What is the relationship between the extent of manualised practice and ‘effective’ Psychotherapy?

Abstract

The research explores the drive for efficacy through method and technique in psychotherapy and the implications this has for the effectiveness of psychotherapy. Considering this from an existential lens raises the question of whether we become conditioned by the very inquiry we attempt to carry out. If this is so, what does this mean for the practice of psychotherapy when we use high levels of manualised practice and technique?
Taking the view that psychotherapeutic technique is a technological matter in which something is learnt, deployed and applied, the study explores how the increase in procedural and technical thinking shapes and mediates experiences for the therapist and their clients. This begins by viewing the capacity to be technical in the therapy room as one potentiality of how the therapist as a ‘Being’ might show up in the world. This prompted an inquiry into the impact on the therapist and their practice when social, economic, and political agendas call upon their technical capacity to maximise metric outcomes as opposed to engaging in what emerges from the therapy. The researcher carried out twelve in depth interviews from therapists across a range of modalities as part of a qualitative study. The purpose of which was to explore how different levels of manualised practice mediated their experience in the therapy room. With the shaping force of method and technique central to this inquiry, it was decided that the methodology would approach the interviews from two perspectives. The first approach used Giorgi’s (2009) method of ‘Descriptive Phenomenological Analysis’ which is highly technical in its analysis but remains within the qualitative umbrella of research methodology as it gathers the lived experiences of therapists whilst remaining technically engaged with the process. The second perspective, moves away from method and technique toward a personalised encounter rooted and in relation to ethics, creativity and exploration rather than instruction. This allowed for an experiential insight into research which emerges from the work as opposed to applying a pre-existing methodology to elicit outcomes. Therefore, approaching these interviews from varying levels of manualised research practice allowed the study itself to become an illustrative component of the research. The findings from this small scale study indicated that tools, techniques and frameworks are at their most helpful when used as a creative component of the process and context in which therapist and client create meaning unique to their space. Highly manualised interventions were viewed as negatively impacting the therapeutic relationship and over time having a detrimental effect on the therapist. In particular, therapists felt their development was hindered, relational depth was impacted and an incremental erosion of their confidence was felt. Often, the therapist’s only tool to navigate or challenge harsh working environments is to leave. The findings implied that the higher the level of manualised intervention, the more likely this was to serve wider organisational systems as opposed to the therapy itself. This brings to the forefront, the importance of acknowledging our relationship with method and technique, as part of an ethical engagement with our practice.

Date of Award	23 Jul 2024
Original language	English
Awarding Institution	University of Roehampton
Supervisor	Del Loewenthal (Director of Studies) & Onel Brooks (Co-Supervisor)