Grounded Theory methods in child psychotherapy research

This article considers the place of qualitative research in psychoanalysis and child psychotherapy. It discusses why research methodology for many years occupied so small a place in these fields, and examines the cultural and social developments since the 1960s which have changed this situation, giving formal methods of research much greater significance. It reflects on the different pressures to develop formal research methods which arise both from outside the psychoanalytic field, as a condition of its continued professional survival, and from within it, where its main aim is the development of fundamental psychoanalytic knowledge, It suggests that the conduct of mainly quantitative research into treatment outcomes is largely a response to these external pressures, whilst the main benefits to be gained from the development of qualitative research methods, such as Grounded Theory, are in facilitating the knowledge-generating capacities and achievements of child psychotherapists themselves. The paper describes Grounded Theory methods, and explains how they can be valuable in the recognition of hitherto unrecognised meanings and patterns as these are made visible in clinical practice. Finally, it briefly describes five different examples of completed doctoral studies, all of which have added significantly to the knowledge-base of child psychotherapy, and which demonstrate how much can be accomplished using this method of research.

What is the Role of Attachment in Contemporary Psychotherapy? A Grounded Theory Exploration of the Perspective of Experienced Psychologists

Since Bowlby devised his theory of attachment, originally for clinical purposes, refinements and extensions have developed its clinical utility. The research question asked how experienced contemporary clinicians now perceive the role of attachment in the formulation and treatment of distress by reference to their clinical work. Using grounded theory methodology, underpinned by a relativist, moderate social constructionist epistemology, initial sampling consisted of 16 in-depth interviews with experienced clinicians. The tentative theoretical categories that emerged were then developed in theoretical sampling in further interviews with 5 of the initial interviewees. The final theoretical categories to emerge concerned the prevalence of caregiver-related problems, the provision of safety together with the prioritisation of the relationship with self as attachment-related treatment strategies, and attachment theory’s provision of understanding in problem formulation. Whilst this suggests that attachment-related ideas are integrated in contemporary practice, it also suggests that the clinical utility now offered by attachment theory, as established in the literature, has not found broad appeal amongst clinicians despite the commonness of attachment-related presenting problems. The implications of this are manifold. To begin with, attachment theorists have largely failed to bring the potential now offered by attachment-related therapeutic interventions to the market. This situation makes it incumbent on the next generation of attachment researchers to more clearly articulate techniques with which clinicians, of whatever theoretical orientation, can better leverage attachment-related knowledge in their clinical work. In this enterprise, perhaps the knowledge and experience of expert clinicians could be harvested, as this research has done. Moreover, researchers must expand the evidence base that such interventions actually work. Beyond the implications for clinical utility and efficacy, the findings strengthen counselling psychology’s influence on society’s perception and treatment of attachment-related problems.

A Comparison of Audio Recordings and Therapist's Process Notes in Child and Adolescent Psychoanalytic Psychotherapy

Therapistsʼ process notes - written descriptions of a session produced shortly afterwards from memory - hold a significant role in child and adolescent psychoanalytic psychotherapy. They are central in training, in supervision, and in developing oneʼs understanding through selfsupervision and forms of psychotherapy research. This thesis examines such process notes through a comparison with audio recordings of the same sessions. In so doing, it aims to generate theory that might illuminate the causes of significantly patterned discrepancies between the notes and recordings, in order to understand more about the processes at work in psychoanalytic psychotherapy and to explore the nature of process notes, their values and limitations. The literature searches conducted revealed limited relevant studies. All identified studies that compare process notes with recordings of sessions seek to quantify the differences between the two forms of recording. Unlike these, this thesis explores the meaning of the differences between process notes and recordings through qualitative data analysis. Using psychoanalytically informed grounded theory, in total nine sets of process notes and recordings from three different psychoanalytic psychotherapists are analysed. The analysis identifies eight core categories of findings. Initial theories are developed from these categories, most significantly concerning the role and influence of a ʻcore transference dynamicʼ between therapist and patient. Further theory is developed on the nature and function of process notes as a means for the therapistʼs conscious and unconscious processing of the session, as well as on the nature of the influence of the relationships – both internal and external – within which they are written. In the light of the findings, a proposal is made for a new approach for learning about the patient and clinical work, ʻthe comparison methodʼ (supervision involving a comparison of process notes and recordings), and, in particular, for its inclusion within the training of psychoanalytic psychotherapists. Further recommendations for research are also made.

Investigating Links Between Intimacy and Violence in Intensive Psychotherapy

This research examines links between intimacy and violence within the transference relationship of a three year old boy during intensive psychotherapy. Psychoanalytic clinical findings are used to examine triggers to violence that initially appeared to link with moments of emotional warmth. The research uses a retrospective single case study design. The clinical data cover a period of transition in the child's life from being a 'looked after child' in foster care to being adopted. There was a history of early trauma from neglect and domestic abuse. Clinical process notes from supervised sessions were coded using an adapted grounded theory approach to reveal complex interlinking themes of intimacy, violence, Oedipal issues, control and difficulties regulating affect. Data in this study show how intimacy and violence are linked when there is evidence of a separation between the self and the object of intimacy. Explosive violence is triggered by the threat of loss of the object and the rage is, at times directed towards the object of intimacy. The findings of this study support concepts identified by earlier research in the field about the impact of a lack of maternal containment on innate violence, associated struggles with the Oedipal complex and the impact upon the capacity for symbol formation and thinking. However, the research findings challenge Glasser's (1979) theory of the 'core complex' that suggests that intimacy triggers violence. The results of this research indicate that it is the threat to the loss of intimacy as a result of separation from the object that is the trigger to violence. I believe this study may, in a modest way, further understanding about links between violence and intimacy in human relationships. This may help other child psychotherapists be alert to certain dangers when dealing with violence in the therapy room.

Integrating life design counseling and psychotherapy: Possibilities and practices.

The debate on the relation between career counseling and psychotherapy revealed the close relation between psychosocial and career issues. The connection between these two approaches paves the way for the integration of career counseling into psychotherapy. One of the key challenges of integrating career counseling into psychotherapy is to avoid discontinuities and inconsistencies in the psychotherapeutic intervention. The aim of this article is, therefore, to present the Systematic Treatment Selection perspective as a framework for an effective integration of psychotherapy and career counseling. Then, Life Design Counseling is described, highlighting its possibilities to fit the psychotherapeutic approach. Finally, an illustrative case is presented and discussed.

Assessment of change in psychoanalysis : Another way of using the change after psychotherapy scales

A systematic method is presented whereby material from a full course of psychoanalytic treatment is analyzed to assess changes and identify patterns of change. Through an analysis of session notes, changes were assessed using the CHange After Psychotherapy scales (CHAP; Sandell 1987a), which evaluate changes in five rating variables (symptoms, adaptive capacity, insight, basic conflicts, and extratherapeutic factors). Change incidents were identified in nearly every session. Early in the analysis, relatively more change incidents related to insight were found than were found for the other types of change. By contrast, in the third year and part of the fourth year, relatively more change incidents related to basic conflicts and adaptive capacity were found. While changes related to symptoms occurred throughout the course of treatment, such changes were never more frequent than other types of change. A content analysis of the change incidents allowed a determination of when in the treatment the patient's main conflicts (identified clinically) were overcome. A crossing of quantitative data with clinical and qualitative data allowed a better understanding of the patterns of change.

The practices of existential psychotherapists: Development and application of an observational grid

Within the major therapeutic paradigms, observational instruments have been developed to assess orientation-specific interventions or processes. However, to date, no such instrument exists to assess existential practices. Recent research indicates the key practices of existential therapists, and forms an empirical basis on which to develop an observatory grid. This paper describes the development of such a grid, and its exploratory testing with eight clients of four Portuguese existential psychotherapists. A total of 32 sessions were observed and both speaking turn and whole-session analysis showed that it was feasible to assess existential therapy using the instrument, although psychometric findings recommend further refinement of the tool. Session-rating data suggest that the chief practices applied by existential therapists were relational, followed by the use of hermeneutic interventions and reformulations. Interventions based on phenomenological and existential assumptions were observable in practice but limited in frequency. Further refinements and developments of the observational grid, together with additional research – using a range of therapists from different schools of existential therapy – are recommended.

The Role of Existential Beliefs Within the Relation of Centenarians’ Health and Well-Being

The purpose of this study was to explore the role of existential beliefs in mediating the influence of health on centenarians' well-being. A total of 80 centenarians (mean age 101.1; SD = 1.3; 81.3 % women) with no/minor cognitive impairment were included. The OARS questionnaire for diseases and functional capacity (ADL, IADL), the Satisfaction with Life Scale, and the existential beliefs subscale were used for data collection. The findings suggest that existential resources are a crucial element for mitigating the impact of health constraints in subjective well-being in this population. Appropriate models of intervention for very old age that recognize the importance of religion, spirituality, and meaning of life are to be considered.

Integrating Life-Design Counseling and Psychotherapy: Possibilities and Practices

The relationship between career counseling and psychotherapy is not a new subject. The debate allows the affirmation of career counseling as a dimension of personal counseling and recognizes the close relationship between psychosocial and career issues (Blustein & Spengler, 1995). The connection between these two approaches paves the way for the integration of career counseling with psychotherapy. Indeed, the inseparability of mental health and career issues frequently leads psychotherapists to help their clients to deal with work satisfaction, underemployment or unemployment through psychotherapy. Moreover, when working with specific populations (e.g., people with intellectual disabilities and people with addiction or mental health problems), psychotherapy calls for occupational integration to consolidate and enhance therapeutic gains (Blustein, 1987; Jordan & Kahnweiler, 1995; Leff & Warner, 2006).

Vihara architecture: defining the existential foothold of VIII century Buddhist monastery "Somapura Mahavihara" of ancien Bengal

Lost in history, the ruin of ‘Somapura Mahavihara’ was not recognized separated from its birthplace, i.e. nature, for more than 700 years. Yet, within its silent presence, the monument dominated the name of the region: ‘Paharpur’ (land of hillock), according to its appearance surrounds by its flat land topo¬graphy. Discovered in 1919, the single largest Buddhist Vihara (monas¬tery) of ancient Bengal came into light, pronouncing the flou¬rishing minute of Buddhist architecture, once dominant religious force of the subcontinent. The earliest historical monumental architecture of greater Asia, had long been deriving itself from the Buddhist monastic architecture as early as VI century BC. In line of history, the discovery of ‘Somapura Mahavihara’ contributed attesting the sensitivities of a highly sophisticated architectonic typology of Vihara Architecture in the land of ancient Bengal. The recovery of ‘Somapura Mahavihara’ was not only from its cradle of nature, but also from its remarkable existence imprinted in the reign of Pala dynasty (750 - 1155 AD) announcing the existential foothold of man in his nature. The existential foothold of ‘Somapura Mahavihara’ comprises the factors, responsible in shaping the anchorage of the mo¬nument since the birth of Vihara architecture, as early as 530 BC. These factors not only denote the building technology in response to its environment but also the amalgamation of be¬lief, upon which the dwellers transformed the site as a place announcing their existence on earth. This research paper aims at exploring the existential foothold of ‘Somapura Mahavihara’, in terms of its territorial, functional, structural, social, cultural, religious sym¬bolic hierarchies of human achievement while clarifying the architectonic typology that shaped ‘Somapura Mahavihara’ through evolution process of ‘Vihara Architecture’. This understanding intends to combine the archaeological knowledge with comparative architectural analysis of contem¬porary Viharas of ancient Bengal, to define the singularity of ‘Somapura Mahavihara’. In consequence, the glorious past of ‘Somapura Mahavihara’ is intended to portray through iden¬tifying the relation of religious and functional rationalism with the connotation of art, architecture and belief moulded within natural forces, as one complete entity; RESUMO: Vihara Arquitetura: Definindo a posição existencial do século VIII Budista mosteiro “Somapura Mahavihara” de Bengala antiga. Perdidas na História, as ruínas de ‘Somapura Mahavihara’ foram confundidas com uma montanha durante mais de setecentos anos. Contudo, no seu silêncio presente, o monumento marcou a toponímia da região; ‘Paharpur’ significa ‘a terra do outeiro’, evidenciando a singularidade deste monumento numa região dominada por uma extensa planície. Em 1919, foi descoberto o maior mosteiro budista da antiga região de Bengal, demonstrando a prosperidade da arquitectura budista. Tem¬poralmente, a descoberta de ‘Somapura Mahavihara’ contribuiu para atestar a evolução e a sofisticação da tipologia arquitectónica denominada ‘Arquitectura Vihara’, existente na antiga região de Bengal. A noção de pegada existencial de ‘Somapura Mahavihara’ compreende os factores responsáveis por moldar a ancoragem do monumento ao lugar em que se insere desde o início da arquitectura Vihara, que remonta a 530 a.C. Estes factores evidenciam a tecnologia construtiva empregue para responder ao ambiente envolvente mas também a evolução da religião, factores estes que os monges construtores consideraram ao transformar o lugar e anunciar a sua existência na Terra. Esta investigação tem por objectivo explorar a noção de pegada existencial de ‘Somapura Mahavihara’, nas suas dimensões territoriais, funcionais, estruturais, sociais, culturais e nas hierarquias simbólicas das realizações humanas para clarificar a tipologia arquitectónica que deu forma a ‘Somapura Mahavihara’ durante a evolução da arquitectura Vihara. Este entendimento pretende combinar/cruzar o conhecimen¬to arqueológico com estudos arquitectónicos comparativos de Viharas na antiga região de Bengal, com o objectivo de definir a singularidade de ‘Somapura Mahavihara’. Neste estudo estudar-se-á também o confronto entre a dimensão religiosa e a artística (divino vs. humano), integrados na arquitectura de ‘Somapura Mahavihara’ em perfeita harmonia.

Calling Home

Through the exhibition implicit conceptions of home held by the participating artists and those viewing the exhibition were externalized. Represented as images, the conceptions conveyed different as well as shared understandings categorized as physical, cognitive, emotional, instrumental and existential. Unlike written papers on the meaning of home, the exhibition enabled access to a richer understanding of home as facilitating a way of being-in-the-world.

At-the-edge-of-the-forest

This exhibition was the outcome of a personal arts-based exploration of the meaning of interiority. Through the process it was found that existentially the architectural wall differentiating inside from outside does not exist but operates as a space of overlap, a groundless ground providing for dwelling in the real existential sense of the word.