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Research and Cognitive Analytic Therapy: What do we need to know?

Pollard, R., 2001. Research and Cognitive Analytic Therapy: What do we need to know?. Reformulation, ACAT News Autumn, p.x.

When I first heard about cognitive analytic therapy, I was attracted by the radical possibilities suggested by a therapy that drew on the ideas of thinkers such as Vygotsky and Bakhtin and that differentiated itself from more narrowly focused psychological therapies by endeavouring to understand and work with people in their social and historical contexts. As I learnt more I felt that CAT was a therapy that could both be respectful of each person's subjective experience whilst conceptualising those aspects which were a source of distress in ways which were non pathologising. When I read the research committee's position paper, however, I felt increasingly dismayed that what was being proposed (with only a token nod in the direction of qualitative research) was the unqualified adoption of a research training agenda centred around positivist empirical methodology without full acknowledgement of the problems associated with this type of research in psychology/psychotherapy. Whilst, in many ways, it may seem highly desirable for CAT therapists to be equipped with these sort of research skills, there seems to me to be a danger that in thus equipping ourselves, we could pay insufficient attention to the social and political dimensions of research activity, unless we also take full account of the criticisms that have been levelled against it.

To question the politics of research, is also to question the politics of psychotherapy. To me, the future of radical socially responsible psychotherapy lies as much if not more in its ability to critically examine its own practices and knowledge base as it does in extending that knowledge base by research. There are considerable pressures on us as therapists in a competitive society to "prove" our effectiveness in ways that can be quantified, and a belief in the efficacy or even superiority of one's own practice can inspire confidence in therapists and clients. However, to claim a particular expertise for one's profession or school of therapy is also a political statement and in order to avoid the pitfalls of arrogance or complacency, we need to be constantly calling into question our own authority and institutionalisation as therapists. An ethical approach to research and practice also obliges

"the producers of therapy discourse to actively participate in the deconstruction of their own texts" (Lowe 1999).

CAT as an established and widely respected therapy, perhaps has as much to gain from constructive and scholarly criticism as it has from being promoted by quantitative research.

" The canonisation of the basic principles of a theory entails much greater danger than criticism from within or without. Theories never are killed by criticism, they die in the hands of jealous disciples who are in a hurry to canonise them..." (Asmolov 1986).

The research agenda of traditional "scientific" psychology has been widely criticised for its psychological reductionism, its individual/social dualism and its unexamined assumptions about the neutrality and objectivity of researchers. Some radical therapists have refuted the notion that there can be any objective social research ( Hoffman 1992) and have claimed that research "findings" are merely a reflection of what is acceptable in a particular social and political context (Kitzinger 1990). Psychotherapists have also been criticised for psychological reductionism and for not for not being equipped with the knowledge to understand their own practice in its socio-political context. That is to account for their own existence other than in psychological terms (Pilgrim 1990). If research is mainly asking psychological questions, requiring psychological answers then it will tend to come up with psychological solutions, but the practice of research itself (like the practice of psychotherapy) may have effects nd implications that are social and political.

Against this it can be argued that whilst it is relatively easy to deconstruct positivist research, it is much harder to produce the empirical knowledge that may help to alleviate emotional and psychological distress. To maintain that all empirical research is spurious also removes one of the means whereby therapists can be held publicly accountable for what they do. Perhaps the adoption of a more uncertain intermediate position that is both cautious and sceptical about the truth claims of positivist research but also resists the nihilism of ever decreasing circles of deconstruction would allow for continued debate without unhelpful polarisation. I would like to see a CAT research agenda that encompasses what Pilgrim (1997) suggests is a much needed dialogue between objectivist and subjectivist positions.

If knowledge about quantitative research and how to do it is to be part of CAT training, then perhaps there ought also to be a commitment to developing a critical understanding of its implied philosophical assumptions about the nature of the person and their specificity to a particular historical and social context. I think we should also be thinking about the possible social and political implications of researching psychotherapy (whether in quantitative or qualitative ways), and trying to develop an understanding of research itself as a social practice which seeks to measure and evaluate psychological phenomena.

Quantitative Research

How research functions is separate from and maybe quite independent of and even contrary to the intentions of the researchers (Richer 1992). My own distrust of the objectivity claimed for quantitative research arose from my experience whilst employed temporarily as a researcher/therapist on a randomised control trial evaluating the effectiveness of family therapy with the families of children who had deliberately harmed themselves or attempted suicide.

The research project, lead by academics and psychiatrists, was funded by the department of health. The stated intention was to find a cost effective way of helping these children and their families in the NHS so as to improve their emotional and psychological well being and to reduce the likelihood of further deliberate self harm and its attendant risk of death.

One of the first things I noticed was the huge variety in the accounts the children and their families gave about themselves and how they came to be so distressed. I became aware of the very subjective nature of the judgements I had to make about how to assess all this information and the how uncertain and how undecidable so much of it was. And then how all this messiness and complexity was somehow to be seemlessly translated into objective data that could be codified, counted and subject to statistical analysis.

It was also apparent, despite the highest intentions of the research team, just how much they had invested in getting a clinically significant and positive result. Much work had already gone into designing and piloting the therapy model. They were anxious to justify the money being spent on the research, not least because there were applications for more funding for more research projects in the pipe line. There was also much talk about the papers they hoped to publish, impact ratings and research assessment exercises.

I became increasingly disturbed and uncomfortable about the social distance between the researchers and the people being researched. Nearly all the families involved were working class and living in areas that are socially and economically deprived. The reasons the children gave for their distress were often social reasons, such as fear of future poverty and unemployment, fear of bullying, anxiety about a parents illness or a parental divorce. Nearly all the families I saw were very poor, often single parent families and most of the adults in the families were unemployed.

Perhaps the most chilling illustration of this distance was the way that the numbers of families recruited into the trial were counted for each research meeting and the hope expressed that enough families could be found to fulfil the statistical requirements of the study before the funding ran out. This was tantamount to saying that children were needed to take risks with their lives so we could go out and assess them and deliver therapy.

(One comment made during the conference debate was that the social distance between researcher and researched is no greater than that between therapist and client. That should not mean that such distance which is essentially a difference of power is not something that should concern us both as researchers and therapists. We may not like the idea that we have power in relation to clients but in avoiding this issue we fail to take account of the role power plays in peoples' distress (Parker 1999). The knowledge that research produces, whilst it may increase the "expertise" of therapists, also increases our power relative to our clients and "... the potential violence of theory, authority, expertise and technology to override the client's contribution to their life narrative" (Larner 1999).)

From the design of the research, it was apparent that the decision about the issues to be researched had been taken by the research team and their decision making was considerably influenced by the funding body. Funding bodies tend to be positivist in outlook and have a considerable influence on how research is conducted. It was also apparent that the people directly affected, the children and their families had no say in what was researched and how it was investigated . They might, if consulted, have had very different ideas about what might have helped alleviate their distress or how all that money could have been spent.

Furthermore the information they gave about themselves was not in a way believed or taken seriously in that it was turned into data for interpretation. This seemed to part of a process whereby the data was separated from the people who supplied it and so removed from its social context (Shotter 1990). In asking only psychological questions, the answers were construed or reconstrued in psychological terms that were amenable to a psychological solution. In disregarding the social and political dimensions of the children’s distress an effect of the research was to locate the causes of distress in the psychological functioning of the children themselves and their families, perhaps adding to their sense of failure and being pathologised or even blamed.

It could be argued that this research project functioned to maintain and promote a psychological explanation of adolescent self harm and in doing so it distracted attention and resources away from the social and political causes of peoples’ distress and the radical implications of the solutions these might suggest.

It also functioned to keep researchers in employment, to further academic and medical careers and to keep money flowing into the university. It also perpetuated the practice whereby middle class researchers and therapists inscribe the subjective experience of distressed working class children and their families.

The Position Paper

A reading of the research committee's position paper suggests that it is far from disinterested or neutral when it comes to research. The paper positions CAT as being different from and by implication superior to other psychotherapies because of its commitment to research, although there seems to have been a general increase in research activity across the whole spectrum of therapy and therapists of many different persuasions seem keen to evaluate, improve and promote their own theories and practices through research. The mental health professions have staked their claim for public credibility to a large extent on the knowledge produced through scientific research. The extent to which they can claim a scientific knowledge base has also been used to draw boundaries around and between different professional groups and demarcate professional territories.

The claims that psychologists, psychotherapists and others in the social sciences make for being scientific, neutral and objective also disguises their (our ) role in societal control both in defining what is normal/abnormal and attempting, however benign our intentions, to get our clients/patients to accommodate to the dominant social norm.

That research is, according to the position paper, is to be used in the "battle " against the forces opposed to psychotherapy is indicative of the fact that research is not value free and that researchers always have a vested interest in an outcome that either promotes psychotherapy over other forms of psychological treatment or CAT over other schools of psychotherapy. The current controversy over genetically modified foods illustrates how saturated scientific research is with values and how commercial and political interests exert a powerful if not controlling influence. If the objectivity and disinterestedness of research into the natural sciences is shown to be a myth how much more this must be true of the human sciences when we are both the researchers and the researched.

And yet the paper refers to the knowledge produced by research as "evidence" as if the beliefs one holds as a result of such knowledge are incontestably true and obviously sensible rational beliefs to hold as opposed to the beliefs one holds as a result of other forms of experience which are dismissed as mere "dogma" and "doctrine" so clearly irrational and prejudiced and representative of narrow sectional interests. It as if "scientific" research could establish the " truth" once and for all and there need never be any more disagreements as to what it is.

What I think is missing from the position paper is an acknowledgement of the many cogent and persuasive critiques of the scientific credentials of research in psychology/psychotherapy. These accounts have exposed the unstated philosophical assumptions about the nature of the social world and the nature of the person that it is inherent in most psychological research. The idea that researchers can adopt the position of neutral detached observer, has been discredited by post-structuralist critiques as have the linear, teleological and binary (subject/object) assumptions of positivism and the representational role of language ( Lather 1992). They have also queried the separation of dependant and independent variables and how some are accorded more significance than others ( Spears & Parker 1996).

In response to the charge that psychotherapy is a social practice which tends only to look at psychological variables, we need to look beyond the methodology and outcomes of research, and consider the ideological and political agendas that maybe behind the decisions as to what constitutes a problem, what issues need to be researched and what sort of questions need to be asked.

Perhaps most important, there needs to be an acknowledgement of the role of power in research, the relationship between power and knowledge and how scientific research or rather research seen as scientific empowers its possessors with knowledge often at the expense of others who are excluded from this knowledge. Related to this is the potential for research whether quantitative or qualitative to exploit the people it uses as its subjects in the pursuit of agendas and aims they have no say in and might perceive as contrary to their own interests.

These arguments may not necessarily succeed in undermining the case for quantitative research and people actively engaged in CAT research are no doubt very familiar with them. But in not acknowledging these accounts, the position paper is written as if they don't exist. I think these arguments need to be taken very seriously and engaged with. Research does not have a monopoly on knowledge or the truth and has to make a case out for itself. The position paper is written as if there is no case to answer.

References

Asmolov, AG. (1986), Basic Principles of a psychological analysis in the theory of activity, Soviet Psychology xxv, 2:78-101.( cited in Daniels, H. (ed) (1986) An Introduction to Vygotsky, Routledge.)

Kitzinger, C (1990), The Rhetoric of Psuedo Science, in ed. I. Parker & J. Shotter, Deconstructing Social Psychology, Routledge.

Larner, G. (1999), Derrida and the Deconstruction of Power as Context and Topic in Psychotherapy, in ed. I. Parker, Deconstructing Psychotherapy, Sage.

Lather, P (1992), Postmodernism and the Human Sciences, in ed. Kvale, S. Psychology and Postmodernism, Sage.

Lowe, R (1999), Between the 'No Longer' and the 'Not yet': Postmodernism as a Context for Critical Therapeutic Work, in ed. I. Parker, Deconstructing Psychotherapy, Sage.

Hoffman, L (1992), A Reflexive Stance for Family Therapy, in eds. S. McNamee, & K. Gergen, Therapy as Social Construction, Sage.

Parker, I (1999), Deconstruction and Psychotherapy, in ed. I. Parker, Deconstructing Psychotherapy, Sage.

Pilgrim, D (1997), Psychotherapy and Society, Sage.

Pilgrim, D (1990), Researching Psychotherapy in Britain, The Limits of a Psychological Approach, in eds. Parker, I. & Shotter, J. Deconstructing Social Psychology, Routledge.

Richer, P (1992), An Introduction to Deconstructionist Psychology, in ed., Kvale, S. Psychology and Postmodernism, Sage.

Shotter, J (1990), Social Individuality Versus Possessive Individualism, The Sound of Silence, in eds., Parker, I & Shotter, J., Deconstructing Social Psychology, Routledge.

Spears, R. & Parker, I (1996), Marxist Thesis and Psychological Themes, in eds. I. Parker & R. Spears, Psychology and Society, Radical Theory and Practice.

Rachel Pollard

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Pollard, R., 2001. Research and Cognitive Analytic Therapy: What do we need to know?. Reformulation, ACAT News Autumn, p.x.

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Research and Cognitive Analytic Therapy: What do we need to know?

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