10 Principles of Pluralistic Counselling and Psychotherapy Research
Mick Cooper, Professor of Counselling Psychology, University of Roehampton
What does counselling and psychotherapy research look like, from a pluralistic perspective? Here are ten principles that, for me, would be essential to such research (and, of course, this is a very personal perspective).
A genuine openness to the evidence. We just don’t know and we want to find out. That’s the brilliant thing about research. Of course we’ll have assumptions–for instance ‘Empathy is associated with better outcomes’ or ‘Clients value having their preferences accommodated’–and it’s good to acknowledge what these are. But, from a pluralistic standpoint, there’s a real encouragement to put these to one side and be open to whatever is out there. There’s nothing we need to defend or prove. As Rogers put it, ‘The facts are always friendly.’
Both quantitative and qualitative methods are of value. We don’t need to fight over whether quant or qual is best. From a pluralistic standpoint, both do helpful things for different research projects at different times–it depends what we’re asking. So pluralistic research takes a ‘both/and’ standpoint rather than ‘either/or’. And if we can triangulate across from one method to the other, that’s brilliant in terms of reliability.
Epistemology shmepistemology. No, I don’t really mean that. But pluralism holds a fairly pragmatic stance, with a priority on getting meaningful answers to meaningful questions. So a hard core constructionist perspective wouldn’t really suit; but neither a hard core empiricism that held perceptions as absolute truths. Probably, a mid-position like critical realism sits well with pluralism; and pluralism can also be considered an epistemological stance in itself. How would that be defined? As a belief in the validity of multiple perspectives, but also that a real ‘reality’ is possibility, and that research can help us get somewhere closer to it.
A focus on client perspectives. Pluralism really wants to know how clients experience therapy, and trusts that their perceptions have something valuable to contribute to knowledge. It’s not, of course, the only source of knowledge, but it’s a great place to start: see, for instance, the Client Helpfulness Interviews that John McLeod and I articulated. I’d definitely say this: that if you need to do a research project (say for a Master’s) and don’t know where to start, do think about something where you are just asking clients about what they found helpful and/or unhelpful in therapy: gay clients, focusing-oriented psychotherapy clients, people who have had therapy for bereavements. There’s so much learning just from that very simple question.
And make the research process, itself, collaborative. There’s a lot of focus these days on ‘PPI’ (patient and participant involvement) in research, and that’s entirely aligned with a pluralistic standpoint. So think about how the people you are talking to might be able to contribute to the design, methods, or dissemination of your study. Always a crucial question to be asking.
Discovering change processes. How do people actually change in therapy? That’s a question that’s of particular interest to pluralism, because we’re trying to make sense of individual journeys through the experience, not just ‘black box’ inputs and outputs. Qualitative research can be great for understanding that, but also quantitative analysis of mediators and moderators. And, of course, from a pluralistic standpoint we don’t need to be looking for change processes that are ‘true’ for all. Rather, it’s possible mechanisms of change that might be true for some clients some of the time. Understanding factors that may inhibit or undermine positive change processes is also of great interest to pluralistic research.
Common-ish factors. From a pluralistic standpoint, we’re particularly interested in processes, associations, and outcomes that cut across ‘brand name’ therapies. The brand names, themselves, aren’t of particular interest. Of course, a study of clients in a particular approach, like focusing-oriented therapy, would be fascinating; but we’d kind of expect to see certain processes come out that are common across therapies, like the importance of warmth or attention to experiences. Then again, maybe not; and it would be fascinating if particular therapies had effects through very distinctive mechanisms. Again, pluralism is great here because it doesn’t pit common factors against therapy-specific ones: both can exist (but with all the evidence, to date, pointing to the former, that seems a good place to start until we know otherwise).
Averages are average. A lot of research, particularly quantitative statistics, gives us information about average associations or effects. That can be incredibly useful: for instance, on average, do people show improvements in therapy for bereavement or is it cost-effective? But, from a pluralistic standpoint, average don’t tell us anything about what will happen to specific individuals. There’s no universal mechanisms that statistical associations are pointing to. So an average effect in one direction doesn’t mean that some people won’t be affected in another direction and, from a pluralistic standpoint, that’s something we would want to acknowledge. Pluralistically, we can hold both the whole and the parts.
Pluralistic therapy has some of its own research questions. Some topics of particular interest: preference assessment and accommodation, therapist-client collaboration, client resources and agency, deliberate practice, working towards goals, the process and outcomes of pluralistic therapy. An example of research around a pluralistic topic (goals) can be found here.
Research evidence is great, but it’s not the only thing. And finally while, pluralistically, empirical data is great, so is theory, and therapist experiences, and learning from cultural resources, etc. So we don’t need to privilege research evidence as a guide to practice, just as we don’t need to derogate it. It’s one part of the great plurality that we can use to inform our work.
If you’re interested in pluralism and research, have a look at: Hanley, T., & Winter, L. A. (2016). Research in pluralistic counselling and psychotherapy. In M. Cooper & W. Dryden (Eds.), Handbook of pluralistic counselling and psychotherapy (pp. 337-349). London: Sage. Also, Chapter 7 in our original text, Cooper, M., & McLeod, J. (2011). Pluralistic Counselling and Psychotherapy. London: Sage.