and non-quantitative research methods have been developed which are well geared towards exploring human experience. Qualitative research is the broad name given to this type of research, and I have used it myself to research aspects of the experience of my clients.

A suitable resource for research methods generally is Crabtree and Miller’s Doing Qualitative Research (1992), in which five research styles are presented. The advantage of Crabtree and Miller’s book is that it makes research styles accessible. Anyone wanting to research qualitative aspects of experience could usefully consult Valle and Mailing’s Existential-Phenominological Perspectives in Psychology (1989), which provides full worked examples of how to research the phenomena of human experience.

For the psychotherapist thinking of undertaking research, the key question is “what would be useful for me to research?” The question that then arises is “how can I research it?” The issue to be researched can be anything from the esoteric to the practical, and the scope of the research can be anything from a major Ph.D. thesis, to something as simple as researching one person’s experi­ence of a particular issue. The style of research to be used can be quantitative or qualitative, and can be drawn from any one of several research styles.

An Example of a Research Project

I think it would be useful here to indicate how a research project might take shape. As I have said already, some years ago I felt that I would be interested in exploring the question of whether there was anything mystical in the experi­ence of the clients with whom I was working. Accordingly I set about design­ing a qualitative research project to investigate the issue. However, as I thought more about the subject, I realised that I also wanted to know how I handled, or could handle, the mystical dimension of experience in psychotherapy. With the help of a colleague I found a research method, from the qualitative approach, which was well suited to exploring the mystical in experience.

The particular method which I used was field research. The research in­volved my clients keeping journals over a one month period, while in therapy with me. The content of the journals was interpreted using seven very precise steps indicated in an article by Polkinghorne (1989) in Valle and Halling’s book. In the research I worked with the experience of just three clients. If that seems a small number, it is because field research is concerned with the richness of the information gained, rather than with gaining information from a large group of people (Polkinghorne, 1989). It must be said that three journals written over a month are indeed a rich source of information!

The definition of the mystical which I decided upon, for the purposes of the research, was that it was “the absolute/beyond limitation” aspect of living. I arrived at that definition with the help of some well chosen books on eastern and western mysticism. Having defined the mystical, I set about looking at the journals of my three clients to see if this mystical (absolute/beyond limitation) aspect of experience manifested itself. In order to interpret the mystical content of the journals, I applied the field research in the seven steps suggested by Polkinghorne. It is important to note that I enlisted the help of my clients in much of the interpretation process, so the project was truly about learning from my clients. I will now outline the steps.

Step 1

In the first step the text (which may be journals, transcripts of interviews, essays, etc.) is read through by the researcher in a general way to get the broad sense of the whole.

Step 2

In this step the researcher interacts with the text to divide it into self-contained units of psychological meaning. This is not quite as simple as it may seem for two reasons: 1) the researcher is looking at the text through a psychological filter, but the text may be written by someone who has a poor psychological vocabulary and, or, poor psychological insight, 2) the boundaries around meaning units are often not clear.

Step 3

Having divided the text into psychological meaning units, the researcher then rewrites (transforms) the text of each meaning unit in his or her own words, seeking to make explicit the psychological theme in the unit, and retaining its situated and concrete character.

Step 4

In this fourth step both the original meaning unit, and its transformation into psychological language, are looked at from the point of view of the issue being researched (in my case the mystical in experience) and they are asked to yield up their meaning under the scrutiny of a research method. The resulting transformation of the original text once again retains its situated context.

Step 5

In this step all the transformed meaning units from a particular text (say, one person’s journal) are gathered together and synthesised into a whole which adequately describes the meaning of the complete text. Here, what is non­essential is left out, so that only that which is being researched is included. Again in this stage the description is kept in a situated and concrete key. What results is a Situated Structural Description of the Experience (in my case, of the mystical).

Step 6

A sixth stage allows the researcher to develop a description of the experience under investigation which is not tied to the specifics of the situation, but which is trans-situational. It is not being claimed that this description will then have universal validity, but it will have a general validity for a wide range of people. The description of the experience which arises in this sixth step is no longer tightly situated, and is therefore a Non-situated Structural Description of the Experience. Step six is, in fact, the research finding in regard to the particular text under examination, which might be the journal of one person.

Step 7

Where several people are providing the raw data for the research, a seventh step is used in the research. There are two ways in which this last step can be applied. Firstly, all the previous six steps can be followed in regard to each person’s contribution, thus giving rise to several Non-Situated Descriptions of the Structure of the Experience. These can then be synthesised into a single General Description of the Structure of the Experience. Alternatively, all the transformed meaning units from each person’s contribution can be garnered together and synthesised into a whole, which will also be a General Description of the Structure of the Experience. For anyone hoping to integrate the research into their work with clients, the former approach works best, as it gives a research result which is closely tailored to each individual client who has participated in the project.

The Research Finding

The final steps of the procedure produced the research finding. Before I present the results of my own research, let me say that there was a lot of effort in­volved, as I had to interpret a great deal of text (some people write quite a lot of journal over a one month period!).

Based on my research into my client’s experience I found that the funda­mental uncertainty of life is an absolute and irreducible aspect of living, and as such is mystical. What that means is that when, for instance, a fellow passenger in a car crash is killed but you survive, or when your child becomes suddenly seriously ill, or when your wife leaves you out of the blue, you are encount­ering uncertainty as a fundamental and absolute aspect of human experience. It is in that sense that the experience of uncertainty can be described as a mystical experience.Having arrived at the field research conclusion as to the nature of the mystical in experience, I could have left it as a piece of pure research. Earlier in this article I did suggest that pure research of experience had a validity in its own right. However, I also said that research in psychotherapy tends to focus on outcome or process. I found myself drawn to asking myself how I would apply the field research finding in my psychotherapeutic practice. I work in what is best described as an existential-phenomenological way, which is heavily influenced by the German philosopher Martin Heidegger. I decided that I would see what Heidegger had to say about the mystical. After much trawling through existential philosophy I discovered that he saw people as having our ground in an abyss, which he called Being. Having such a mysterious and inscrutable ground, Heidegger felt that all we can do is adopt an attitude of letting-be when it comes to the things Being can throw our way. It is claimed that this attitude of letting-be, in regard to what Being does to us, is what constitutes the mystical in Heidegger (Caputo, 1986).

It occurred to me that there was a remarkable similarity between the mystical element of the experience of my clients (uncertainty), and the mystical element in the theory upon which my practice is based (i.e. Heidegger’s view that we are always in relationship with Being, who may do what it pleases with us). By ex­tending my research slightly I was able to see that my therapeutic practice needed to be adjusted, so as to provide space for my clients to “let-be” when they en­countered the fundamental uncertainty of life. The adjustment that was needed was one of attitude rather than technique, and it involved allowing myself to be-with my clients’ experience of life’s uncertainties, before attempting to move them on.

CONCLUSION

My purpose in presenting my own research is to highlight how even pure research of experience can contribute something useful to psychotherapeutic practise. My piece of research arose out of pursuing a personal interest, and that is often how research arises. Clearly the methods are available which allow us to research human experience, be it experience in its pure form, the experience of the client in therapy, or the experience of the therapist in the therapy. In presenting my own research I have shown how a major project might take shape. But, of course, smaller-scale projects can be very valuable. The important thing to take on board is that research methods are available which are easy to apply, even for the uninitiated. All that is really needed is a subject that the therapist wishes to research , and a willingness to put the time and effort into it. The benefit for therapy is that research moves us out of our insular world by helping us to talk with others, it challenges us to question what we do, and it helps us to learn from our clients. And, of course, when all training courses in Ireland include research modules, doing research will be easier.

Bibliography

Barkham, M., (1990), Research in Individual Therapy, in Dryden, W. (Ed.), Individual Therapy, A Handbook, Milton Keynes, Open University Press.

Caputo, J., (1986), The Mystical Element in Heidegger’s Thought, N.Y.: Fordham University Press.

Crabtree, B., & Miller, W., (1992), Doing Qualitative Research, London: Sage.

Polkinghorne, D., (1989), Phenomenological Research Methods, in Valle R., & Halling S. (Eds.) Existential-Phenomenological Perspectives in Psychology, London : Plenum.

Rowan, J., (1992), Response to K. Mair, in Dryden W., & Feltham, C, (Eds.), Psychotherapy and its Discontents, Milton Keynes: Open University Press.

Spinelli, E., (1994), Demystifying Therapy, London: Constable.

Valle R., & Hailing S., (Eds.) (1989), Exislential-Phenomenological Perspectives in Psychology, London : Plenum.