Doing Practice-Based Research in Therapy: A Reflexive Approach

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Sofie Bager-Charleson

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    About the Author

    Sofie Bager-Charleson is a psychotherapist, supervisor and writer. She draws from psychoanalytic, existential and cognitive behavioural theory with a particular interest in postmodern influences on therapy. She holds a PhD from Lund University in Sweden, where she specialised in attachment issues within families and reflective practice among teachers. She writes both fiction and non-fiction. She works as an academic adviser for psychotherapists on the work-based doctorate programme, DPsych with Metanoia/Middlesex University. She runs workshops and courses in therapeutic practice, reflective and creative writing, in both Sweden and England.

    Preface

    Learning how to use oneself creatively and effectively in the treatment process is an important aspect of psychotherapy. While emphasised in training for clinical practice, this level of self-awareness is often neglected in research about mental health. Research tends to be construed as something separate to ourselves and our daily lives; it is still commonly perceived as something which people in white coats do in laboratory-like circumstances. This book aims to demystify research, and will provide a step-by-step account with references to real-life research. The book links practical research skills to reflexivity. Reflexive awareness involves a deliberate attempt to position oneself as researcher in a linguistic, cultural, theoretical and personal context with potential biases and blind spots in mind. A significant feature for practice-based research is that it is situated in offices, hospitals and other real-life settings. It is never conducted in a vacuum; the purpose with practice-based research is often to include this ‘messiness’ of life. What is it like really to work in a ward with people suffering from dementia? What happens between staff and patients in their everyday meetings? What is it like to be staff, and to be a patient? How do the experiences differ between different individuals, and why?

    The practice-based researcher listens out to everything from the most basic experience, such as the experience of attending others to the toilet, to more complex, organisational concerns. By learning more about everyday experiences in wards, schools and the psychotherapists' consultation rooms, the practice-based researcher hopes to contribute with a holistic approach to improvements. The way that practice-based researchers approach clients or patients in the context of different relationships and systems is carried through into the way they position themselves in their research. Their relationship with the research participants will be referred to as a significant conduit for the outcome. We will look at examples of how researchers pay careful attention both with regard to how their participants and interviewees perceive them, but also how they themselves are impacted by their participants. Seemingly small and mundane reactions, responses and findings are often attended to as significant features of the study. The impact that researchers and research participants may have on each other is, just like in therapeutic practice, carefully considered and assumed to impact the interviews, data analysis and general outcome of the study. The layout of the book runs as follows:

    In Chapter 1, some key characteristics of practitioner research are explored. We will look at the role research may play in our everyday life and practice, for instance with reference to overlaps and differences between ‘private’ and ‘public’ research. The researcher as a person is at the forefront of Chapter 2. We will look at how prior personal and professional experiences may be integrated in our practice and research, for instance with regard to our choice of theory as well as our emotional responses to new situations. Methodological approaches play a crucial role in the layout and the outcome of our studies. We will look at the difference between quantitative and qualitative research, and also explore options for combining the two. In Chapter 3, Jean-Marc Dewaele and Beverley Costa illustrate this combination, and write about how mixed-methods became their chosen approach. Randomised controlled trials, systemic reviews and meta-analysis are some of the frequently used terms in today's research about therapy. In Chapter 4 we will look closer into these concepts. Evidence-based research will be explored in more depth, and we will focus on the meaning and implications of a hierarchy of trustworthiness, with objectivity as an overarching aim. Chapter 5 focuses on how to identify and articulate the research question. We will look at several different real-life examples and you will be encouraged to formulate a research question of your own. In Chapter 6, Simon du Plock writes about ‘doing’ a literature review and about how to critically engage with literature and research in your field. Chapter 7 revolves around the ethical dimensions of research. The relationship between the researcher and research participants is typically close in practice-based research. These relationships will need to be carefully negotiated. We will explore some of the key differences and overlaps between research relationships and therapeutic relationships, and examine how we can prepare for the personal change and growth which both types of relationship tend to involve. The chapter includes examples of how to write research invitations and consent forms. Chapter 8 pursues the focus on the relationship and its impact on the researcher and their research participants. We will look at examples where researchers consider their emotional responses with care, and take into account how their responses will impact on the way they meet, listen to and relate to their research participants. Emotional and unconscious processes will be explored in the context of reflective practice, and will be linked to the difference between espoused theory (the theory we are committed to) and our actual theory in action. Chapter 9 revolves around the way that our epistemological stance may impact on the study. We will particularly explore the difference between realism, idealism and postmodern critique, and focus on the different approaches of subjectivity and objectivity in research. Chapter 10 explores the meaning(s) of reflexivity. Practice-based research is never conducted in a vacuum. Underlying personal and cultural expectations, values and beliefs held by both the researcher and research participants are inevitable aspects of research conducted in real-life settings. In this chapter reflexivity is considered as ways of incorporating implicit, explicit, conscious and unconscious aspects of the research process without losing sight of scientific ‘rigor’. Particular attention will be paid to what Finlay and Gough (2003) refer to as ‘five variants’ of reflexivity. Chapter 11 looks at examples of research where reflexivity on introspection is adopted, for instance with reference to real-life examples of heuristic and autoethnographic research. Chapter 12 looks at research where reflexivity focuses on intersubjective processes and reflections, for instance with reference to psychoanalytic research which puts transference, countertransference and ‘unconscious’ processes to the forefront. Chapter 13 provides examples of research characterised by an emphasis on collaboration. For instance, we will look at real-life examples of co-operative inquiry into school-based therapy in socially deprived areas, and with reference to the role of black issues in counselling training. The chapter includes examples of how to invite people to join co-operative inquiry groups. Finally, in Chapter 14, Simon du Plock writes about the impacts of research and about ways of communicating our research findings with the outside world. Chapter 15 offers some concluding remarks and reflections about the overall content of the book.

    Acknowledgements

    This book would never have been written without the contributors listed below. I am particularly grateful to Simon du Plock, who has contributed two chapters to this book. Simon is the Director of the Centre for Practice-Based Research and Head of the Post-Qualification Doctorates Department at the Metanoia Institute, London. His experiences from practice-based research have been invaluable.

    I am also immensely grateful to Beverley and Jean-Marc for their contributions about research that is so close to my heart, and for their invaluable support at a vulnerable stage of the writing process. I am pleased to congratulate them for recently being awarded the BACP Equality and Diversity Award for their research. Jean-Marc Dewaele is Professor of Applied Linguistics and Multilingualism at Birkbeck, University of London. He researches individual differences in psycholinguistic, sociolinguistic, pragmatic, psychological and emotional aspects of Second Language Acquisition and Multilingualism. Dr Beverley Costa is a psychotherapist and the founder of Mothertongue, a multi-ethnic counselling service. She has been its director from its establishment in 2000 until the present day. Mothertongue provides a professional culturally and linguistically sensitive counselling service to people from the black and minority ethnic communities in their preferred language.

    Another exceptionally inspirational friend and contributor is Dr Marie Adams. She is a psychotherapist, writer and works at the Metanoia Institute as a trainer. Marie's book, based on her research into the private lives of therapists, will be published later on this year. Thank you, too, to Dr Stephen Adams-Langley. He has worked in the voluntary sector for thirty years promoting the mental health of children and young people. His kindness, resilience and knowledge have found a home in school-based mental health programmes targeting hard-to-reach children who have been exposed to multiple risk factors for many years. Stephen has worked as a regional manager at Place2Be for sixteen years. Dr Alan Priest is another friend I want to thank. In this book, Alan shares examples from his innovative doctoral research about the relationship between change in clients' pronoun usage and outcomes in therapy. His study describes the impact of inviting clients to clients' ‘own’ experiences and emphasises how such interventions should be used with care.

    I am grateful to Dr Anne Atkinson, who generously shares her valuable insights into the research process. Anne is a psychotherapist who originally carried out anthropological research. As a psychoanalytic psychotherapist with an insatiable spirit of inquiry, her research developed in new directions, as shown in this book. I am also immensely grateful to Dr Maxine Daniels, who has contributed for a second time to one of my books. Maxine brings fascinating insights into reflexivity in emotionally charged research settings. Maxine works as National Trainer with criminal justice agencies and as a Consultant and Supervisor in medium secure hospitals. Pamela Stewart has also contributed with invaluable insights and experiences. Her reflective infant-observations research in prison for the Tavistock Institute is referred to at several stages of this book. Pamela has worked in a Philadelphia Association therapeutic community and continues to work as a psychotherapist and supervisor in prisons as well as in private practice. Thank you, too, to Stella Gould, who works as a forensic psychotherapist with the Psychological Intelligence Foundation and who generously shares her experience of ethical procedures in difficult settings. Dr Melanie Jo Hopkins Womble also works as a psychotherapist in forensic settings. She recently completed her doctorate in Psychotherapy from Metanoia Institute which focused on ‘staff experience of hope’ with a view to developing the Forensic Recovery Model. Dr Claire Asherson Bartram is another former Metanoia student whose contribution is greatly appreciated. Claire works as Gestalt psychotherapist and group leader. Her doctoral project ‘Narratives of mothers in stepfamily situations’ interweaves her story as a mother with those of the women she interviewed. Thank you, too, to Dr Roz D'Ombraine Hewitt, who is a psychotherapist and trainer. Her experience of working in a psychiatric hospital inspired her first book, Moving On: A Guide to Good Health and Recovery for People with a Diagnosis of Schizophrenia (2007), and her doctoral research. Guy Harrison contributes with insightful reflections about methodology. Guy is a psychotherapist and an Anglican priest. He has worked for sixteen years at a senior level as a healthcare chaplain and counsellor within hospice, acute care and mental healthcare contexts. Dr Lynne Souter-Anderson shares her fascinating research journey, regarding her interest in the use of clay, arts and sand in therapy. She is the Director of the Bridging Creative Therapies Consultancy and offers workshops to all levels of practitioners nationally and internationally. Rupert King is currently undertaking a DPsych at Metanoia Institute and shares insightful reflections on the research process. He works as an existential psychotherapist in private practice and has taught on a number of Post-Graduate Diploma courses. I am also extremely grateful to Dr Isha Mckenzie-Mavinga, who contributes with so many important angles to contemporary research. Isha works as an integrative transcultural psychotherapist. She also lectures, supervises and has published several papers from her doctoral study on the process of understanding ‘black issues’ in counsellor training and practice.

    I would like to thank Laura Walmsley, Kate Wharton, Luke Block and Alice Oven from Sage, for being so brilliant to work with. Thank you also to Mandy Kersey, our coordinator at Metanoia, for being such a kind and considerate friend.

    Finally, I want to give a special thank-you to our children, Fina, Finbar and Leo. They have contributed to everything, from their kindness and inspiration to providing practical help. Fina contributed with editorial assistance and Finbar made abstract concepts digestible through graphics. Leo was there when I fell ill from a prolapsed disc in the neck during the project. I shall never forget! I also want to thank my husband Dermot for being my soul mate and for dancing with me in the office when my back injury threatened to return! Thank you, too, to my mother, Anna-Lena Bager, for always being so encouraging and supportive.

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