Learning from the client: The challenges of psychotherapy research and the contribution of qualitative methodologies

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By Eva Fragkiadaki

The implications of nomothetic psychotherapy research

Psychotherapy research has made significant progress in providing strong evidence for process and outcome in favour of specific approaches. However, after many years of research and advanced methodologies, we are still unsure about why psychotherapy works, and how and to what degree these findings can be applied in everyday practice (Kazdin, 2009). Evidence-based approaches do not appear to be effective for everyone, and the mechanisms of change are still investigated with diverse findings. Randomised controlled trials (RCT) and meta-analyses inform policy and guidelines followed by the likes of the National Institute for Health and Care Excellence (NICE). Illustrating this, NICE Guidelines for the treatment of Depression state that “well-defined” depression can be treated with CBT based on its proven efficacy, however “it is not effective for everyone” (NICE, 2009). Clinicians need evidence-based recommendations to inform their work with clients. It is notable though that evidence-based practice is based on nomothetic, quantitative approaches of inquiry but what is actually demanded from practitioners is to apply these theories in an idiographic context and adjust to the needs of the individual who seeks help (Persons, 2008).

One cannot reduce psychotherapy to specific factors and cannot reduce the person to a specific list of symptoms. Added to that, each psychotherapeutic encounter is unique, in terms of transference and real relationship factors. Rigid diagnosis criteria are challenged and culturally sensitive, social models of diagnosis are encouraged in the literature, which question the constant pursuit of functionality, fulfilment and happiness (Kirmayer, Gomez – Carillo & Veissiere, 2017). In reality, clients with the same labels are likely to experience their diagnosis in different ways (Hayes et al, 2019). Moreover, each therapist has inherent biases and internal processes of interpreting each client before deciding which interventions to apply and how (Makhinson, 2012). The therapist’s training, expectations, overgeneralisations and pressure for positive results have a significant impact on the decisions they will make for therapeutic action plans. Lastly, each psychotherapeutic dyad is different, each process that unfolds in this context is a different experience for both parties. Even if the therapist follows the same approach guidelines, they will be different with different clients (Hill, Chui & Baumann, 2013). Each therapeutic encounter forms a new interaction and discussion; a new therapy (Baldwin & Imel, 2020).

Traditional psychotherapy efficacy research struggles to capture the level of complexity therapeutic interactions entail. The findings make inferences about the general population but do not necessarily apply to the individual (Hayes et al., 2019). Another issue is the difficulty in defining each therapeutic modality given the new approaches that appear and their variations in application. Too many approaches are now presented in the literature for too many syndromes which account for too many statistical models, and the number is growing (Hayes et al., 2019). Moreover, there are many confounding factors when trying to measure the effects of psychotherapy, such as the therapist’s subjectivity, training, supervision, the therapist and researcher’s expectations and the clients’ presenting difficulties. The researcher’s subjectivity must also be recognised in the research process even for the most rigorous RCTs. Psychotherapy research entails bias and the effectiveness of psychotherapy can be exaggerated. Moreover, many studies may remain unpublished if results support null or negative hypotheses (Dragioti, Karathanos, Gerdle & Evangelou, 2017).

Going back to case analysis: the idiographic paradigm in psychotherapy research

Psychotherapy is a multi-faceted, complex phenomenon. How can we understand and represent its variability in evidence-based findings? Research is moving away from protocol and approach specific treatments towards a more client-centred way of exploring psychotherapy efficacy; it instead becomes a “personalized treatment” (Zilcha-Mano, 2019, p. 694). The focus is on the implementation of methodologies which can do justice to the complexity and variability of the phenomenon of psychotherapy. Qualitative research allows the exploration of the multidimensional interactions in psychotherapy encounters and the emergence of unexpected results (Hill et al., 2013; McLeod, 2011). By implementing methods such as the Narrative Assessment Interview (Angus, Levitt  & Hardtke, 1999), the  Change Interview (Elliott, Slatick & Urman, 2001) or the Hermeneutic Single-Case Efficacy Design (Elliott et al., 2009), qualitative research is nowadays being used more often in exploring psychotherapeutic processes and effects.

As psychotherapy researchers, we need to pursue a route that is different to “protocol-to-syndrome.” We are moving away from labels and therapy “brands” (Hofman, 2020, pp. 297 – 298) towards elaborate descriptions of people and therapies, focusing on what works, why and how, for both specific individuals or groups that share common characteristics. The suggestion is to distance ourselves from theory-driven process and outcome studies, from measurable and quantifiable behavioural changes (Hill et al., 2013) and instead to approach the client’s perspective in an open and explorative way; to enable learning and knowledge derived from the clients’ experience of psychotherapy efficacy. In particular, idiographic qualitative phenomenological research offers the means to explore intrapsychic change. A well-designed case study provides detailed, in-depth knowledge which is readily applicable to everyday clinical practice (Persons & Boswell, 2019).

Interpretative Phenomenological Analysis (IPA) is a qualitative methodology that focuses on the individual’s unique experiences of the situation studied. IPA can make a significant contribution by enabling researchers and practitioners to gain insights into client’s experiences of therapeutic processes. The philosophical, epistemological, and methodological underpinnings and guidelines of IPA allow for an in-depth exploration of the client’s experience, leading to significant conceptualisations on how therapeutic approaches work (Larkin & Thompson, 2012). It is based on the phenomenological paradigm as outlined by Husserl, Heidegger, and Merlau-Ponty (Smith, 1996; Smith, Flowers, & Larkin, 2009). It provides the framework to place the therapeutic encounter in context and analyse it; to go back to the phenomenon of psychotherapy “on its own terms.” The focus is on individuals, their subjective accounts and perceptions, bracketing the understanding of preconceived ideas, beliefs, and expectations.  IPA methodology views persons in-context as they expound on embodied, dynamic, and interactive experiences. Interpretation in IPA implies moving away from the obvious, focusing on the meaning participants attribute to their experience, engaging in a dialogue with the data, and illuminating sense-making (Smith, 1996; Smith et al., 2009). 

Adhering to an existential framework, IPA methodology does not rely on psychological theories for the collection and analysis of data. It is data-driven, emphasizing personal experience (Smith, 2017). It is deemed a useful method for psychotherapy process exploration as it frees the researcher from the compounds of psychotherapy theory and gives voice to the clients’ unique experience and intersubjective meaning-making processes (Larking & Thompson, 2012). Phenomenological methods have been applied to the exploration of adults’ experiences of psychotherapy during their childhood have changed their live, clients’ experience of positive change and to psychotherapy outcome studies (Binder et al., 2010; Midgley, Target, & Smith, 2006; Olofsson et al., 2019; Wilmots et al., 2019). IPA applied to psychotherapy research allows for the exploration of the clients’ perspective, the meaning they attribute to seeking and receiving help and how they conceptualise the psychotherapy process rendering the results useful for incorporation into everyday clinical practice (Binder et al., 2010; McLeod, 2011; Midgley et al., 2014). IPA guidelines help researchers keep the focus on the participants’ experiences and meaning-making processes, and can further bolster and clarify the knowledge of psychotherapy effects from the clients’ perspective.

Conclusions

Nomothetic approaches to research claim that there is one absolute truth outside of us to be discovered (Ponterotto, 2005). As psychotherapy researchers, the phenomenological perception of truth helps us view psychotherapy as real however it is the individual’ consciousness that determines its reality. IPA exploration of psychotherapy brings research back to the clients, to their experience of change, from which we can acquire significant insight on how and why psychotherapy works. We go back to the individual case and understand the psychotherapy processes from their perspective. Thus, the findings are closely linked to practice. Inventories and questionnaires may capture a small proportion of this variability in psychotherapy change procedures, but they are restricted to overt behaviours and symptoms whilst the questions might not be applicable to the person’s issues. The use of qualitative research methods in psychotherapy effectiveness and outcome research adds to our efforts to comprehend when and how psychotherapy works in an explorative and descriptive manner.

Qualitative psychotherapy research allows for the client’s voice to be heard. Their perceptions and interpretations of psychotherapy process and change may guide research conclusions, theory advancements and policies. Hence, psychotherapy is adjusted to the clients and the service users, and not the other way around. In recent literature, a more pluralistic method of inquiry is now considered in an effort to address the diversity of psychotherapy processes, encouraging researchers’ reflexivity on the aspect of psychotherapy they choose to explore (Rieken & Gelo, 2015). Various methodologies and epistemologies are now employed in the search for an answer to why psychotherapy works. Qualitative methodologies, and especially IPA, places the client in–context considering psychological, physical and social aspects of their experience of psychotherapy. Like clinicians who tailor their use of techniques to the specific client in the specific therapeutic relationship, researchers should consider individual needs, culture and social context, tailoring research methods to specific aspects of psychotherapy process and change.

References

Angus, L., Levitt, H. & Hardtke, K. (1999). The narrative processes coding system: Research applications and implications for psychotherapy practice. Journal of Clinical Psychology, 55(10), 1255 – 1270.

Baldwin, S. A., & Imel, Z. E. (2020). Studying specificity in psychotherapy with meta-analysis is hard. Psychotherapy Research, 30(3), 294–296. https://doi.org/10.1080/10503307.2019.1679403

Binder, P.-E., Holgersen, H., & Gier Høstmark, N. (2010). What is a “good outcome” in psychotherapy? A qualitative exploration of former patients’ point of view. Psychotherapy Research, 20(3), 285 – 294. doi: 10.1080/10503300903376338

Dragioti, E., Karathanos, V., Gerdle, B., & Evangelou, E. (2017). Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatrica Scandinavica, 136(3), 236–246. https://doi.org/10.1111/acps.12713

Elliott, R., Partyka, R., Alperin, R., Dobrenski, R., Wagner, J., Messer, S. B., . . . Castonguay, L. G. (2009). An adjudicated hermeneutic single-case efficacy design study of experiential therapy for panic/ phobia. Psychotherapy Research, 19, 543–557. doi:10.1080/
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Elliott, R., Slatick, E., & Urman, M. (2001). Qualitative change process research on psychotherapy: Alternative strategies. In J. Frommer & D. L. Rennie (Eds.), Qualitative psychotherapy research: Methods and methodology (pp. 69–111). Lengerich, Germany: Pabst Science Publishers

Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117(October 2018), 40–53. https://doi.org/10.1016/j.brat.2018.10.005

Hill, C. E., Chui, H., & Baumann, E. (2013). Revisiting and reenvisioning the outcome problem in psychotherapy: an argument to include individualized and qualitative measurement. Psychotherapy, 50(1), 68 – 76. doi: 10.1037/a0030571

Hofmann, S. G. (2020). Imagine there are no therapy brands, it isn’t hard to do. Psychotherapy Research, 30(3), 297–299. https://doi.org/10.1080/10503307.2019.1630781

Kazdin, A. E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19(4–5), 418–428. https://doi.org/10.1080/10503300802448899

Kirmayer, L. J., Gomez-Carrillo, A., & Veissière, S. (2017). Culture and depression in global mental health: An ecosocial approach to the phenomenology of psychiatric disorders. Social Science and Medicine, 183, 163–168. https://doi.org/10.1016/j.socscimed.2017.04.034

Larkin, M. & Thompson, A. (2012). Interpretative phenomenological analysis. In Thompson, A. & Harper, D. (eds), Qualitative research methods in mental health and psychotherapy: a guide for students and practitioners. John Wiley & Sons: Oxford, pp. 99-116.

Makhinson, M. (2012). Biases in the evaluation of psychiatric clinical evidence. Journal of Nervous and Mental Disease, 200(1), 76–82. https://doi.org/10.1097/NMD.0b013e31823e62cd

McLeod, J. (2011). Qualitative research in counselling and psychotherapy. London: Sage.

Midgley, N., Ansaldo, F., & Target, M. (2014). The meaningful assessment of therapy outcomes: Incorporating a qualitative study into a randomized controlled trial evaluating the treatment of adolescent depression. Psychotherapy, 51(1), 128 – 137. doi: 10.1037/a0034179

National Institute for Health and Care Excellence. (2009). Depression in adults: Recognition and management (NICE Clinical Guideline CG 90). Retrieved from https://www.nice.org.uk/guidance/cg90

Olofsson, M. E., Oddli, H. W., Hoffart, A., Eielsen, H. P., & Vrabel, K. R. (2019). Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study. Journal of Counseling Psychology, advanced online publication. doi: 10.1037/cou0000375

Persons, J. B. (2008). The case formulation approach to cognitive – behaviour therapy. Guildford Press.

Persons, J. B., & Boswell, J. F. (2019). Single case and idiographic research: Introduction to the special issue. Behaviour Research and Therapy, 117(March), 1–2. https://doi.org/10.1016/j.brat.2019.03.007

Ponterotto, J. G. (2005). Qualitative research in counseling psychology: A primer on research paradigms and philosophy of science. Journal of Counseling Psychology, 52(2), 126–136. https://doi.org/10.1037/0022-0167.52.2.126

Rieken, B. & Gelo, O. C. G. (2015). The philosophy of psychotherapy science: Mainstream and alternative views.  In: Gelo O., Pritz A., Rieken B. (eds) Psychotherapy Research. Springer, Vienna

Smith, J. A. (1996). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology and Health, 11(2), 261 – 271. doi: 10.1080/08870449608400256

Smith, J. A. (2017). Interpretative phenomenological analysis: Getting at lived experience. The Journal of Positive Psychology, 12(3), 303 – 304. doi: 10.1080/17439760.2016.1262622

Smith, J. A., Flowers, P. & Larkin, M. (2009). Interpretative Phenomenological Analysis. London: Sage Publications Ltd.

Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S. & Loades, M., (2019). The therapeutic relationship in Cognitive Behaviour Therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy: Theory, Research and Practice. doi: 10.1111/papt.12232

Zilcha-Mano, S. (2019). Major developments in methods addressing for whom psychotherapy may work and why. Psychotherapy Research, 29(6), 693–708. https://doi.org/10.1080/10503307.2018.1429691

Here be ‘cognitivism’

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By Miltos Hadjiosif

Psychology, like all disciplines, has a history. Like all histories, it is a contested one, and it often unravels within a dominant narrative that might surprise you. For instance, the birth of the psychological laboratory in Leibzig, Germany in 1879, its founder Wilhelm Wundt, and the American behaviourist B.F. Skinner are considered far more influential to the development of contemporary psychological science than the psychoanalytic insights of Carl Jung or Melanie Klein. My teaching experience suggests that, in their vast majority, psychology undergraduates are left a little dissatisfied at the end of their degrees insofar as their understanding of human behaviour is concerned. Psychological knowledge in the last 40 years has developed largely in silos and final year courses offer quite specialised explorations of processes (social, developmental, biological, or cognitive) that underpin human psychic life. Thus, rare opportunities are afforded for some sort of synthesis of perspectives that can form an even partially satisfactory answer to the question: ‘so, why do I do the things I do?’.  As academics, we face enormous pressure to profess expertise in specialised topics, publish our work in journals that mainly speak to other academics, and create our brand by accentuating the unique contribution(s) we have made to the discipline. ‘I teach why people do the things they do’ sounds just as silly as it is impossible. But shouldn’t studying psychology help us understand ourselves and others around us?

Cognitivism is a term that has been used to describe the influence of cognitive psychology (the study of mental processes such as attention, memory, and problem solving) on mainstream psychological theory as well as popular perceptions of human subjectivity. Experimental social psychology for instance talks of social cognition, namely what our brains do when we are in groups. Many theories suggest that the social world ‘enters’ individuals via biosensory pathways and cognitive mechanisms, which can be schematically represented as diagrams (and who doesn’t love a good, self-evident diagram?) and subjected to empirical testing. The brain (or ‘mind’) is widely hailed as the seat of selfhood, and I bet that if you asked people which organ represents them best, most people would pick their brains. That is, despite emerging evidence from medicine that implicates the digestive system (gut) in interesting psychophysiological processes, few people would name their intestines as the bit of tissue they would want preserved in a jar, and I am probably not one of them. Psychoanalytically speaking, there’s nothing surprising in the finding that the gut is a significant locus of psychological activity; after all emotions have to be symbolically digested somewhere. ‘One brain per person’ is how it works, and psychology loves some good old-fashioned dualisms. And so it has come to pass that psychology will leave the study of societies to sociology and social anthropology and cast its expert light on the unit of analysis that no mortal shall divide: the individual.

Cognitivism seeps into all other branches of psychology; thus, a unitary subject that is knowable, predictable, and bound by reason emerges undisputed.  How I hear you ask? Let’s rewind. Cognitive psychology arose as a direct challenge to Watsonian ‘black box’ psychology, a necessary critique of the idea that humans are shaped solely by environmental contingencies and schedules of reinforcement. It blossomed in parallel with the computer revolution and adopted much of the language of computer science (input, network, information processing, mechanism etc). Some 70 years later, this language is not confined to the study of largely involuntary brain processes such as space perception or executive function. Quite the contrary, it has implied, assumed, and naturalised the reality underpinning most of human behaviour. It’s not cognitive psychology’s claims that solidify cognitivism, in fact cutting-edge research in this area has probably moved beyond it.  This is how discourse (a devilishly slippery concept) works: an ideology such as the one we are dealing with can only become entrenched if it is propped up by a myriad of supporting beams. Cognitivism engulfs reality with every university psychology department that uses imagery such as an electrode-wired person to promote itself to prospective applicants (and funders). It lurks in the most innocuous of everyday utterances: ‘it’s all in your head’. And it goes unchallenged because no self-respecting psychologist would ever explicitly defend the position: ‘we are just our thoughts’.    

This creates several problems for contemporary psychology, if one takes that to mean the study of ‘why we do the things we do’. It is less of a problem if one is concerned with ‘how we do what we do’, but the critique still applies I believe. Humans are not like computers in that we possess a tricky little thing called consciousness and an equally tricky if not more tangible thing called the body. Let’s pretend that there’s no such tricky little thing as soul or spirit, otherwise this brief commentary will get derailed. How consciousness manifests, is embodied, and interacts with other conscious beings is, really, what psychologists are studying. We need access to more than just cognition to understand why people fall in love, why they fight, why they suddenly act in unpredictable ways, and what happens when many people co-exist for prolonged periods of time. Family dynamics, ambivalent friendships, and toxic couples won’t make much sense by illuminating the intricacies of individuals’ cognitive apparatus. Why we feel what we feel is, invariably, more interesting to the undergraduate student than why the ‘tip of the tongue’ phenomenon occurs. Affective cognition is cognitive psychology’s answer to the former. So what about relationships? Cue crickets.

There are good reasons why cognitivism has prevailed, not least because it squares with scientific methods, Western biomedicine, and reasonable expectations for publicly funded psychological research to have utility and applied value. Measuring things and discovering variables that affect human behaviour often translates into practical solutions for many a modern malady. In consequence, mainstream psychology enjoys widespread applications in health, occupational, and even recreational settings. At the same time, we should not ignore the more sinister reasons. As it squares, it concurrently dovetails with an ideology of the human subject as a predictable, fixable machine that can be controlled and programmed. It delights advertisers who are in search of the ideal font, image, or message to feed consumerism. It makes sense to politicians who, through no fault of their own, are also entangled in its discursive net and therefore look to psychology to fix symptoms (or hide them) rather than transform conditions to prevent the problems in the first place. It makes people feel cleverer as it follows a rational methodology and can be delightfully illuminating to the mind that has been trained all its life to excel and produce without ever pausing to reflect on the unbearable question: ‘what and who am I producing for?’.

A little context on the writer so that the reader can more fully appreciate the vested interests in this article (free tip: all discourse carries vested interests and (dis)locations of power). I studied for a 4-year experimental psychology degree, which I enjoyed, and my first job was as a statistics instructor for the university I graduated from. After a brief detour that involved meeting Avril Lavigne and dining with Patti Smith, I trained as a counselling psychologist. Whilst in training I took issue with several other assumptions counselling psychology made (the allure of cognitivism is perhaps less felt in this particular corner of applied psychology) but I finally found a home so to speak in another sub-discipline: community psychology. After struggling for many years, I can finally combine my passion for community psychology with my expertise as a counselling psychologist and proudly co-organise the Community Psychology Festival, an annual event borne out of hope and glitter. Even though I write from this intersection, I am informed and shaped by theories and experiences that are not immediately apparent in my professional identities.

It might therefore not surprise the reader to know that I take issue not with the very existence of cognitivism, but with its obliterating influence on all other ways of conceptualising human beings. I don’t for a second believe that we are rational and unitary; our internal worlds consist of affectively laden ‘bits’ that can be pre-verbal and unconscious (this is a Kleinian view), and I have started wondering whether producing a coherent self is more of a hassle than it is to surrender to the possibility of multiple selves, even if some of them are conflictually aligned against others. ‘Make happy thoughts’ is just about the worst advice you can give someone experiencing depression or anxiety. I have a problem with cognitivism’s unintended consequence of eradicating the social dimension of what it means to live and act in this world. I try hard to instil in my students a scepticism of mechanistic claims that do not recognise just how deliciously neoliberal their implications for the human condition are (see previous blog entry on ‘resilience’ by Dr Miles Thompson). Speaking of ‘resilience’, this research paradigm is only just beginning to acknowledge that metals should be resilient, humans not so much. Imagine a person who suffers a messy breakdown at work when they are working on a temporary contract and their partner is diagnosed with a terminal illness, at a time when healthcare has been privatised. A breakdown is the healthy response here; that is what should happen in the name of ‘normality’. Quite what form that breakdown may take is a different matter; I do not wish to absolve our fictional friend from personal responsibility. I am not comfortable with ‘victim culture’ and people who are unwilling to locate their own complicity in their suffering; that is if social-material conditions allow for such agency. But to condone any notion that said fictional (yet easily recognisable) person will be described as ‘resilient’ if they continue to work with a stoic half-smile and be in rational control of their emotions is where I draw a line.

No account can ever be ‘objective’, or definitive for that matter, and I do not wish to naively scapegoat cognitivism; rather I seek to reiterate that complex institutional and social conditions have allowed it to enjoy unprecedented platforms (hello inane ‘wellbeing’ apps) and unchallenged status in the Western world. This point has been made before. Several times. It is articulated every time sacred wisdom such as the Buddhist practice of mindfulness is usurped, diluted, decontextualized, and packaged in a cognitivised version, easily available for mass consumption. Distinguished cognitive scholars have grappled with some of the issues described here, and some have actually protested the dominance of the machine as the ultimate metaphor to symbolise psychological activity (cf. Jerome Bruner’s work). How many psychotherapists must speak up to protest the irrational (the irony!) program of mass mental hygiene that IAPT has become? How many psychologists must swallow their ‘depression’ and ‘anxiety’ (50% at the last count) in mental health settings before we all agree: “The psychologists and their cognitive errors (‘I can’t cope’, ‘I’m not good enough’, ‘This is hopeless’) are not the problem here!” Clinical and counselling psychologists know that cognitive interventions have a place in working with distress, but it is certainly not the place they currently occupy. So you might ask, if this has been said many times before, and it is not a hugely incomprehensible point to get hold of, why is there need to still write about it? Hmmm…Let’s call it ‘selective attention’, shall we?   

Further reading:

Bruner, J. (1991). The narrative construction of reality. Critical Inquiry, 18(1), 1-21.

Desai, M. & Hadjiosif, M. (2020). The evolution of the community psychology festival. In C. Walker, S. Zlotowitz, & A. Zoli (Eds.), New ideas for new times: A handbook of innovative community and clinical psychologies (in preparation). London: Palgrave.

Henriques, J., Hollway, W., Urwin, C., Venn, C., & Walkerdine, V. (1998). Changing the subject:  Psychology, Social Regulation and Subjectivity (2nd ed). London: Routledge. (Original work published 1984).

Parker, I. and Shotter, J. (Eds.) (1990) Deconstructing social psychology. London: Routledge.

One novel and one TV show that stimulated this piece:

‘The word for world is forest’ by Ursula K. Le Guin (1976)

‘The OA’ by Brit Marling and Zal Batmanglij (2016-)

Follow the Community Psychology Festival on facebook: https://www.facebook.com/communitypsychologyfestival/

Introducing our new lecturer, Dr Eva Fragkiadaki!

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By Eva Fragkiadaki

My name is Eva Fragkiadaki, and I have recently joined the UWE Department of Health and Social Sciences as a Senior Lecturer in Counselling Psychology.

I received my undergraduate degree in Psychology from University of Crete in Greece. I then moved to London where I completed my Master of Science in Counselling Psychology as well as my Professional Doctorate (PsyD) in Counselling Psychology at City University of London. Prior to joining UWE, I worked as an Assistant Professor and Director of the Psychology Division at Hellenic American University (Athens, Greece) for three years.

At UWE, I will be primarily teaching at the Professional Doctorate in Counselling Psychology programme, and I will also be involved in the roles of Placement Coordinator, Director of Studies as well as supervisor of undergraduate dissertations.

I am a qualitative researcher and my projects have been based on constructionist methodologies like Grounded Theory and Narrative Analysis, but recently I have engaged more into phenomenological paradigms and Interpretative Phenomenological Analysis in particular. My scholarly interests initially involved the exploration of psychotherapy termination, trainees’ professional development, mental health practice and the impact of financial crisis on people and services. Over the last years, my research focuses on the investigation of psychotherapy process, change and outcome, developing longitudinal, mixed method and qualitative study designs. I have collaborated with academics and researchers from Greece, UK, Netherlands, and USA, and I have published academic articles and peer-reviewed chapters based on my research activities. Given my expertise in qualitative methodologies, I have been invited to facilitate seminars and also consult on projects by a number of institutions. Moreover, I have been the organizer of five qualitative research panels in national and international conferences and I have been invited to participate in numerous discussions as a presenter. Recently, I was invited to be the keynote speaker in an international conference of the American Counseling Association.

I am a trained psychotherapist, adhering primarily to the psychodynamic and psychoanalytic model of formulation and practice but I have also been trained in Cognitive Behavioural approach. I have worked on short and long term therapeutic basis with a variety of clinical cases (depression, anxiety disorders, personality disorders, psychosis etc.) and ages (adults, adolescents, children and families). I have collaborated with social workers, play therapists, psychiatrists, teachers and other professionals in the fields of mental health and education. I adhere to the scientist – practitioner model based on my academic and clinical training and practice. As a researcher and a psychotherapist I believe the two domains interact and inform each other. I try to encourage this model to my students and trainees.