Developments in Qualitative Psychotherapy Research

Del Loewenthal, Evrinomy Avdi, Del Loewenthal, Evrinomy Avdi

• Publisher: Taylor & Francis
• Year: 2018
• eBook ISBN: 9780429875045
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book examines developments in qualitative psychotherapeutic research. It focuses on different methods and aspects of clinical practice. Theserange from the experiences of service users and clinicians, examining in detail different aspects of how therapy gets done in practice, to critiquing the politics and ideologies of psychotherapy practice. It aims to reflect the diversity that characterises this developing field and to represent practice-based research carried out in different clinical settings, from different perspectives and in different sociocultural contexts.

The wide range of research projects presented arise from a network of clinicians and psychotherapy researchers who have established an international transdisciplinary forum for dedicated qualitative research on a range of topics in the field of mental health, using a variety of methodologies and theoretical approaches. In the spirit of dialogue, this book further provides chapters written by key practitioners in the field of qualitative research in mental health discussing these contributions.

This book was originally published as a special issue of the European Journal of Psychotherapy & Counselling.

Interventions in everyday lives: How clients use psychotherapy outside their sessions

Ole Dreier

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.

Psychotherapie hat zum Ziel, Probleme, die Klienten in ihrem Alltag begleiten und stören, aufzuzeigen und zu überwinden. Therapie kann deshalb nur gelingen, wenn Klienten die Erkenntnisse aus den Sitzungen in ihren Alltag integrieren, um mit ihren Problemen zurecht zu kommen. Eine differenzierte und systematische Forschung soll über die diversen Praktiken der Klienten außerhalb der Sitzungen Aufschluss geben. Ein allgemeines Forschungsdesign entlang explorativer Fallstudien wird hierzu in diesem Artikel vorgestellt. Die wesentlichen Ergebnisse einer solchen Studie im Rahmen der Familientherapie werden in allgemeinen Begriffen dargelegt. Sie zeigen, wie Praktiken innerhalb der Sitzungen und die Alltagspraktiken der Klienten aufeinander einwirken, wenn Klienten ihre Praktiken im Alltag ändern, um ihre Probleme zu überwinden. Sie streichen ebenfalls heraus, was es für die Klienten mit sich bringt, dies zu erreichen. Abschließend lässt sich sagen, dass mehr Forschung zum besseren Verständnis von Interventionen benötigt wird; zu den Wechselbeziehungen zwischen Intervention und dem Klientenverhalten im Alltag; zu Sitzungen als einem speziellen, „abgeschlossenen Teil” im täglichen Leben der Klienten, und, entsprechend, die Betrachtung der Sitzungen des Therapeuten in Bezug auf dessen Methodik und Verhalten.

El objetivo de la psicoterapia es ayudar a los clientes a enfrentar y resolver los problemas que les aquejan en sus vidas cotidianas, por lo tanto la psicoterapia puede funcionar solamente si los clientes la incluyen en el curso de su vida diaria. Se necesitan investigaciones sistemáticas y detalladas acerca de qué hacen los clientes en su vida fuera de las sesiones. En este artículo se presenta un diseño exploratorio de estudio de casos. Se dan los resultados más importantes de tal estudio en terapia de familia; ellos destacan cómo el tratamiento y la vida diaria de los clientes interactúan cuando ellos efectúan cambios en su vida cotidiana para resolver sus problemas. Alzo destacan lo que esto implica por parte de los clientes. Se concluye que se necesitan más investigaciones acerca de: cómo entender las intervenciones, la interacción entre las intervenciones y cómo los clientes conducen su vida diaria, las sesiones como una parte aislada y particular en la vida de los clientes y acerca de cómo considerar los procedimientos y maneras de conducir las sesiones.

Lo scopo della psicoterapia è quello di aiutare i clienti ad affrontare e superare i problemi che li angustiano nel loro quotidiano. La terapia può quindi funzionare solo se i clienti la utilizzano nel concreto svolgersi della loro vita per affrontare le questioni problematiche. Al fine di comprendere come i clienti utilizzano la terapia nella loro vita quotidiana al di fuori delle sedute sono necessarie ricerche dettagliate e sistematiche. Questo articolo presenta uno studio di caso che esplora il tema. I principali risultati emersi dall’analisi di questo caso relativo ad una terapia familiare sono presentati in termini generali. Essi evidenziano come il trattamento interagisca con le pratiche ordinarie e quotidiane dei clienti quando essi cercano di cambiare la loro vita di tutti i giorni al fine di superare i loro problemi. I risultati evidenziano inoltre che cosa implica per i clienti attuare questa integrazione. In conclusione è sottolineato come debbano essere realizzate ulteriori ricerche per meglio comprendere le interferenze, l’interazione tra interventi e comportamenti della vita quotidiana dei clienti, le sedute come una particolare area separata dalla vita di tutti i giorni del cliente e, di conseguenza e coerentemente, come considerare le procedure dei terapeuti e lo svolgimento delle sessioni.

Le but de la psychothérapie est d’aider les clients à adresser et surmonter les problèmes qui les gênent dans leur vie de tous les jours. La thérapie ne peut alors être efficace que si les clients l’incluent dans leurs vies pour traiter leurs difficultés. Une recherche systématique détaillée est nécessaire afin de trouver comment les clients opèrent dans leur vie de tous les jours en dehors de leurs séances. Nous présentons dans cet article la structure générale des études de cas à visée de recherche concernant ce sujet. Les résultats principaux d’une étude de cas de thérapie familiale sont ensuite exposés en termes généraux. Ils montrent les interactions entre les pratiques propres au traitement et les pratiques ordinaires des clients dans leur vie quotidienne lorsqu’ils la modifient pour surmonter leurs problèmes. Les résultats montrent également ce que cela implique pour y parvenir. En conclusion, il est proposé que des recherches supplémentaires soient menées afin de comprendre l’intervention ; d’étudier les interactions entre les interventions et la façon dont les clients mènent leurs vies quotidiennes ; sur les séances comme partie particulière et isolée de la vie de tous les jours des clients et par conséquent sur la manière dont on doit considérer les procédures des thérapeutes et la conduite des séances.

Ο σκοπός της ψυχοθεραπείας είναι να βοηθήσει τους πελάτες να αντιμετωπίσουν και να ξεπεράσουν προβλήματα που τους ταλαιπωρούν στην καθημερινή ζωή τους. Ως εκ τούτου η θεραπεία μπορεί να λειτουργήσει μόνο εφόσον οι πελάτες τη συμπεριλάβουν στη ζωή τους, για να αντιμετωπίσουν τα προβλήματά τους. Κρίνεται αναγκαία η ενδελεχής και συστηματική έρευνα για το πώς οι πελάτες εφαρμόζουν την ψυχοθεραπεία στην καθημερινή ζωή τους, έξω από τις συνεδρίες τους. Στο παρόν άρθρο παρουσιάζεται ο σχεδιασμός των διερευνητικών μελετών περίπτωσης σχετικά με το θέμα αυτό. Στη συνέχεια παρουσιάζονται τα κύρια αποτελέσματα μια τέτοιας μελέτης περίπτωσης οικογενειακής θεραπείας. Τα ευρήματα της έρευνας αναδεικνύουν πως αλληλοεπιδρούν οι θεραπευτικές πρακτικές και οι συνήθεις καθημερινές πρακτικές των πελατών όταν οι πελάτες αλλάζουν την καθημερινή ζωή τους για να ξεπεράσουν τα προβλήματά τους. Επίσης, διαφαίνεται τι χρειάζεται να κάνουν οι πελάτες προκειμένου να επιτευχθεί αυτή η αλλαγή. Συμπεραίνεται ότι χρειαζόμαστε περισσότερη έρευνα για να κατανοήσουμε βαθύτερα την παρέμβαση, την αλληλεπίδραση μεταξύ των παρεμβάσεων και της δράσης των πελατών στην καθημερινή ζωής τους, τις συνεδρίες ως ιδιαίτερο, αποκομμένο τμήμα από την τρέχουσα καθημερινή ζωή των πελατών, καθώς και σχετικά με το πώς να προσεγγίσουμε τις θεραπευτικές διεργασίες και τη διεξαγωγή συνεδριών.

Research on mental health usually focuses on the professional practices of defining and treating mental distress. There is also a substantial body of research about clients’ experiences of living with mental distress. But an important link between these two research areas needs to be investigated in depth. We need research on how clients use their treatments in their everyday lives.

This claim becomes most obvious when viewing treatment and mental distress in practical terms – as practices. Then, distress is not merely a mental state. It is something clients must do something about in practice in their everyday lives. Treatment is something clients use to overcome their distress in relation to other aspects of their everyday life. And clients are not just acted upon and bearers of experiences. They are also agents in relation to their everyday life and treatment.

This expands our view on treatment practices from encounters in sessions to interventions in everyday lives. Still, research on treatment generally focuses on sessions. It rests on the implicit, general belief that the effect of treatment is brought about in sessions and merely transferred by clients afterward into their everyday lives and applied so that what the clients got in sessions is what continues elsewhere afterward. This reflects a poor theory of human learning (Dreier, 2008b, in press; Lave, 1988). It also reflects a general feature of the arrangement of expert practices. Experts generally conduct their practice in a particular setting – be it a therapy room, health-care consultation, or hospital – which is set off and secluded from the ordinary everyday life of the persons they serve. So it seems that we must look in sessions if we want to consider the treatment effect as caused by the experts. But the belief in the session as the place where therapy works has unfortunate consequences. One is that it has not been researched in detail how these expert practices come to make a difference in the everyday lives of the persons they serve. Another is that, in order to work as intended in the ongoing lives of their clients, these practices must rely on client agency elsewhere. But what clients do elsewhere to make them work is not researched systematically and in detail.

For some years, I studied how clients make their therapy work in interplay between their therapy sessions and their ordinary everyday lives (Dreier, 1998, 2000, 2008a, 2011). To do so, I developed a type of exploratory qualitative case studies of Psychotherapy in Everyday Life (Dreier, 2008a). The theory and methodology behind this work, a review of the pertinent literature, and the outcomes of such a case study are laid out in detail in that book. This article focuses on what I found about the client processes of bringing about outcomes outside sessions. These findings are summarized and, to some extent, clarified and elaborated below.

Design and method

The project reported in the above-mentioned book was carried out at an outpatient unit of child psychiatry in Copenhagen. The design of the study was quite straightforward. It involved four long family therapies with me as a co-therapist. All sessions were audio taped, and a research assistant interviewed the families in their homes at regular intervals throughout the period of their therapy and until half a year after it terminated. The examined therapies ran up to one and a half years. In the interviews, the clients were primarily asked about their everyday lives with key questions like: ‘What happened in your everyday life since your previous interview?’ ‘Did anything change?’ ‘If any changes occurred, how did they come about?’ ‘Which role did you play in these changes?’ ‘Did you do things differently compared to before?’ ‘Did your sessions matter in these changes?’ ‘If they did, how did they matter?’ Only then were they asked about their experiences of their sessions and of their therapists and about their participation in the sessions. Finally, they were asked what they now believe they need sessions for. By repeating these questions in each interview, we could track changes in their practices and in their points of view on their lives, distress, and therapy. We also gained access to what triggered particular changes and to the course of bringing them about by means of their sessions and various situations and events in their ordinary everyday lives. The guide for these semi-structured interviews can be downloaded from my homepage http://psychology.ku.dk/emeriti/ole_dreier/downloads/interviewguide_to_psychotherapy_in_everyday_life.pdf.

This design reflects a decentered understanding of therapy as seen from the perspective and locations of clients’ everyday lives instead of from their sessions. After all, the clients’ troubles arise in their everyday lives and must, in the end, be overcome there, among other things, by means of a therapy that takes place elsewhere. Participation in a therapy is, in fact, a temporary addition to the clients’ ordinary everyday life. The design also lets us illuminate the clients’ change processes and the role of their sessions in these changes by following their practice as they move from their home to the sessions and from there to their home, school, work, and other regular and occasional parts of their everyday lives. In the book, I analyze one project case in depth and detail. This case was chosen because it contains the richest materials. The case analysis is based on the clients’ statements in their interviews and sessions.

Semi-structured interviews were chosen because we wanted to learn from the clients about their experiences and activities. But such projects about ongoing therapies are rare. We, therefore, took care to design and conduct the interviews so that they were in accordance with the general aim of their therapy and did not disturb it or become too much for them; should such complications occur, interviews let us discover and respond to them. So we instructed the interviewer how to avoid them and respond to them. Interviews also let us ask the clients about the meaning for them of being interviewed. All the clients in the project responded that they were interested in talking about their everyday life and treatment in the interviews because they were in the process of reconsidering and changing their everyday life and using their treatment to do so. We registered no instances of the disturbances we wanted to avoid. The interviews could, therefore, be conducted as intended in a collaborative and supportive manner as enquiries with and not on the clients (Holzkamp, 2013).

Using interviews in such a project has some limitations. Clients can only tell us what they experience so clearly that they can articulate it in conversation with the interviewer. On the other hand, repeated interviews let us register when an idea or issue becomes clear to them and in connection with what this happens. Having somebody else than their therapists interview, the clients at home rather than at the clinic also proved vital to gaining other perspectives and pieces of information than in their sessions. But, to some extent, it entailed a family-centered perspective on their everyday lives as a whole. Furthermore, the fact that all family members were present in the interviews made them support or object to each other’s statements in ways that further illuminated many issues. And, finally, the special focus of therapy on problems affected which features of their everyday lives we came to know most about.

The analysis of the materials is theory guided and grounded in a theory of persons in social practice (Dreier, 2008a). They are grasped in the first person perspective of subjects situated in and moving across the various settings of their ongoing everyday lives. Core concepts refer to their activities in taking part in these settings, to their positions, co...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• Notes on Contributors
• Introduction
• PART I
• PART II
• PART III
• Index