Child Psychotherapy and Research

New Approaches, Emerging Findings

Nick Midgley, Jan Anderson, Eve Grainger, Tanja Nesic-Vuckovic, Cathy Urwin, Nick Midgley, Jan Anderson, Eve Grainger, Tanja Nesic-Vuckovic, Cathy Urwin

• Editore: Routledge
• Anno: 2009
• ISBN:
  9781135277215
• Edizione: 1
• Argomento: Psychologie
• Categoria: Psychotherapie

Child Psychotherapy and Research brings together some of the most exciting and innovative research activity taking place within psychoanalytic child psychotherapy today.

Drawing on the expertise of an international range of contributors, this book describes work at the cutting edge of research in psychoanalytic child psychotherapy and related areas. It presents many of the emerging findings while also illustrating a whole range of methodologies – both quantitative and qualitative – that have been developed to investigate this field. The book examines the historical and philosophical background of child psychotherapy research and shows how research illuminates different clinical phenomena, the processes of psychotherapy, its evaluation and outcome.

Recent developments in therapeutic work with children, including the increased focus on evidence-based practice, make research a much higher priority in the field than ever before. With this increasing significance, a whole new generation of clinicians are required to become familiar and competent with research methods and research literature. Child Psychotherapy and Research will be a vital resource for anyone involved in research and training related to psychotherapy and child mental health, as well as of great interest to a range of mental health professionals.

Part I
What is child psychotherapy research?

Introduction

The title of this book, ‘Child Psychotherapy and Research’, might suggest a fairly straightforward connection between two distinct, but well-defined fields. In fact, this is far from the case. Not only is child psychotherapy, even within the psychoanalytic tradition, made up of a range of concepts and clinical practices; but the term research also covers a number of quite different activities, each based on quite distinct philosophical and methodological assumptions. Finding an appropriate methodology for research in psychoanalytic child psychotherapy, sustained by cogent theory from the philosophy of science, has been a challenge identified by Mary Boston almost twenty years ago (Boston 1989), and has been the topic of lively debate among child psychotherapists themselves in recent years (e.g. Midgley 2004, 2006, Anderson 2006, Desmarais 2007).

The first part of this book, therefore, aims to highlight some of the complex issues that are raised when we ask ‘what do we mean by “child psychotherapy research”?’ While the scientific community has often been preoccupied with the question of whether psychoanalytic concepts can be tested in a suitably rigorous and scientific way, clinicians have often been more concerned about whether the approaches taken to investigating psychotherapy can truly capture the complexity of the work, or whether they will distort what is important in the very act of studying it.

But gradually the discussion has become more sophisticated, so we can now talk about a range of approaches to doing psychotherapy research, informed by different models of science and with different scientific and political aims. Desmarais (2007) identifies five broad ways in which the relationship between psychoanalysis and research has been configured, from extreme forms of empiricism to radical hermeneutic approaches. Although Desmarais’ paper implies a pluralistic model of child psychotherapy research, tensions and debates about the nature of the research process in child psychotherapy and which approaches are more valid or important remain.

The two chapters in this part of the book present two very different, but influential, views about the nature of research in child psychotherapy. Peter Fonagy, a clinical psychologist and psychoanalyst, argues for the integration of child psychotherapy research with mainstream research methods in psychology. He sees a fault line that runs between experimental psychology and psychoanalysis and calls for more communication across this divide. Fonagy urges the child psychotherapy profession to develop a unified model of the mind and argues that cross-fertilization with other research traditions, such as developmental neuroscience, can help child psychotherapy to put its own findings on a firmer footing.

Michael Rustin, a social scientist with a deep interest in psychoanalysis, puts forward the view, well illustrated by the work of the post-Kleinian schools, that research in child psychotherapy has been taking place since its inception. He argues that this clinical research process, carried out singly or as part of clinical-case workshops, has led to the development of valuable clinical concepts and theories as clinicians struggle, individually and collectively, to find ways of understanding the complex situations that they face in their clinical practice.

Both Peter Fonagy and Michael Rustin are aware of the need to take psychoanalytic findings beyond the consulting room to the wider community, and while they share this aim they offer contrasting views about the best way to do this, each with its own merits and limitations. The development of the understanding of the mind calls on the mental capacity to hold conflicting and contradictory aspects of a situation in view simultaneously. In presenting these two chapters we hope that readers will draw on this capacity in themselves in order to appreciate the value of multiple perspectives in what is a very complex field.

References

Anderson, J. (2006) Well-suited partners: Psychoanalytic research and grounded theory. Journal of Child Psychotherapy, 32(3), 329–348.

Boston, M. (1989) In search of a methodology for evaluating psychoanalytic psychotherapy with children. Journal of Child Psychotherapy, 15(1), 15–46.

Desmarais, S. (2007) Hard science, thin air and unexpected guests: A pluralistic model of rationality, knowledge and conjecture in child psychotherapy research. Journal of Child Psychotherapy, 33(3), 283–307.

Midgley, N. (2004) Sailing between Scylla and Charybdis: Incorporating qualitative approaches into child psychotherapy research, Journal of Child Psychotherapy, 30(1), 89–111.

Midgley, N. (2006) The ‘inseparable bond between cure and research’: Clinical case study as a method of psychoanalytic inquiry. Journal of Child Psychotherapy, 32(2), 122–147.

Chapter 1
Research in child psychotherapy: Progress, problems and possibilities?

Peter Fonagy

Introduction

This chapter overviews the relationship between research and psychoanalytic child psychotherapy. It notes the complex attitudes that psychoanalysis adopts towards the systematic gathering of data, and will attempt to understand the partial lack of past interest in systematic empirical work related to child therapy in terms of the clinical rootedness of the discipline. This first part of the chapter touches briefly on epistemological issues that affect all professionals practising psychoanalytic psychotherapy or psychoanalysis, and considers various suggestions that have been advanced to address the epistemic problems inherent in psychoanalytic approaches. The second part of the chapter attempts to show how the conceptual challenges of modern psychodynamic thought may be at least partially addressed by extraclinical theory and research. The paper gives an example using evidence gathered from developmental psychopathology, in particular social cognition, which not only provides evidence that is at least consistent with many of the psychoanalytic model’s assumptions but also helps to organize psychoanalytic thought in some ways. I point to some key issues regarding the communication of psychoanalytically informed ideas within the wider community. Finally, I turn briefly to the external validation of psychodynamic thought, and point to some difficulties involved in conducting empirical studies of the outcome of psychodynamic child psychotherapy.

The problem of child psychotherapy

Talking about research to psychotherapists can feel like selling deep freezes to Eskimos. Paul Whittle (Whittle 2000) has drawn attention to ‘a fault line running down the middle of psychology’. There are two cultures with completely different attitudes to empirical research. On the one side there are those in experimental psychology, cognitive neuroscience, neurobiology, human development and other subspecialties of the ‘science of the mind’, who have embraced empirical research and benefit from a powerful, reasonably well-funded discipline that has progressed particularly rapidly over the last quarter of a century. This discipline prides itself on having a cumulative knowledge base that is strong enough both to generate a range of technologies and to interface with neighbouring disciplines, and it is generally acclaimed as a relatively successful natural science. On the opposite tectonic plate, Whittle argues, psychotherapists have historically restricted themselves to personal insight; that is, the objective study of subjectivity.

Whether understandings gleaned through psychotherapy can be considered ‘true’ depends on there being an accepted criterion for truth, but such a criterion has thus far eluded all students of the mind. In terms of personal accounts, most of us who have had substantial psychotherapeutic experiences can readily testify to moments of genuine recognition that have extended our understanding of ourselves, and which we would have little hesitation in labelling as ‘truths’. It would be overly simplistic to define the fault-line as the boundary between science and non-science. Whereas psychotherapy is probably not a science, by most definitions of this term, the whole question of what is scientific is so fraught, subjective and ambiguous that entering into it here would only obscure the debate. The issue is not whether psychotherapy can be made scientific by changing our definition of science or the way we carry on our business. Far more important than a mere label, however prestigious, is whether the scope of research work undertaken by psychotherapists can be meaningfully extended without destroying the precious understandings that can be achieved through clinical work.

So, what is the nature of the fault or, perhaps preferably, where is the line between the two traditions in the study of mind? In psychotherapy, communication, whether in writing or clinical discourse, is judged by its impact. We accept that something has been understood when the discourse about it evokes a response. Elusiveness and ambiguity are not only permissible in the context of a psychotherapeutic process, they might also be critical to accurately depicting the complexity of a piece of human experience and its evolution. By contrast, the culture of systematic research, particularly that of experimental psychology, is governed by the principle of ‘cognitive asceticism’, as Whittle has termed it. From this perspective, interpretation and theoretical constructions are temptations to be resisted: a position can justifiably be maintained only if it is demonstrable. Given these constraints, it is not easy for empirical psychologists to account for subjective experience, and they have largely preferred to steer clear of attempting to provide such accounts until quite recently, when functional magnetic resonance imaging (fMRI) has brought subjective experience and demonstrable phenomena (brain activity) into close contact again (e.g. Eisenberger & Lieberman 2004, Pessiglione, Schmidt, Draganski, Kalisch, Lau, Dolan & Frith 2007).

But even here there remain incompatibilities between an approach that is essentially ‘first person’, concerned with individual subjective experience, and a third-person observation of neuronal states that represents the traditional neuroscience approach (Northoff, Bermpohl, Schoeneich & Boeker 2007). No wonder psychotherapists fear that the introduction of empirical research methods from this barren world risks the destruction of the phenomena they cherish. Cognitive asceticism is of little relevance to the clinician, whose principal task is to help patients create a narrative that fills the gaps in their understanding of themselves and how they have come to be the way they are. Theory has a heuristic value, supporting a clinician’s understanding of particular cases. Historically, psychoanalytic theories have not been bound by the constraints of empirical research methodology. They can be seen as acts of imagination about how our minds function, which are judged principally according to how well they are felt to fit our own and our patients’ subjective experience. This is not to say that the theories are not true; rather, they are best understood as metaphoric approximations at a subjective level of certain types of deeply unconscious internal experience. We should not accept simplistic critiques of metaphoric thought in psychoanalysis. As Eisenberg (1992), Rothbart (1997) and many others have noted, science uses metaphor in the absence of detailed knowledge of the underlying process. Provided that metaphor is not confused with a full understanding, or, to use Freud’s metaphor, provided that the scaffolding is not mistaken for the building (Freud 1900 p. 536), heuristic considerations outweigh any disadvantages of their use.

However, the problem of psychotherapeutic theorizing is precisely one of heuristics (Fonagy 2003c). The very fecundity of clinically rooted concepts is beginning to threaten the clinical enterprise. Psychotherapists appear to take special pride in producing new theories, fresh elaborations based on the same data. There are currently over 500 distinct clinical approaches to psychological therapy for children (Kazdin 2004). It is hard to believe that all are necessary, or indeed that all are working on different and distinct principles. This has led to an (over) abundance of ideas in the field. What we do less well is to test these ideas in meaningful ways that might help eliminate some of these suggestions. Psychotherapists, like all of us, are vulnerable to uncritical acceptance of charismatically presented new ideas, which then come to be pooled in an eclectic purée of clinical strategies and techniques that create increasing problems in the transmission of psychoanalytic knowledge and skills. Conceptual research, as advocated by Dreher (2000), for example, which aims at the systematic clarification of psychoanalytic concepts, could be an answer. But, despite some brilliant attempts, for example, Sandler’s (1987) examination of identification, projection and projective identification, I know of no example where a serious conceptual study has led to a generally accepted reconceptualization of any psychoanalytic construct. Sadly, the very complexity of extant theory also makes for a built-in resistance to the systematization of psychoanalytic knowledge, as those whose frame of reference depends on ambiguity and polymorphism can be threatened by scientifically based systematic clinical reasoning. In defence of this overly liberal epistemology, many fall back on the Freudian argument of ‘the inseparable bond’ between cure and research (Freud 1926 p. 256).

Psychotherapeutic practice, like all clinical endeavour, has well-established limitations as a form of research. The chief problem with using clinical experience as research is the well known one of induction (Wason & Johnson-Laird 1972). In our clinical activity we mostly tend to concentrate on confirming our theory-based expectations from our patient’s material, and data is not the plural of anecdote. A physician practising internal medicine learns from clinical observations, but is not under the illusion that he or she is engaged in research. However, we are entitled to expect that the physician’s work will be influenced by the results of research, and that his or her reasoning will have been disciplined by scientific training. Of psychoanalytic psychotherapy, it is fair to expect something comparable.

The difference in epistemic approach between psychoanalytic clinician and psychological researcher is largely explained by a distinction in the content of the enquiry. The clinical aims of psychotherapy, and its firm grounding in the context of personal relationships, inevitably push theory towards the deep understanding of mental contents, which can be construed as the key themes that underpin the patient’s reported experiences, feelings and ideas. On the other side of the fault-line, the other sciences of mind such as experimental psychology and cognitive neuroscience are more concerned with mental processes, the way that the mind functions, and the machinery that gives rise to feelings and ideas. Each has its preferred focus. There are occasional attempts to stray into the other domain – social psychology often concerns itself with mapping norms and beliefs, whereas ego psychology attempted to generate a general psychology that anticipated cognitive science in many respects (e.g. Rapap...

Indice dei contenuti

• Cover Page
• Title Page
• Copyright Page
• List of contributors
• List of Figures
• List of Tables
• Preface
• Introduction
• PART I What is child psychotherapy research?
• PART II Studying the process of child psychotherapy
• PART III Evaluating the outcomes and the clinical effectiveness of child psychotherapy
• PART IV Creating connections through interdisciplinary research