An Investigation of Session Impact and Alliance in Internet-Based Psychotherapy - Literature review Example

?Psychology Final Assignment (a) Summarise the research article on “An investigation of session impact and alliance in internet based psychotherapy” which you will find in Appendix 2 (500 words). The main purpose of the study on session impact and alliance in internet based psychotherapy (D’Arcy et al., 2006) is, as the title suggests, to investigate how therapists and clients rate two aspects of the counselling experience in a context of internet based delivery rather than the more conventional face to face context. This is a relatively new area of research, because the technology for such forms of communication has only been developed in the last twenty years, and the population at large has only become proficient in email and instant messaging in the last ten years or so. It is important to evaluate any changes in traditional delivery systems as they are being introduced in order to check whether they are having any positive or adverse effects, and to ensure that all the usual mechanisms for client welfare and quality control are in place. The two aspects of “session impact” which refers to the effect of the counselling session on the client, and “alliance” which refers to the quality of the relationship between the client and the counsellor, are critical factors in the counselling process. The presence of the computer between client and counsellor could, in theory, interfere with these two aspects, and that is the main reason why the researchers investigated this topic. The methodology used in this study is that of questionnaire and analysis. The researchers used two existing questionnaires, which had previously been adopted in respected studies of traditional face to face counselling sessions. The sample size was 16 therapists, who rated a total of 178 sessions, and 17 clients, who rated a total of 205 sessions. Participation was voluntary, with due regard for ethical issues such as the completion of consent forms and the recruitment of participants. Some of the results were dyadic, meaning that both counsellor and client rated the same session, but the majority of the ratings were just from either the counsellor or the client of a session. Demographic data was collected, showing a predominance of Caucasian female clients having at least high school education, and the majority of the counsellors were qualified to practice in the United States. The session evaluation questionnaire (SEQ) used “21 seven point bipolar adjective items” and the alliance measurement was the Agnew Relationship Measure, consisted of a short form with 12 items, using a seven point scale ranging from “strongly disagree” to “strongly agree”. The results are discussed using tables which show consistency reliabilities (coefficient alpha), means, and standard deviations and a commentary explaining what they mean. There are also some key questions which are highlighted inside a textbox, and this helps the reader to focus on the main points while looking at the detail of the data. The results, which are described by the authors as “preliminary results” (D’Arcy et al., 2006, 167), show generally positive evaluations on the part of both clients and counsellors, in terms of both session impact and alliance. Internet based counselling appears therefore to be rated as at least as effective as face to face counselling. This is interpreted as showing “a qualified encouragement for current face to face practitioners and potential clients” (D’Arcy et al., 2006, 167). There are some caveats relating to sample size and narrow demographic range, and there is an interesting finding that counsellors rated the alliance aspect more positively than clients, which raises a number of issues that merit further investigation. (b) Discuss the strengths and weaknesses of the approach to research contained in this article (1000 words). A major strength of this article is that it is breaking new ground by investigating the way that new technologies are being introduced into the counselling profession. There has been some research done in this field already, and the authors briefly mention this, but it is clear that the subject has not been exhausted, and that so far there is not much agreement on the effectiveness of internet based counselling as compared with traditional face to face counselling. The article thus contributes to this on-going debate and clarifies areas which need to be researched further. The decision to use established questionnaires which had been designed by previous researchers was a very good one, because this allows the data to be compared easily with research which has already been tried and tested. This means that the methodology and data analysis parts of the article are not very original but in cases where new aspects are being investigated, it is often wise to start with a foundation that is accepted and secure. This pre-empts arguments against the work from researchers who may have initial reservations about internet counselling. There is a long discussion about the way that participants were recruited, and this betrays some insecurity on the part of the authors about the nature of the sample. There is an inherent bias in both counsellors and clients in so far as they all must have a relatively positive attitude to computers, and considerable confidence and proficiency in using them. These factors indicate levels of prosperity, attitude to novelty, stability and education that are perhaps above the average in any national population. This means that the article cannot make any generalized statement for the whole population. Another weakness was the fact that the majority of the clients were female, and that there was a wide range in presenting conditions, with uneven distribution towards depression. This means that there is a danger here of significant variables being missed, since there is no disaggregated comparison of, for example, those meeting as a result of childhood abuse, and those meeting as a result of stress. The numbers of clients in these categories are very small ( N= 2 and N=4 respectively) but they may be similar or different to the larger cohort meeting as a result of depression (N= 8). The article appears not concerned with these variables, but focusses instead on the mean for the whole sample. The article has a clear focus on quantitative rather than qualitative analysis. This can be a positive feature, because it allows conclusions to be drawn on the basis of the numbers alone, and there is no distracting interpretation needed, before actual results are seen. The logic behind this is rooted in the beginnings of counselling, when efforts were made to demonstrate the scientific basis for interventions, and the tangible benefits that it can bring. The table produces a concrete evidence base which can then be manipulated and tested against other similar evidence bases, giving information that can be tracked back to the original data. The disadvantage of this particular set of evidence is that it is all derived from self-reporting, and there is no guarantee that participants are applying the measures in the same or similar way. People interpret their feelings in different ways, and may apply widely different standards to measure such things as their level of satisfaction with a session, or their own affective situation at the end of a session. There is no consistent and reliable way of recording what people feel, and this must be borne in mind when interpreting the numerical data. The instrument used to gather the data (with graded responses, rather than yes/no, for example) tries to keep such variation to a minimum by channelling participants into producing results which are comparable with one another. Some of the individuality of responses is lost in this process, but a big advantage is that a measure of consistency is gained. It was interesting that the researcher used a mix of dyadic and non-dyadic reporting with no attempt to correlate the views of counsellor and client. If I had designed this research I might have tried to organise the data in such a way as to bring out any overlaps and contrasts in the way that each half of a dyad sees the same session. This may have produced interesting findings, especially in the cases where counsellors rated the alliance aspect as being particularly smooth and deep. There might have been, for example, particular sessions which were exceptionally fruitful, and others which did not appear as valuable, for reasons related to the case itself, and not the computer medium, but in this study there is no way of knowing this. As it is, the opportunity to analyse individual variables this more closely was not taken up, and so it is impossible to draw any conclusions about them. The authors resort to quite a lot of speculation in their discussion, for example when they comment on the possible reasons why counsellors rate the sessions more highly than clients. There is an assumption that the medium of the computer makes the counsellor feel more powerful, and that this in turn influences their judgement on the level of alliance that takes place. I found this speculation to be unfounded and rather biased towards the perspective of the counsellor. What was missing was any individual feedback from the clients which might have illuminated this point. Another factor which the authors mention but do not explore, is the increased potential for deception that exists in the internet context. Without visual and auditory clues, much can be missed, and the article does not explore very fully the potential problems with this aspect. The disappointment of a counsellor is mentioned in relation to a client who was smoking while communicating , but a much bigger problem might be the failure of the counsellor to interpret important details from the written word alone. Overall I found the article interesting as a starting point for discussion, but I felt that it stopped short of examining the real issue with internet counselling, which is what is actually lost and what is actually gained by this medium. The authors could have designed supplementary questions on how the participants felt about the difference between the two methods, or could have designed a control group situation with two comparable groups, one using internet and one using face to face counselling. As it is, however, the results show only a partial view, in a very small sample, and so there is not very much that can be generalized or relied upon in its conclusions. Conclude by discussing which understanding of the counselling relationship you feel most drawn to and why (450 words). I have been drawn to the cognitive-behavioural side of counselling for a long time, because I do think that in the modern world many people have lost touch with their own feelings, and that counselling from this theoretical perspective can help a person to become more conscious of what is happening in relationships with other people. The first step to realising how to cope with many modern pressures such as stress, bereavement, and behaviours which have become less than helpful for an individual, is for that individual to be able to define the problem and know where to start from. The application of logic and planning can only help if the client and counsellor agree what the basis is. As I have reflected on modern lifestyles I have noticed that the internet can introduce extra stress because it brings so many distractions and contradictory inputs and feedbacks. People are overwhelmed by this. Internet counselling is perhaps a good way to counteract this, because it changes the way that people see the computer, and this could enhance good habits rather than the general temptation to become overloaded with negative influences. The concept of mindfulness is one that I find interesting, and perhaps a focus more on writing things in emails, or writing things down for personal use, is a way of slowing down the pace of life, and helping people to become more self-aware. I have never been very comfortable with the idea that a counsellor has control or power over a client, and this aspect of the article under discussion worried me quite a bit. I think that the internet could give back more control to the client, because after all the client can decide what to put in an email, and how to structure it, and can reflect for longer on how to express things. Some people take longer to formulate their ideas, and face to face counselling, with its tight time schedules, may not always be the best forum for full disclosure and reflection. Anything that encourages mindfulness, reflection, and taking time to weigh things up, rather than just reacting to an immediate stimulus is a good thing in counselling. We have perhaps become accustomed to thinking of face to face counselling as the gold standard and the norm, and it may be that times are changing, and we need to think of more suitable ways of interacting with busy people. On the other hand, there may also be a large number of clients, such as older people, less well educated people, those with difficult economic circumstances, and those with cognitive impairment for whom internet counselling could be positively harmful, since it might increase anxiety and create feelings of low self-esteem. I am interested in the gender stereotyping that occurs in counselling (both in counsellor and in client behaviours) and so I would like to investigate further whether there is a difference in the way that males and females respond to computer mediated interventions. There is a great deal to think about in how to make sure our counselling keeps up with trends in contemporary society, but also retains its universal value and application to all types of client. References Barkham, M. and Barker, M. (2010) Outcome Research. In D. Langdridge, M. Barker and A. Vossler, (Eds.) Understanding Counsellling and Psychotherapy. London: Sage, pp. 281-305. D’Arcy, J., Reynolds, J.R., Stiles, W.B. and Grohol, J.M. (2006) An investigation of session impact and alliance in internet based pscychotherapy: Preliminary results. Counselling and Psychotherapy Research 6 (3), 164-168. Reflection: what was most interesting and what was difficult. (50 words) The most interesting aspect of this assignment was to question the decisions of professionals. The technical language and layout creates an impression of reliability which I am learning to question more fully. I found it difficult to relate the theory to practice, however, and am still thinking about this aspect. Read More