Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

What is psychotherapy research? What should it primarily address? How should it be carried out? In this book, we attempt to answer these basic questions, and we do so by strongly relying on the following four interrelated assumptions: (1) Psychotherapy research as well as its object of investigation are socially negotiated and institutionally legitimated cultural products, which are grounded on values and beliefs shared by the members of a specific community at a certain time and place. This helps to explain, for example, the historical and contemporary diversity and heterogeneity of the conceptions of the nature of psychotherapy and psychotherapy research (see Frank and Frank 1991; Lambert 2013; Chap. 3). (2) It follows that an explicit and self-critical reflection on the foundational assumptions of psychotherapy research, far from being trivial, is essential to make psychotherapy researchers aware not only of what they do but also of why they do it (Gelo 2012; Slife 1998, 2004; see Chaps. 4 and 5). (3) From the first assumption, it also follows that different conceptions and/or theories of scientific investigation in psychotherapy cannot be proven to be absolutely true or false but rather are evaluated as more or less plausible, persuasive, and useful. Thus, pluralism—the stance of acknowledging and engaging with diversity (i.e., otherness)—and multiplicity should be considered not only a valuable attitude but also an a priori condition of any scientific account of psychotherapy [see also Kellert, Longino, and Waters (2006) and Teo (2010)]. Specifically regarding methodology, this means that several methods and their underlying principles and philosophies should be allowed to complement one another (Cooper and McLeod 2007; Elliott 2010; Gelo and Gelo 2012; Slife and Gantt 1999, Chap. 4). (4) Finally, to find out how and why psychotherapy works, self-reflective and methodologically pluralistic psychotherapy research should be conducted on both the process and outcome of psychotherapy. This would enhance the possibility of producing results useful in informing the clinical practice of psychotherapy.

This book, which is organized into three parts, aims to provide the readers with knowledge of the foundations of psychotherapy research (part I) and its applications to the study of the process (part II) and outcome (part III) of psychotherapy.

1.1 Foundations of Psychotherapy Research

The first part of the book addresses some foundational issues of psychotherapy research on a historical, philosophical, and theoretical level. Such issues are usually treated in a sporadic and/or isolated way in mainstream psychotherapy research literature; our aim is to try to stimulate a further reflection on them. Chapter 2 focuses on the prehistory of psychotherapy and its implications for psychotherapy science. This issue is very relevant because it shows how what we consider to be the object of our investigation (i.e., psychotherapy) has varied greatly at different times and in different places. We believe that a reflection on the nature of a discipline’s object of study is fundamental to better understanding the discipline itself. Chapter 3 offers a review of the history of psychotherapy research, which represents for us an indispensable body of knowledge that researchers and clinicians should be aware of to understand where psychotherapy research comes from and where it can go.

Chapter 4 addresses the extent to which what we consider to be the appropriate way of conducting psychotherapy research is necessarily influenced by our deep and hidden but fundamental philosophical assumptions about the basic aspects of our world. Mainstream and alternative views are discussed. Always from a philosophical perspective, Chap. 5 attempts to provide an epistemological argument for psychotherapy to be considered an academic discipline. This issue, which has been addressed since the birth of modern psychotherapy through Freud’s conceptualization of psychoanalysis, is particularly relevant to providing an epistemic status to psychotherapy as science as opposed to psychotherapy as clinical practice. Finally, a philosophical stance is also taken in Chap. 6, where the author attempts to show that interpretation, far from exclusively being an instrument used in clinical practice, may be considered one basic cognitive instrument for the practice of psychotherapy science.

Chapter 7 discusses some of the differences in the regulation of psychotherapy training in different countries. The issue is relevant because different formal requirements for psychotherapy training—which Orlinsky and Howard’s (1984) Generic Model of Psychotherapy would ascribe to the domain of input (or antecedents) of psychotherapy—very likely produce different “psychotherapies” with consequences on the nature of the object of our investigation (see also Orlinsky 2009). The implications for psychotherapy research are discussed. The last chapter of this first part, Chap. 8, provides a bridge to the subsequent two parts of the book by innovatively distinguishing three different and alternative purposes of psychotherapy research: theory building, enriching, and fact gathering.

1.2 Psychotherapy Process Research

The second part of this book addresses psychotherapy process research, which is very broadly referred here as any research that focuses on the process of psychotherapy and, eventually, its relationship with the outcome. Both quantitative and qualitative approaches are given equal consideration in order to reflect the increasing relevance that qualitative approaches have gained in recent decades. The first three chapters of this part provide a general introduction to both basic and more advanced issues concerning the psychotherapeutic process and its investigation. Chapter 9 unpacks the general meaning of psychotherapy process research by offering an introduction of its aims, typologies, methodology, limitations, and emerging trends. In Chap. 10, the authors outline a general theory of the psychotherapeutic process that is described, from a semiotic and dynamic perspective, in terms of a communicational field. The theoretical considerations that sustain such a view are drawn, and the methodology implications are discussed. Finally, Chap. 11 attempts to provide an evolutionary-based, tripartite model of the relationship to explain how psychotherapy works.

1.2.1 Quantitative Process Research

After these three introductory chapters, a first group of contributions specifically focuses on quantitative process research. Chapter 12 provides an introduction to quantitative data analysis in psychotherapy process research. The way psychotherapeutic process data can be organized and structured is described; moreover, an interesting heuristic framework to organize the multitude of basic statistical data-analytic procedures is offered. In Chap. 13, the authors give an overview of three main quantitative approaches that differently focus on the process of psychotherapy and/or its relationship with treatment outcomes: treatment process, change process, and process-outcome research. These are described in terms of research design, data collection, and data analysis. Chapter 14 offers an overview of quantitative process research on group psychotherapy that synthetizes the most recent developments in the field.

Chapter 15 addresses the process of change in psychotherapy by introducing the readers to the debate between common and unique factors. This debate is discussed with regard to both theoretical and empirical arguments. In the following chapter, Chap. 16, the authors focus on the therapeutic alliance, which over decades of empirical research seems to have gained the status of an empirically supported common therapeutic factor in contemporary literature. After an historical and theoretical introduction and overview, the authors focus on some of the most recent developments in the investigation of alliance ruptures and resolutions. Chapter 17 discusses the contribution of positive psychology to psychotherapy theory, research, and practice. The contribution is interesting because it provides insight into possible change mechanisms that have been largely unexplored up to now. Chapter 18 reviews empirical research on the psychotherapeutic process conducted from the perspective of psychotherapists and discusses therapists’ experiences of the process. Finally, in Chap. 19, the authors provide an interesting account of how the traditional psychoanalytic narrative case study has evolved into quantitative single-case research. This latter approach is exemplified by a description of the research conducted by the Ulm Psychoanalytic Process Research Study Group.

1.2.2 Qualitative Process Research

The remaining contributions of the second part of this book focus, on the contrary, on qualitative process research. The first two chapters respectively describe the methodology and applications of qualitative process research. Chapter 20 provides a detailed outline of qualitative research methods that may be used to analyze the psychotherapeutic process. Research designs, data collection, and data analysis are reviewed; with regard to the latter two, a dimensional conceptualization is offered that aims to provide a heuristic framework to locate the different existing methods described in the literature. Chapter 21 extensively reviews and discusses applications of qualitative and mixed methods research for the investigation of counseling and psychotherapy.

Finally, the last four contributions describe specific qualitative approaches frequently used in psychotherapy process research. Chapter 22 focuses on Grounded Theory (GT) and develops a detailed compilation of interpretation-driven guidelines for designing and evaluating GT research. Chapter 23 presents a review of Consensual Qualitative Research (CQR) by focusing on its background and methods. Chapter 24 provides a practical overview of the principles of Conversation Analysis (CA) and the main dimensions according to which it may be applied in the investigation of the process of psychotherapy. Lastly, in Chap. 25, the author proposes a pragmatic approach to the study of the therapeutic interaction that integrates theoretical propositions derived from developmental psychology and pragmatics with the methods of CA.

1.3 Psychotherapy Outcome Research

The third and final part of this book addresses psychotherapy outcome research, which aims to investigate whether a treatment produces the desired and expected clinical results. Unlike the second part of the book dealing with process research, this part is focused mostly on quantitative approaches, testifying their predominance in this type of research. Two methodological contributions open this part. Chapter 26 reviews the main methodological issues in quantitative psychotherapy outcome research. The main characteristics of Evidence-Based Medicine (EBM) are sketched out along with the research designs’ hierarchy of evidence and meta-analysis. The issue of Randomized Controlled Trials (RCTs) is discussed, and other relevant issues such as sampling, treatment manualization, the difference between efficacy and effectiveness, outcome measurement, and statistical data analysis in outcome research are addressed. Chapter 27, on the contrary, reviews the main qualitative methods used in qualitative research with the aim of showing that qualitative methods can complement, enrich, and deepen the more traditional quantitative methods in the study of outcomes.

In Chap. 28, the authors elaborate on research on the outcomes of grief therapy—one class of disorder-specific therapy; discuss its efficacy based on the results of a meta-analysis; and offer recommendations for future outcome research on disorder-specific treatments. Chapter 29 reviews findings concerning the use outcome measures in routine care to provide therapists with patient progress feedback; the extent to which such an approach may enhance therapeutic efficacy is discussed. Finally, in Chap. 30, the authors discuss the use of neuroimaging in investigating the outcome of psychotherapy and review the main empirical results produced in the field.