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Embracing the Art and Science of Counselling
and Psychotherapy in Research
https://onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)1746-1405.Art-
Science-Counselling-Research
First published: 12 July 2022
Last updated: 12 July 2022
Editorial by Sofie Bager-Charleson and Terry Hanley
This virtual Research Methods edition of
Counselling and Psychotherapy Research
invites
readers to consider and discuss the issue of therapist-researchers’ ‘epistemological
home(s)’.
What do we hold as ‘true’ and how do we generate knowledge about that?
Therapy
research has evolved in a multitude of directions since Freud’s case study research. It is
multifaceted and an ever-developing field, frequently positioned between art and science.
As such, right from its conception, the CPR journal has adopted a broad view on research. It
supports therapists to develop as researchers in a space between art and science where
embodied, emotional and socio-cultural sources of knowledge are combined with evidence-
based, scientific interests.
John McLeod, in the first edition of the journal noted that the CPR aimed “to demystify
research and inquiry, to realign research and practice, and basically to make it interesting
and relevant” (McLeod, 2006, p.10). True to this aim, we note how at the time of us starting
this issue in spring 2022, the content of CPR covers a broad range of topics including
therapy and humour, the use of intuition, consideration of environmental concerns and the
consequences of working with facial masks in response to the pandemic. Methodologically,
it covers both quantitative and qualitative research approaches ranging from
phenomenology, grounded theory, narrative research to cross-sectional and outcome
research-based studies
Being positioned between art and science can be both an asset and a hindrance. Some of
our own studies into ‘therapists as research-informed practitioners’ highlighted, for
instance, a sense of ‘homelessness’ and lack of belonging among other disciplines. One of
the doctoral research students in our research (Bager-Charleson, 2021) said for instance:
“When I think of research, I associate it with feeling lonely, the largest upset is to not find
research which reflects what I work with. Being a psychotherapist can feel like being a
second-class citizen in the NHS. Cognitive, neuro, biological, outcome measures – there’s a
whole bunch of people I can contact and speak to. But I’m not working within those
approaches … I struggle with the idea that emotions are measurable”
(Bager-Charleson &
McBeath 2021,
p.556).
References are often made to a strained relationship between psychotherapy research and
psychotherapy practice, with therapists mentioning that they feel like they are at the
margins of the research community. Our studies conducted under the umbrella of
Therapists as Research-informed Practitioners (see
more: https://metanoia.ac.uk/research/research-groups-events/therapists-as-research-
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informed-practitioners-trp/ ) included a literature review (Bager-Charleson& McBeath 2021)
which suggested that:
• Therapists’ research typically stems from an unstructured integration of knowledge
gained from workshops, books, and theoretical articles
• Their research knowledge is often ‘patchy’ with in-depth knowledge being associated
to areas of personal interest
• Therapists build more on clinical experience, supervision, personal therapy, and
literature rather than on research findings
The CPR journal resonates with therapists’ grappling with the importance of developing
an evidence-based practice whilst keeping emotional, embodied, and socio-cultural sources
of knowledge in mind. This means straddling interests ranging from an idiographic focus on
the individual, for instance in terms of shifting embodied, intuitive, and emotional
understandings, to hypothesis testing, objective, and nomothetic foci on commonalities
modes of explanations.
Psychotherapists are always researching
Psychotherapists are natural investigators, always exploring, tracing and considering
underlying meanings – it is what we do. Each therapeutic modality offers ‘a set of
assumptions and principles about the nature and sources of psychological problems, and
about approaches and interventions to address them’ (Stiles 2007, p.123). None of the
modalities covers exact descriptions for moment-to-moment interventions, and therapists
need to regularly interpret and adapt to events. In an CPR article about ‘theory-building case
study’ Stiles (2007) approaches the previously mentioned case studies of Freud from new
angles. Interested in how clinical experience can be accumulated and shared, Stiles’ model
focuses on how empirical observations of case material can lead to amendments and
elaborations of theory on a daily basis. His model has been applied in numerous settings
since then, for instance with contemporary focus on online and avatar-based therapy (Van
Rijn et al 2019).
Moving beyond divisive research ‘chasms’
Counselling and Psychotherapy Research has evolved within an incredibly complex
landscape. It has published work that is methodologically varied and, rather than excluding
research due to their design, places value on overarching assessments of the originality,
rigour and significance of the work. It has included work from exemplary quantitative
researchers, qualitative research pioneers and ground-breaking mixed methodologists. In
the sections that follow, we outline some of the papers that we believe have proven
influential in the development of the profession – chosen with the wide span from art to
science in mind and suggesting that psychotherapy research benefits from a dialogue
between both viewpoints. In doing so, we resonate with other pluralistically inspired
disciplines like Sui and DeLyser’s (2012) who, within human geography, refer to unhelpful
‘divisiveness’ when exploring multi-layered aspects of our existence. Sui and DeLyser
suggest that for multifaceted disciplines ‘to develop and survive [they need] move beyond
the qualitative-quantitative [divisive] chasm between scientific and humanistic knowledge’
(p.111).
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The Counselling and Psychotherapy Research as a Scientist
Science is a complex phenomenon to define. Within the realm of counselling and
psychotherapy, the dominant discourse in decision making has historically been weighted
towards perspectives that value quantitative research with a more positivistic outlook on
the world. This thinking is often framed around common understandings of pathology and
prizes the reduction in the symptoms associated with these definitions. Most notably, we
can see this view influencing the choices of advisory bodies such as the National Institute for
Health and Care Excellence (NICE), with the hierarchies of evidence being strongly weighted
towards randomised control trials (Sackett et al 2000). Running parallel to this view, has
been the steadily growing opinion that, when assessing the counselling professions value,
such a reductive perspective is not always helpful. Indeed, pioneers of the counselling and
psychotherapy would such as Carl Rogers, started to question whether positivist science
were doing the disciplines justice (Rogers 1961). Such work has led to strong critiques of the
purist positivist perspectives as a means to evaluating the role of therapy in peoples’ lives,
both questioning whether the ‘gold standard’ RCT method is indeed outdated (Cartwright,
2007) and proposing alternative perspectives (e.g. Rennie, 1994). Resonating with this,
Barkham et al (2017, p.257), in a previous virtual edition of CPR, conclude that how it ‘within
the counselling and psychotherapy outcomes literature [has been] long-standing debate
regarding what counts as evidence’.
Valuing numbers in Counselling and Psychotherapy Research
To start with, we would like to emphasise the value of Michael Barkham’s contributions
in the field of research into ‘evidence’. Barkham’s CPR articles have indeed already been
selected for a virtual issue about the meaning of ‘best available evidence’ and we
recommend the readers to revisit that for an in-depths discussion around psychotherapy
research in context of NICE guidelines and understandings of
‘evidence’. https://onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)1746-1405.depression. The
editors of that special issue (Duncan & Smith-Lilley, 2021), highlight the broad view of
‘evidence’ taken in CPR as they assert that ‘
whilst we support conducting RCTs and can see
value in the data generated from them, they’re only part of picture and we are
fundamentally committed to ensuring that other types of evidence are recognised and
valued; including data from real world practice’
(Duncan & Smith-Lilley 2021).
CPR provides an important home for practice-based evidence. Gibbard and Hanley (2008)
made use of five years of real-world routine evaluation data to demonstrate the value of
person-centred therapy in primary care settings. Cooper (2009) also shared research which
summarised the audit and evaluation data from school-based counselling services in the
UK, developing arguments for increasing such provision going forward. Whilst other
countries in the United Kingdom have worked to ensure school-based counselling is
provided in every school, this has yet to happen in those in England. It was therefore
positive to see Cooper’s work being used to argue its case in the Government document
‘Counselling in Schools: a blueprint for the future (Department of Education, 2015).
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Further examples of recent contributors now running with the baton to develop ‘good
evidence’ are Schiepek et al (2022) who expand on the challenge of ‘how to measure
outcome' with 'a perspective from the dynamic complex systems approach’. Schiepek et
al write about evaluation and assessment of outcome as crucial for psychotherapy research
and practice, suggesting how the focus on optimising mental health care is ‘hampered by
limitations’ which includes ‘the predominant use of standard questionnaires neglecting
personalised outcome criteria’. They suggest new means of data collection in the ‘real-life
setting of patients’ by focusing on “the real-world settings of patients for experiences in the
clients’ ecosystems”.
Finally, on the quantitative front, we would like to highlight the CPR publication focusing
upon the development of the Person-Centred and Experiential Psychotherapy Scale (PCEPS)
(Friere, Elliott & Westwell, 2013). This scale has provided an important scale to review
person-centred therapeutic practice. Since its development, it has been used as a training
tool on numerous courses and a means to assessing the fidelity of work delivered in
randomised control trials. In recent years, this has also led to the develop a version of the
scale for work with young people (Ryan et al, 2021). Such tools prove important
developments in the field as a whole.
Focusing on meaning-makings and experience in Counselling and Psychotherapy Research
Qualitative research has always been well represented in the CPR, providing platforms
for innovative, creative trail-blazers like Jane Speedy (2006) Les Tordes (2003) and Kim
Etherington. The journal covers a broad range of approaches including phenomenology, IPA,
heuristic research, narrative inquiry, discourse analysis and grounded theory– ranging from
more ‘pure’ use of approaches such as in Atiyeh and Gray’s (2021) interesting constructivist
grounded theory study about 'counsellors’ competency to counsel refugees, to pluralist
studies challenging both the meaning of ‘evidence’ and methodological orthodoxy such as in
Omylinska-Thurston et al’s (2021) article titled ‘Arts for the Blues: The development of a new
evidence-based creative group psychotherapy for depression’.
Multi-layered meanings to what we call ‘reality’
Qualitative research often turn our attention to the multi-layered meanings to which we
define ‘being in the world’ and ‘reality’. Charura and Lago (2020) and Charura and Wicaksono
(2022, in press) use the term ‘decolonising research’ for when subjugated and not usually
expressed (sometimes earlier dominated or 'colonised') meanings and experienced aspects
of 'reality' are being put to the forefront - as part of a critical engagement with ontological
and epistemological positionings in counselling, psychotherapy and psychology research
design. In the June issue, 2022 - and as we complete this review, CPR resonates with these
values for instance through articles about ‘effects of a reflective cultural audit intervention
on multicultural and social justice counselling competencies of counselling students’ (Kim et
al, 2022) and about ‘cisgender therapists' attitudes towards, and experience of, working with
trans people in the United Kingdom’ (Mollitt 2022). The emphasis is compounded through
the excellent virtual issue titled 'the core role and responsibility of counselling practice and
research in addressing race and ethnicity issues’ which we direct the reader to, via this link
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https://onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)9999-0009.counselling-practice-
ethnicity-issues
The issue is a joint production between the CPR and the Journal of Multicultural Counseling
and Development (JMCD), guided by commitment to ‘address race and ethnicity to our core
ethos and strategy’ (Adkison-Johnson & Vostanis 2022).
Reflexivity
Qualitative research typically regards experiences as contextual, which puts the researcher’s
own involvement in the study to the forefront. Reflexivity is a key-concept for most
qualitative researchers when discussing how researchers’ may incorporate own experiences
coupled with critical self-awareness as part of the findings (Levitt et al, 2018). With this in
mind, Kim Etherington represents another example of a ‘beacon’ which the CPR has
provided a platform for. Having paved the way for reflexivity in counselling and
psychotherapy research, Etherington revisits some of her key concepts in Wyatt and
Wright’s (2017) CPR special section about reflexivity and the use of personal experience in
research. In her article entitled Personal experience and critical reflexivity in counselling and
psychotherapy research (Etherington 2017), Etherington addresses the
‘value of critical
reflexivity as a means for including ourselves and our personal experiences in counselling
and psychotherapy research through examples of (a) reflexively contextualising ourselves
and our participants, (b) reflexively co-constructing knowledge and meaning making and (c)
a critically reflexive approach to addressing issues of voice in research by highlighting a
potential dilemma about choosing which stories should be told
’(p.85).
Some further illustrations, from the same special section (Wright & Wyatt 2017) are
articles by Bondi et al (2017). In their article titled “Getting personal: A feminist argument for
research aligned to therapeutic practice”, they write:
“
Students and practitioners tend to assume that research requires them to set aside their
embodied knowledge of practice and to produce radically different, objective, and
depersonalised forms of knowledge. Troubled by these assumptions and coming from
backgrounds within the humanities and social sciences shaped by critiques of this model of
research, we offer personal stories through which to articulate and argue for a very different
approach” (p.113)
In a similar vein Gabriel et al (2017) , offer a methodological paper titled “Reflexive
research with mothers and children victims of domestic violence”. It described ‘a
participatory and reflexive research approach’ in the format of an ‘in-depth, small-scale and
preliminary qualitative research conversations with a vulnerable population’. A final
example is our article titled ‘Embodied situatedness in research’ (Bager-Charleson & Kasap,
2017) which explores dimensions in research when considering a ‘felt’ sense rather than just
a ‘thought’ sense, with personal biographical, theoretical and socio-cultural aspects of the
researcher during data analysis in mind.
The Pluralist Counselling and Psychotherapy Researcher
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Qualitative and quantitative research approaches bring different paradigmatic viewpoints,
guided by different ontological and epistemologically positioned questions into mental
health, emotional wellbeing and psychotherapy (Hanley & Winter, 2016). To our mind, the
CPR supports a dialogue between different interests, allowing for ‘methodological integrity’
but supporting a dialogue and what Johnson (2017) might call a ‘dialectical pluralism’ where
each approach aims to learn from the other with a new ‘synthesis’ of understandings in
mind. Some examples of this can be found in the earlier mentioned ‘arts for blues’ study
(Omylinska-Thurston et al 2020), but also in Kramer and Timulak’s special CPR section
(2020) about ‘innovative, cutting-edge methods …with the potential to shape counselling and
psychotherapy research into the future’. [insert reference] Their special section titled
‘Innovative counselling and psychotherapy research methods’: Defining the future of
counselling and psychotherapy research’ includes both qualitative and quantitative research
papers. In this section, Howe et al (2020) offers examples of how to negotiate the
traditionally conflicting principles in qualitative and quantitative research by suggesting
means of combining idiographic and nomothetic interests. Howe et al (2020) write about
‘Idiographic network analysis of discrete mood states prior to treatment’ (p.470) Instead of
generating nomothetic information to compare individuals, for instance through cross-
sectional data sets, Howe et al (2020) suggest the use of ‘idiographic network models’ to
‘explore relationships among symptoms and behaviours as they unfold in an individual
participant's time series’. Another contribution in this special section concerns the
‘methodological integrity in counselling and psychotherapy research’. Levitt et al ,(2020)
expand on how in ‘counselling and psychotherapy research, qualitative methods have been
a longstanding tradition of inquiry due to the mutual interest of therapists and researchers
in both internal experiences and intersubjective processes’ (p. 442)
Some further examples of dialogues between quantitative and quantitative interests are
offered in one of our own earlier special section about mixed methods research (Bager-
Charleson, McBeath & Vostanis 2020). The integration of different approaches often involves
mixing quantitative and qualitative approaches, which is illustrated in the journal section,
but it can also involve the combining qualitative methods. O’Reilley et al (2020) contributed
to our section with an article titled “
Mixing qualitative methods versus methodologies: A
critical reflection on communication and power in inpatient care”.
Positioned in a UK
inpatient psychiatric hospital, O’Reilley et al (2020) refer to their aim to ‘extend the mixed-
methods evidence base beyond the traditional discussions of quantitative and qualitative
paradigms’. O’Reilley et al (2020)continue:
“
when two methods of data collection are integrated under a single methodological
approach has epistemological congruence. Where two methodologies are combined, they
are not mixed, rather they are synthesised after the quality indicators for both separate
approaches have been adhered to
” (p.74)
Returning to our point about beacons and trailblazers among CPR published authors, Braun
and Clarke are examples of researchers who have paved the way for others interested in
combining deep and broad knowledge. Their paper “
Can I use TA [Thematic Analysis]?
Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other
pattern-based qualitative analytic approaches”
(Braun and Clarke 2020) critically reflect
upon the broad range of ways that people have made use of thematic analytical
approaches. Finlay (2021) distinguishes helpfully between ‘scientifically descriptive’ and
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‘artfully interpretive’ ways of using Thematic analysis, highlighting its usefulness in what
often is regarded as conflicting approaches and paradigms. Braun and Clarke’s contribution
to research methodology is impressive. Apart from their flexible use of thematic analysis,
they provide innovative research options like the ‘story completion method’ and the so
impactful ‘qualitative survey’ which both illustrate how idiographic and nomothetic interests
can meet through respectful, mutual learning and adaptation of approaches. Qualitative
surveys aims to capture a diversity of perspectives, experiences, or sense-making without
treating individual respondents as ‘a spokesperson for their particular demographic or
background’ (Braun et al 2021, 556) as often happens in smaller samples of interview
research. The approach has been used broadly by other researchers for some time, ranging
from for instance Brown and Moller’s (2013) article about ‘recording therapy sessions: What
do clients and therapists really think?’ to later studies like McEvoy et als (2021) qualitative
survey study titled ‘rarely discussed but always present’: exploring therapists’ accounts of
the relationship between social class, mental health and therapy’.
Bringing ‘it all’ together
As we bring together our thoughts about ways that scientific and aesthetic knowing might
be understood within the constantly growing body of work in CPR, we acknowledge that
there are no simple answers regarding ‘epistemological home(s)’ for psychotherapy
research. What we regard as true and how we generate knowledge in that field is ever
developing, with psychotherapy requiring a dynamic perspective that focuses both on the
individual and their personal and sociology-political circumstances. Our openness and
sensitivity to these changes are crucial, and both qualitative and quantitative research play
important roles for our understandings. Further, it would be as wrong to assume that all
qualitative work is based on intuitive, aesthetic, and typically idiographic sources knowledge,
as assuming that all quantitative research is scientific. Some qualitative research is guided
by assumptions about ‘rigour’ aligned to positivistic philosophy and some quantitative work
truly embraces the importance of the analyst’s interpretation of the figures they are making
sense of. There is difference and, we would imagine, there should always be space for
difference because not every research question or context warrants the same response.
Fundamentally, we hope for a respectful dialogue – with mutual openness for learning from
the other, between these different perspectives. Original ideas can, in this sense, be
transformed into excellent research by designing projects that are rigorous in their
execution and that prove significant or impactful to the individuals as well as the
communities to whom they speak. Improving much needed research into mental health and
emotional wellbeing is paramount, and we suggest that the CPR journal plays a significant
role in this aim. As a final ‘beacon’ we chose the editor of the CPR, Professor Panos Vostanis,
for positioning the journal in a by now well known, international context. In his editorial for
the mentioned virtual issue about multiculturalism, Vostanis asserts that ‘counselling
publications have a major opportunity to promote knowledge transfer and exchange and,
crucially, a social responsibility to address inequality’. We believe that the journal meets
these aims, guided by its ongoing invite to new and old readers to engage in vibrant,
inspiring debates and development in therapy-related research on all levels.
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