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10 Reasons Why You Should Care about Research

By Dr Cóilín Ó Braonáin

 


Dr Cóilín Ó Braonáin delves into Mick Cooper’s ‘Essential Research Findings in Counselling and Psychotherapy: The facts are friendly’ and discovers some results that you may find surprising

How do we know what we know? Typically, we all go through life with a sense of knowing what’s what. We know where we are, what we are doing, and we have a sense of general competency. For everyday purposes, that assumption of understanding, knowing and confidence in ourselves is mostly effective. When it comes to effectiveness as a counsellor, following training, a similar approach to knowledge is often taken. But is experience, intuition and self-belief actually enough to justify how we do therapy, in the absence of hard facts? Well, let’s take a quick look at 10 aspects of psychotherapy upon which we may have firm views and see if there are any surprises.

1.    Does therapy work?

As it happens, different studies produce varying answers to this and other questions. Consequently, we need to look at many studies and compile an average result. In this case, when counselling clients are compared to people with similar problems who don’t receive treatment (control groups), there is 79 per cent more improvement in people who have received therapy. So, about eight out of 10 clients get better. Not bad, eh? But what happens to the other two clients?


2.    Do some people get worse in therapy?

Well, yes. About five to 10 per cent of clients deteriorate in therapy (some others experience no change either way). Clearly, this raises the question of whether or not all potential clients should be screened in private practice. Such screening could identify contraindications to therapy, and those people could be referred elsewhere saving them unnecessary distress.


3.     How good is your client retention?

Probably not great, according to the research. About 50 per cent of clients drop out for a variety of reasons. Some obvious reasons are the cost of therapy, and modality factors (not every client is amenable to every type of therapy). However, less obviously, have you ever considered the possibility that counselling may be simply better suited to some cohorts than others? In fact, those from lower socio-economic groups, those with lower levels of education, and ethnic minorities are more likely to drop out. Food for thought?


4.    Does psychotherapeutic orientation matter?

This hot potato is more difficult to answer. Research tends to look at differential effectiveness, that is, which modality is best for which ailment. A problem with this approach is that some modalities, especially cognitive behavioural therapy (CBT), have done more research than others, which skews the results somewhat. Also, DSM-5 diagnoses are often quite broad, containing menus of symptoms, so that, for example, several people suffering from depression may have different combinations of symptoms. So, it is difficult to compare like with like. Nonetheless, a lot of research has been done and many studies show that there is little difference in effectiveness across modalities (known as the dodo bird verdict). A few studies even show control groups doing as well, or even better than therapy clients! Other studies favour CBT for a variety of problems, including depression and anxieties.


5.    What else makes a difference in outcomes?

Lambert’s Pie suggest that the orientation question may not really matter a whole lot, because it may be the case that modality has limited relevance to outcomes. According to Lambert’s research, only 15 per cent of the benefit of therapy to clients is due to technique and model factors. Another 15 per cent is down to expectancy and placebo, while the therapeutic relationship contributes 30 per cent of the positive effect. However, the largest slice of the pie (40 per cent of effect) is attributed to client variables and extra-therapeutic events. Therefore, more than half of the therapeutic effect may have nothing to do with you, or your modality. Surprised?


6.    Therapist factors: Does it matter who you are?

Mostly, no. Your age and personal experiences do not correlate with client outcomes. There is no strong evidence to say that therapist personality matters. Gender does not matter much, although female therapists may be slightly more effective with female clients, on average. Also, clients from marginalised groups may do better with therapists from similar backgrounds. CPD for therapists has some beneficial effect on outcomes, but not a whole lot. Overall, therapist characteristics don’t matter much - it’s the therapeutic relationship that is most important.


7.    Does what you do work?

There are many therapeutic techniques or intentionally implied procedures used in order to bring about therapeutic results. However, how effective are they in reality? Non-directivity as a ‘technique’ is often of interest, in particular when comparing person-centred therapy (PCT) with CBT. PCT would argue strongly that direction undermines the client’s autonomy and that direction is counterproductive, whereas CBT is typically quite directive. Research shows that many clients do not like a complete absence of direction, however, others dislike a high level of direction. It seems that moderate direction is best supported by the research, whereby the therapist makes tentative suggestions, thus influencing the client is certain directions, without being too pushy. Another more specific example of a techniques is that of Paradoxical Intervention (PI). PI is a technique where the client is encouraged to do the opposite of what she desires, for example, suggesting to an insomniac client she try hard to stay awake instead of trying to sleep. PI has strong support in the literature when measured against control groups. Counterintuitively, PI can bring about the desired result.


8.    Is online therapy effective?

Some would argue that the therapeutic relationship cannot be established effectively by phone or the Internet, but what are the facts? Cooper finds that both phone and Internet therapy seem to be as effective as face-to-face counselling. Clients may even be more comfortable disclosing personal information at a distance, and clients report equal satisfaction with distance therapies compared with meeting in person.


9.    Can clients engage with therapy while on medications?

Another old chestnut is the view that medications such as antidepressants dull the emotions and impede the therapeutic process. True or false? In general, false is the answer; antidepressants do not hamper therapy. But are medications beneficial to outcomes, if taken in conjunction with counselling? Apparently not, says the research, except in cases of severe or endogenous depression. If choosing between medications or therapy, for most clients, therapy alone is equally effective to medicine.


10.    What else might we assume without evidence?

How long should a therapy session last? One hour, 50 minutes? Why not 30 minutes? Is once a week the best frequency for sessions? Yes? How do you know? Is personal therapy for counsellors important? You might be surprised at the answer. Is it wrong to accept gifts from clients? Not necessarily. To close on a cliché, if I may, could it be that more research is needed?

 

This article had been previously published in The Irish Journal for Counselling and Psychotherapy Volume 20 • Issue 1 • Spring 2020

 

Reference:

The information in this article is sourced from Cooper. M. (2008). Essential research findings in counselling and psychotherapy: The facts are friendly. Los Angeles: Sage.





 

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